Psoriasis is a chronic skin condition that affects millions of people worldwide. Foot skin can be affected in several different ways with the most common form being plaques of red skin with silvery scales on the top of the foot, soles, or even between the toes (Kim et al., 2017). These lesions can be very painful and limit a person’s ability to perform many daily activities, even activities such as walking or standing (Parrish, 2012).
Patients with psoriasis can experience a range of foot health problems, and healthcare providers need to have a good understanding of these issues. Plantar psoriasis is a particularly common form of the condition, appearing on the soles of the feet. It can cause a variety of problems, including infection or other foot-related issues, and through cracks in the skin, psoriasis can make feet more susceptible to attack by bacteria and fungi. Smith & Barker (2006) found that people with psoriasis should receive knowledge from healthcare providers about the condition and its effects on feet.
It is also important to be aware of the affects psoriasis can have on the feet and how this can guide appropriate management and treatment. There are numerous different treatment options currently available for psoriasis ranging from topical treatments through to systemic treatments, with the majority being designed to control inflammation and clear lesions. Foot psoriasis, however, requires special consideration, especially with regard to patient mobility. A person with foot psoriasis would require a treatment plan that is specific to the location and severity of their disease. With an increased awareness of the affects of psoriasis, sufferers will be better equipped to manage their condition and look after the health of their feet.
Psoriasis, more than many skin conditions, affects not just the skin. Its effects can be far-reaching, insidious, and very serious for foot health, leading to potentially damaging consequences to mobility. Often overlooked or under-treated, understanding these effects is key not only to patients but to health care providers. By taking a patient centered approach to understanding and managing foot psoriasis, better treatment solutions can be discovered to foster overall health and well-being. Managing foot psoriasis is an ongoing process using a variety of methods that can vary greatly in severity. In many cases topical treatments such as creams or ointments are first used to control and treat psoriasis. Based on the severity and type of psoriasis a patient suffers from, a topical treatment may contain salicylic acid to reduce scaling and thickness of skin, coal tar to slow down drawing of older skin cells and reduce inflammation, or steroidal agents to reduce scaling and itching of the skin. Typically topical treatments are the best method for patients with mild to severe disease. They work by applying medication to affected skin and are considered to be a safe and effective form of treatment. It has been shown through research that many people suffering from psoriasis find topical treatments to be effective in helping to treat the condition, helping skin look healthy and normal and allowing patients to wear their favorite shoes, as well as resume activities and live a life that is uninhibited by symptoms of psoriasis.
If your foot psoriasis is severe your doctor may talk with you about phototherapy or systemic treatments. In phototherapy, controlled amounts of ultraviolet (UV) light are applied to affected areas. Research has established that UV light helps to clear psoriasis by decreasing the excessive skin cell production (Menter & Griffiths, 2007). Systemic medications affect your whole body and are typically prescribed for people with widespread psoriasis or for those whose psoriasis is not satisfactorily controlled with topical treatments. While systemic treatments can be very effective for severe cases of psoriasis, they can also have some serious side effects. Your doctor can explain the potential benefits and risks for any treatment that might be prescribed for you.
Many people find living with foot psoriasis challenging and distressing. There is growing evidence to suggest that people with chronic skin conditions such as psoriasis experience mental health difficulties, including anxiety and depression (Brandon et al., 2019). People with visible symptoms of psoriasis on their feet are likely to feel embarrassed or ashamed and avoid social events and activities. They may hide their feet in public and feel self-conscious about wearing shoes that expose their feet, avoiding activities such as going to the beach or wearing flip-flops in summer (Kuchekar et al., 2011).
For some, foot psoriasis may mean having to avoid exercise or leisure activities that would otherwise bring them pleasure. Even wearing open-toe shoes or going barefoot could become a problem for sufferers. Unfortunately, many activities in life include losing your shoes, and it can be hard to stay within the boundaries required by a foot afflicted with psoriasis. People with psoriasis have been shown to have lower patient satisfaction and higher levels of stress and anxiety than the general population (Reich & Mrowietz, 2007).
Management of foot psoriasis involves both physical and psychological care, and many people with psoriasis find that treatment and management of the condition is aided by counseling and/or a support group, as well as practices such as yoga and meditation, and other activities that encourage mindfulness (Parrish, 2012). A holistic approach can help those with foot psoriasis by treating the skin infection and also by dealing with the many other issues and stresses associated with the condition in order to help maintain the best possible quality of life.
Citations:
Kim, W.B., Jerome, D. and Yeung, J., 2017. Diagnosis and management of psoriasis. Canadian Family Physician, 63(4), pp.278-285. https://www.cfp.ca/content/63/4/278.short
Smith, C.H. and Barker, J.N.W.N., 2006. Psoriasis and its management. Bmj, 333(7564), pp.380-384. https://www.bmj.com/content/333/7564/380.short
Armstrong, A.W. and Read, C., 2020. Pathophysiology, clinical presentation, and treatment of psoriasis: a review. Jama, 323(19), pp.1945-1960. https://jamanetwork.com/journals/jama/article-abstract/2766169
Aldredge, L.M. and Higham, R.C., 2018. Manifestations and management of difficult-to-treat psoriasis. Journal of the Dermatology Nurses’ Association, 10(4), pp.189-197. https://journals.lww.com/jdnaonline/fulltext/2018/07000/Manifestations_and_Management_of.2.aspx/1000
Brandon, A., Mufti, A. and Sibbald, R.G., 2019. Diagnosis and management of cutaneous psoriasis: a review. Advances in skin & wound care, 32(2), pp.58-69. https://journals.lww.com/aswcjournal/fulltext/2019/02000/Diagnosis_and_Management_of_Cutaneous_Psoriasis__A.3.aspx
Singh, N., Sondhi, S., Jindal, S., Pandit, V. and Ashawat, M.S., 2020. Treatment and Management for patients with mild to severe Psoriasis: A Review. Asian Journal of Pharmaceutical Research, 10(4), pp.286-92. https://indianjournals.com/api/article-view/ajpr-10-4-007
Menter, A. and Griffiths, C.E., 2007. Current and future management of psoriasis. The Lancet, 370(9583), pp.272-284. https://www.thelancet.com/journals/lancet/article/PIIS0140673607611295/abstract
Kuchekar, A.B., Pujari, R.R., Kuchekar, S.B., Dhole, S.N., Mule, P.M., Vidyapeeth, B. and Wadi, B., 2011. Psoriasis: A comprehensive review. Int J Pharm Life Sci, 2(6), pp.857-77. https://www.academia.edu/download/96129401/12.pdf
Parrish, L., 2012. Psoriasis: symptoms, treatments and its impact on quality of life. British journal of community nursing, 17(11), pp.524-528. https://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2012.17.11.524
Reich, K. and Mrowietz, U., 2007. Treatment goals in psoriasis. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 5(7), pp.566-574. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1610-0387.2007.06343.x
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