How To Treat Psoriasis on Feet: Treatment Options

Psoriasis is a chronic condition that causes dry, scaly, and itchy patches on the skin. Having it on the feet adds an additional challenge due to the pressure on the skin from walking and wearing shoes. Even simple activities such as walking or standing can be uncomfortable. 

We know you want to feel good on your feet again, which is why we’ve compiled this comprehensive guide on the latest treatments for foot psoriasis. From medical treatments to home therapies, we’ll cover everything you need to know to get back to doing the activities you love.

What Is Foot Psoriasis?

Psoriasis is a chronic autoimmune condition that causes skin cells to replicate too quickly, resulting in a buildup of red, itchy, and sometimes painful scales. It’s most common on the scalp, elbows, knees, upper legs, and buttocks. 

Foot psoriasis, sometimes called plantar psoriasis, is a form of psoriasis that is not as common. Only about 12-16% of people living with psoriasis have foot psoriasis. This form affects the skin on the feet, typically the soles, between the toes, and around or under the toenails. 

Psoriasis of the feet can sometimes be mistaken for other skin conditions, such as eczema, fungal infections, or contact dermatitis. However, unlike these conditions, psoriasis is autoimmune in nature and requires a different treatment approach.

Symptoms

Psoriasis on the feet often appears as thick, red, and scaly patches. These patches are usually dry and may crack open, causing painful cuts called fissures. The skin may feel rough, tight, or even stiff, especially around the toes or joints. 

The toenails may also change, becoming thick, ridged, or full of tiny dents. In more severe cases, the skin can lose its flexibility, making it hard to walk or move the toes without pain.

Triggers and Aggravating Factors

Several triggers or aggravating factors can make foot psoriasis worse. These include:

• Stress
• Cold weather
• Smoking
• Tight shoes
• Standing for long periods
• Infections (strep throat)

Topical Treatment Options

Foot psoriasis is often resistant to treatment, making it difficult to manage. Due to the thickened skin and the added stress from walking and standing, treatment requires consistent care. 

You may need to try several treatments until you find one or a combination of treatments that work for you.

Although there is no cure for foot psoriasis, here are some of the most common topical treatments.

Corticosteroids

Topical corticosteroids are typically a first-line treatment for mild to moderate foot psoriasis. They may help reduce inflammation, redness, and itching. 

You can find mild corticosteroids available over-the-counter (OTC). However, you’ll need a prescription if you need a stronger corticosteroid cream. 

Corticosteroids are generally considered safe for short-term use. There are some long-term side effects, however, so it’s best to work with your dermatology provider. They can guide you on how many times a day you should apply the corticosteroid, where to apply it, and how long to use it for. Your provider can also perform follow-up assessments to monitor for improvement. 

Vitamin D Analogues

Experts have found that many people with psoriasis are low in vitamin D. Applying a topical vitamin D to psoriasis can help slow down the rapid growth of skin cells. It also reduces inflammation. 

Vitamin D is safe for long-term use and can be used in combination with corticosteroids. 

Tar-Based Treatments

Coal tar preparations, available in ointments, creams, or shampoos, have been used for many years to treat psoriasis.

They can help reduce scaling, itching, and inflammation. The downside is that they can be messy and have a strong odor. But you may want to give this treatment a try, especially when your symptoms are flaring. 

Moisturizers and Emollients

Moisturizers and emollients can be used with other treatments to help your skin retain moisture. Thick emollients, such as petroleum jelly or shea butter, can soften plaques and prevent cracking.

Applying a moisturizer or emollient after bathing or soaking your feet can help lock in the hydration and create a barrier against irritants. 

Application Techniques for Feet

Because the skin on the soles of your feet is thicker, and because you need your feet for standing and walking, treating foot psoriasis requires some specific techniques.

Depending on the severity of your psoriasis, you may need to set aside one or two times a day to spend some time treating your feet. 

Before applying a topical treatment, it’s best to soak your feet to soften the plaques, then gently exfoliate. Apply the treatment, then put on cotton socks to help hold the treatment in place. This is known as occlusion therapy. Avoid applying steroids to areas where the skin is broken, and always wash your hands before and after treatment. 

Systemic Treatments for Foot Psoriasis

While topical therapies are effective for many people, severe foot psoriasis may require taking a medication that works throughout your whole body. 

If foot psoriasis is not responding to topical treatment or if it’s impacting mobility or causing severe pain, your dermatology provider may recommend an oral or biologic medication.  

When Oral Medications Are Needed

Dermatology providers often prescribe oral treatments when psoriasis on the feet is resistant to topical options or if it’s also affecting the nails or other areas of the body. 

Common medications include:

• Methotrexate
• Cyclosporine
• Acitretin

These medications work by calming down the immune system’s response. This can help to reduce inflammation and slow down the overproduction of skin cells. 

Biologics for Severe Foot Psoriasis

Biologic drugs are a newer class of systemic therapy that target specific parts of the immune system involved in psoriasis. Dermatology providers typically prescribe them for moderate to severe psoriasis, including difficult-to-treat areas like the palms and soles. 

Common biologics include: 

• Adalimumab (Humira)
• Ustekinumab (Stelara)
• Secukinumab (Cosentyx)
• Ixekizumab (Taltz)

These medications are usually administered via injection and can be highly effective in clearing stubborn plantar psoriasis and nail psoriasis. Biologics are generally well-tolerated, but potential risks include upper respiratory infections, injection site reactions, rare TB reactivation, and, rarely, worsening IBD with IL-17 inhibitors; please discuss with your dermatologist.

