Managing psoriasis on the feet

There are several types of psoriasis. The most common type is plaque psoriasis, which occurs in around 90% of people with the condition.

Plaque psoriasis can occur on almost any part of the body, including the feet. This type causes dry patches of skin known as plaques.

Psoriasis may present differently on light and dark skin. For example, psoriasis often appears red or pink on light skin but may cause violet, gray, or dark brown patches on darker skin.

These plaques are usually covered in silvery scales and can be itchy and sore. In more severe psoriasis, plaques may also crack open and bleed.

The second type of psoriasis, called palmoplantar pustular psoriasis, specifically affects the palms of the hands and the soles of the feet.

People with palmoplantar pustular psoriasis typically notice many tiny, pus-filled blisters on their feet, hands, or both. Despite their appearance, these blisters are not infectious or contagious.

When a person has psoriasis, a rare acute condition can develop on their feet. Doctors call it erythrodermic psoriasis.

Erythrodermic psoriasis is an acute condition and causes inflammation on over 90% of the body’s surface, making it appear erythematous and inflamed. This means the affected skin becomes red, which may appear a deeper red or dusky color on darker skin.

Other than psoriasis, other triggers for this condition include other inflammatory skin conditions, certain cancers and some drugs.

Erythrodermic psoriasis is serious and requires immediate medical attention.

Psoriasis develops when the body replaces skin cells too fast. Doctors do not fully understand what causes this skin condition, but they believe it to be an autoimmune disease. This means the body’s immune system attacks healthy tissue, such as skin cells, by mistake.

A person’s genes may play a role in the development of psoriasis, and it may run in families. People with other autoimmune diseases are also more likely to develop the condition.

Many people with psoriasis find that certain things trigger or worsen their symptoms. Potential triggers can vary from person to person, but may include:

• a recent injury to the skin, such as a cut, insect bite, or sunburn
• emotional stress
• weather changes, especially when they cause skin dryness
• an illness or infection
• certain medications

Some people first notice psoriasis after they have experienced a trigger. If the condition affects the feet, a person may mistake their foot symptoms for an allergic reaction or an infection, such as athlete’s foot.

Athlete’s foot is a common fungal infection that occurs on the feet. Unlike psoriasis, it is contagious.

A person can get athlete’s foot from surfaces, towels, and clothes carrying the fungus.

In most cases, the condition requires treatment. However, a person can usually treat the infection at home with over-the-counter antifungal medications.

Psoriasis on the feet and athlete’s foot can look similar. A person may need to consult a doctor if they are unsure which condition they have, particularly if they have not had psoriasis before.

Some differences between athlete’s foot and psoriasis might include:

• Location: Though both conditions can affect any part of the foot, athlete’s foot can appear between the toes or under the nails. Psoriasis can also affect the nails and the soles of the feet.
• Color: Psoriasis and athlete’s foot can both look scaly and red in people with light skin. On darker skin, these may also appear gray, purple, or dark brown. Psoriasis also tends to change color and appearance over time or develop overlying silvery scales.
• Pain: Psoriasis on the foot can feel sore and painful. Athlete’s foot is mainly itchy, but frequent scratching can cause the infection to hurt.
• Nail changes: Athlete’s foot can trigger an infection in the area under the nails. It can cause the nails to lift and look yellow and brittle. Psoriasis can also cause the nails to look dented.
• Joint stiffness: Some people with psoriasis have achy, stiff joints and other symptoms.

As yet, there is no cure for psoriasis, but a range of treatments can help relieve symptoms and reduce flare-ups. The choice of treatment will often depend on the type, location, and severity of a person’s psoriasis.

The three primary treatments include topical medications, light therapy, and systemic drugs.

Topical medications come in the form of different topical formulations, such as creams and ointments, that people apply directly to their skin. Examples include:

• emollients
• steroids
• vitamin D analogs
• calcineurin inhibitors
• coal tar

A person can buy some topical treatments, such as emollients, mild steroids creams, and coal tar foams, over the counter. A doctor can prescribe stronger topical formulations.

Light therapy, also known as phototherapy, usually takes place in hospitals or clinics and involves doctors exposing a person to UV light. For light therapy to be effective, people may require 2 or 3 sessions a week.

Systemic treatments work throughout the body and include oral and injected drugs. Doctors typically only prescribe these medications for severe psoriasis due to the risk of serious side effects and the need for close monitoring.

Examples of systemic treatments include:

• immunosuppressants, such as methotrexate or cyclosporine
• steroids
• retinoids
• phosphodiesterase 4 inhibitors
• biologics

Treating psoriasis on the feet can be challenging due to its location. Working with a doctor, people may need to try several different treatments before finding one that is effective. In some cases, an individual may require a combination of treatments.

A doctor may recommend coal tar, light therapy, or systemic drugs for people with psoriasis on the feet that they find difficult to treat in other ways.

Current guidelines suggest prescribing a biologic drug, such as infliximab (Remicade) or adalimumab (Humira), among others, for palmoplantar psoriasis. These drugs affect how the immune system works and aim to treat the underlying cause of psoriasis.

Some lifestyle changes may help reduce or prevent flare-ups of psoriasis. These may include:

• staying healthy, such as by maintaining a moderate weight, avoiding smoking if applicable, reducing alcohol intake, and eating a balanced diet
• keeping the skin moisturized, such as by regularly using emollients and avoiding soaps and cosmetics that can dry the skin
• using a symptoms diary to identify and avoid specific psoriasis triggers, such as certain foods and weather
• minimizing stress, such as through meditation, yoga, therapy, or other strategies
• exercising regularly

Here are a few common questions about psoriasis on the feet.

How do you get rid of psoriasis on your feet?

Treatment for psoriasis on the feet may involve a combination of topical medications, light therapy, and systemic drugs, such as immunosuppressants. Several lifestyle changes can also help prevent flare-ups of psoriasis over the long term.

A person can work with a doctor to determine the best course of treatment for them, which may depend on the specific type, location, and severity of psoriasis.

What does psoriasis on feet feel like?

Plaque psoriasis can cause dry patches of skin on the feet, which often feel itchy or sore. Other types of the condition may cause painful, pus-filled blisters on the soles of the feet or scaly, dry patches of skin throughout the body.

Why am I getting psoriasis on my feet?

While exactly what causes psoriasis on the feet is unclear, certain triggers may worsen psoriasis for some people.

Potential triggers may include stress, changes in the weather, illness or infection, certain medications, or a recent injury to the skin.

Psoriasis on the feet can be painful and more challenging to treat than the condition developing on other parts of the body. There are many treatment options available, but a person may need to work with their doctor to find one that is effective for them.

Keeping the skin moisturized, avoiding potential triggers, and maintaining a healthy lifestyle may also help prevent psoriasis flare-ups.

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