From the Guidelines
The best treatment for psoriasis on knuckles and ankles typically involves topical corticosteroids like triamcinolone 0.1% or clobetasol 0.05% applied thinly twice daily for 2-4 weeks, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines of care for the management of psoriasis with systemic nonbiologic therapies 1.
Key Considerations
- For maintenance, calcipotriene (a vitamin D analog) or tacrolimus ointment can be used, as they have been shown to be effective in the treatment of psoriasis, particularly in combination with topical corticosteroids 1.
- These areas are challenging to treat because the skin is thinner and more prone to cracking, making it essential to moisturize frequently with thick emollients like petroleum jelly or ceramide-containing creams to maintain skin barrier function.
- For stubborn cases, consider occlusion therapy by applying medication then covering with plastic wrap overnight, as this can enhance the potency of topical corticosteroids 1.
Additional Treatment Options
- If these treatments don't provide relief within 4-6 weeks, consult a dermatologist for stronger options like phototherapy, oral medications such as methotrexate or apremilast, or biologics, which have been shown to be effective in reducing inflammation and normalizing skin cell turnover in psoriasis patients 1.
- The European League Against Rheumatism recommends the use of disease-modifying antirheumatic drugs, such as methotrexate, and tumor necrosis factor inhibitors for the treatment of psoriatic arthritis, which may also be beneficial for patients with psoriasis on knuckles and ankles 1.
Important Reminders
- Avoid scratching and protect these areas from trauma, as injury can trigger new psoriasis patches (Koebner phenomenon).
- Regular monitoring and adjustment of treatment are crucial to achieve the best possible outcomes and minimize the risks of side effects.
From the FDA Drug Label
INDICATIONS AND USAGE Calcipotriene ointment, 0.005%, is indicated for the treatment of plaque psoriasis in adults. DOSAGE AND ADMINISTRATION Apply triamcinolone acetonide cream USP, 0. 1% as appropriate, to the affected area two to three times daily.
The best treatment for psoriasis on knuckles and ankles is topical calcipotriene or triamcinolone acetonide cream.
- Calcipotriene is indicated for the treatment of plaque psoriasis in adults 2.
- Triamcinolone acetonide cream can be applied two to three times daily to the affected area, and occlusive dressings may be used for the management of psoriasis 3.
From the Research
Treatment Options for Psoriasis on Knuckles and Ankles
- Topical therapy is the most appropriate choice for initial treatment of psoriasis on knuckles and ankles, especially for patients with less than 20% body surface involvement 4.
- Commonly used topical therapies include:
- Corticosteroids
- Calcipotriene, a vitamin D analogue
- Tazarotene, a retinoid
- Anthralin
- These treatments are effective in mild to moderate psoriasis, but each is associated with varying degrees of safety and tolerability concerns 4.
Combination Therapy for Psoriasis
- Combination therapies are widely used by physicians, and adjunctive topical therapies used with other antipsoriatic regimens have been demonstrated to provide many clinical benefits 5.
- The combination of a topical corticosteroid with a vitamin D analogue can work synergistically to improve efficacy and reduce the side-effects from both treatments 6.
- Combining vitamin D analogues with systemic agents exerts a dose-sparing effect, thus reducing the possibility of side-effects, but such combinations require further study 6.
Recommendations for Topical Agents
- Mild psoriasis may be treated with a wide array of topical agents including corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound 7.
- The use of topical agents in psoriasis is more individually tailored, and guidelines may not provide practical indications regarding the therapeutic approach 7.
- Combination therapy is the most common way to treat psoriasis in the United States, with the most common combinations being topical steroid plus other topical, multiple topical steroids, topical steroid plus vitamin D analogue, and topical steroid plus systemic treatment 8.