Because they work throughout your whole body, biologics can also treat psoriasis in multiple areas at once and improve joint symptoms if psoriatic arthritis is present.

Monitoring Considerations

If you take a systemic treatment, your dermatology provider will monitor how your psoriasis is responding and check for side effects from the medication. This may include having blood tests to see how your body is responding and screening for infections before starting therapy. 

If you think you are experiencing a side effect, it’s best to let your provider know right away. 

Phototherapy for Feet

Phototherapy, also known as light therapy, is a well-established treatment for foot psoriasis. One huge benefit is that there are no systemic side effects. 

Phototherapy involves exposing the affected skin to specific wavelengths of ultraviolet (UV) light.  This therapy can slow the overactive skin cell growth associated with psoriasis and reduce inflammation.

Targeted UV Treatment

For foot psoriasis, your dermatology provider may recommend targeted phototherapy using narrowband UVB (NB-UVB) light. This approach allows for concentrated treatment of thick plaques on the soles or around the toes without exposing your unaffected skin. 

In clinical settings, your provider may use a handheld or localized phototherapy unit to deliver precise light to the feet.

Home Phototherapy Devices

Home phototherapy units offer the convenience of treating foot psoriasis in the comfort of your own home. If your foot psoriasis is stubborn or keeps coming back, your dermatology provider may suggest this method.  

The devices range from small panel lights to handheld lamps designed for localized areas like the feet. If using a home phototherapy unit, it’s important to follow the directions to avoid burns or overexposure. 

Effectiveness and Safety

Experts generally consider phototherapy as safe with minimal side effects, and most people tolerate it well. 

Side effects may include temporary redness or dryness. Long-term risks, such as skin aging or an increased risk of skin cancer, are lower with NB-UVB compared to older broad-spectrum UV therapies or PUVA. 

Foot Care Best Practices

In addition to medical treatments, taking proper care of your feet is essential for managing foot psoriasis. Because the feet endure constant stress, even small irritations can lead to pain, cracking, or infection. Integrating these routines into your daily life can significantly improve comfort and treatment outcomes.

Proper Footwear Selection

Wearing the right shoes can help reduce friction and pressure that worsen plantar psoriasis. 

Choose footwear with cushioned soles, wide toe boxes, and breathable materials to minimize irritation. Avoid tight-fitting or non-ventilated shoes, as they can lead to sweat buildup and friction-related flares. 

Orthotic inserts or custom insoles may also help distribute weight evenly and reduce trauma to affected areas.

Hygiene Recommendations

Keeping your feet clean and dry is critical. 

Wash your feet daily with mild, fragrance-free soap and lukewarm water. Avoid soaking for long periods, as this can dry out the skin. 

After washing, gently pat your feet dry, especially between the toes, where moisture can accumulate. Moisturize immediately after to seal in hydration and prevent cracking.

Nail Care for Psoriatic Nails

Nail psoriasis is common if you have foot psoriasis. To minimize discomfort and reduce the risk of infection, trim toenails straight across and file down thickened areas carefully. Avoid cutting the cuticles or using harsh nail products. If your nails are discolored, pitted, or separating from the nail bed, consult a healthcare provider or podiatrist for guidance.

Preventing Secondary Infections

Having cracks in your skin or nails makes you more susceptible to infections. Avoid walking barefoot outside or in public areas like gyms or pools. Always wear clean, moisture-wicking socks. 

Signs of infection include:

• Increased redness
• Swelling
• Warmth
• Pain
• Drainage

If you notice these symptoms, notify your provider right away. 

Lifestyle Modifications

Developing certain habits can reduce stress on the feet, promote healthy skin, and support your overall well-being.

Reduce Stress on the Feet

Limit prolonged standing or walking on hard surfaces. This can help prevent pressure-induced flares. When possible, take breaks during long periods of standing, and wear cushioned shoes or use gel inserts to reduce impact. Elevating your feet when you rest may also help reduce swelling or discomfort after activity.

Weight Management

Excess weight puts additional pressure on the feet. Losing even a small amount of weight can ease the physical stress on your feet and reduce inflammation throughout the body. A balanced diet that prioritizes protein and fiber can support both skin health and weight control.

Exercise Recommendations

Staying active is important for circulation, joint health, and mental well-being, but some forms of exercise may irritate the feet. 

Choose low-impact activities such as swimming, cycling, weight training, or yoga, which minimize foot strain. Always wear supportive footwear during exercise and check your feet afterward for signs of irritation or trauma.

When to See a Specialist

Knowing when to seek specialist care is crucial for effective management of foot psoriasis. A dermatologist specializes in diagnosing and treating skin conditions like psoriasis and is usually the first point of contact for persistent or severe symptoms. They can recommend topical, systemic, or phototherapy treatments tailored to your needs.

A podiatrist focuses on foot health and is particularly helpful if psoriasis affects the nails, causes painful cracking, or leads to biomechanical issues impacting walking. They can provide specialized nail care, custom orthotics, and address secondary infections or foot deformities.

You should see a specialist if you experience worsening pain, signs of infection, or if your psoriasis does not improve despite treatment. Treatment-resistant or rapidly spreading foot psoriasis may require systemic therapies or combined care from both dermatologists and podiatrists to prevent complications and improve quality of life.

Reach out to a Zest dermatology provider today to start your journey towards relieving foot psoriasis symptoms.