Give Them a Hand: Patients With Hand and Foot Psoriasis Require Special Attention

Linda Daus, RN, CCRC

Disclosures

Dermatology Nursing. 2008;20(4):291-293. 

In This Article

Treatment

Currently, there is no known cure for psoriasis, although a number of medications, including the newer biologic agents, may help control the symptoms of the disease. One research group found that there is no standardized treatment or evaluation of treatment that is beneficial to the patient with hand and foot psoriasis (Marsland, Chalmers, Hollis, Leonardi-Bee, & Griffiths, 2006). Most conventional treatments produce limited results, due to short duration of response, and toxicity or tolerability issues. Fortunately, many recent case reports as well as a recent phase IV study suggest that the biologic agent efalizumab (Raptiva®) may be effective in treating psoriasis of the hands and/or feet (Fretzin et al., 2006).

Efalizumab is a humanized mono clonal antibody that blocks the activation of T-cells which trigger the development of psoriasis. Here at Central Dermatology, we recently participated in a phase IV study which found that treatment with efalizumab showed statistically significant improvement in patients with chronic moderate-to-severe plaque psoriasis involving the hands and feet. The 12-week study was the first randomized, double blind, placebo-controlled trial to evaluate a biologic agent in the treatment of this uniquely challenging subgroup of patients with psoriasis (Daus, Jansen, Compton, & Caro, 2007).

Of the 80 patients who were randomized into the study, approximately 46% of patients in the efalizumab group received a Physician's Global Assessment rating of clear (0), almost clear (1), or mild (2), compared to 18% of patients in the placebo group (p=0.015) (Daus, 2007) (see Figures 1-4).

Psoriatic foot at baseline

Psoriatic foot at treatment day 84

Psoriatic hand at baseline

Psoriatic hand at treatment day 84

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