Help for Psoriasis in Difficult Places

If you have psoriasis, you may have noticed patches in unexpected places. Where can it happen? How can you deal with it when it does?

Your Nails

Nearly half of all people with psoriasis have nail problems. That goes up to 80% in those with psoriatic arthritis.

If you have either, you might notice your nails are:

• Pitted, with “pocking” or holes in the nail
• Thicker than normal or discolored
• Separated from the nail bed

What you can do: You may be able to disguise mild nail changes by scraping, filing, or polishing your nails. Try to keep your nails short. Avoid injury to them as much as you can, too. That can make things worse.

For more serious problems, your doctor may give you corticosteroid injections in your nail bed.

Many people with psoriasis have a fungal infection in their nails (called onychomycosis). Ask your doctor or dermatologist to see if you have it. If so, treating the fungal infection will help your nails.

If you have severe psoriasis or psoriatic arthritis, your doctor may want you to take a prescription medication that affects your whole body. That should ease nail problems, too.

Your Scalp

At least half of those with psoriasis have it here. It can cause mild scaling. That can look like and flake off like dandruff. But it’s not the same.

It can be severe. You can get thick, crusted patches that can cover parts or all of your scalp. It can even go past your hairline and onto your neck, ear area, and forehead.

Scalp psoriasis is usually powdery looking. It may be silver in color.

What you can do: Whether your condition is mild or severe, you may have to switch and combine treatments every now and then. That’s because psoriasis can become resistant to a treatment after a while.

If yours is mild, your dermatologist may recommend shampoos or topical solutions with tar or salicylic acid. Both lower the number of skin cells your body makes. They can ease itching, too.

Your doctor may also suggest steroid scalp injections to reduce patches, or an antihistamine to deal with the itch.

For more moderate to severe cases, you may get a prescription scalp ointment, liquid, cream, foam, or shampoo. Some of these have corticosteroids.

If your psoriasis or psoriatic arthritis is severe and affects other areas of your body, you might be prescribed a medication that deals with all your symptoms. An example would be biologic drugs, which target specific parts of your immune system.

Your Hands and Feet

If you notice a flare here, tell your doctor right away. It can lead to cracking, blistering, and swelling. These can be painful and raise your chances of infection.

What you can do: Your first step is usually to put medicine directly on your palms and the soles of your feet. Your doctor may point you to:

• Tar products
• Salicylic acid
• Corticosteroid creams or ointments

You’ll probably have more success if you use more than one of these at a time.

Your doctor may also suggest something called calcipotriene. It’s a form of vitamin D. Wear cotton gloves or socks after you put it on so it can soak in without getting on other areas.

If you have deep cracks in your skin, talk to your doctor about using superglue to seal them. Though this sounds odd, some dermatologists recommend it to keep cracks from getting worse.

If those options don’t work, you may be prescribed medicine (like methotrexate, which suppresses your immune system). They may also point you toward light therapy (also known as PUVA or UVB phototherapy). Only do that with your doctor’s help.

Your Lips

Psoriasis here is rare, but it does happen. Most of the time, patches are white or gray. They can be uncomfortable and may affect the way you talk and chew.

What you can do: Talk to your doctor right away. They will probably recommend a low-potency steroid cream, like 1% hydrocortisone ointment. They may suggest a steroid-free treatment like pimecrolimus or tacrolimus, which will suppress your immune system.

Your Genitals

Psoriasis can affect your genitals. Some people only have it on their genitals. These flares are usually pink or red. They usually have little or no flaking or scaling.

Psoriasis can also cause painful cracks, particularly between the buttocks.

What you can do: Treating psoriasis here can be tricky. Moisturizing regularly can help. Ask your doctor about which moisturizer is best for you. Topical vitamin D creams and ointments are options, as are steroid creams.

You’ll usually get prescribed low-dose steroid creams or Eucrisa ointment (off- label, not FDA- approved) for a little while. That’s because genital skin tends to be thin and steroid cream can make it even thinner.

Coal tar products can irritate your genitals, so don’t use them here. Don’t use light therapy, either. The skin on this part of your body is susceptible to skin cancer.

Friction can make things worse, so think about wearing loose-fitting cotton clothing, including underwear, especially while you’re sleeping.

Your Elbows

These are a common spot for plaque psoriasis, the most common type of the condition. You'll probably see things like red skin patches covered with silvery scales. This type is also common on the knees, lower back, and scalp.

What you can do: You'll want to use a moisturizer each day. Talk with your doctor, too. They will probably start you on a mild corticosteroid ointment. If that doesn't work, you may get prescribed something stronger like triamcinolone (Acetonide, Trianex), or clobetasol (Temovate). You may take these with synthetic forms of vitamin D called vitamin D analogues. For more severe cases, light treatment could help, as could biologic drugs that target specific parts of your immune system.

It may take a few tries to find a treatment or a combination of treatments that work best for you, so work with your doctor and be as patient as you can.

Where your arms and knees bend are common places for psoriasis plaques. When that skin moves and rubs together, it can irritate your skin. Make sure to wear loose-fitting clothing and keep those areas moisturized as best you can. Also be very careful in sunlight, as sunburn can make things worse.

Read more on: skin problems and treatments, psoriasis, skin relief