Different types of psoriasis cause different symptoms. It can appear as thickened, discolored plaques that may be itchy.
Psoriasis is an inflammatory condition that involves skin changes. It can also affect the joints.
Recognizing psoriasis and getting an early diagnosis can help a person access effective treatment, manage the symptoms, and possibly reduce the frequency and severity of flares.
In this article, learn about some types of psoriasis and what the symptoms can look like.
Psoriasis is a psoriatic disease. It results from a problem with the immune system and leads to an overgrowth of skin cells, among other changes. As the skin cells grow too fast, they accumulate on the surface, forming lesions or plaques of thickened, scaly skin that can be painful or itchy.
Depending on the type of psoriasis, skin changes often affect the following areas:
- other areas where the skin folds
However, psoriasis can affect any area of the skin and also the nails. The symptoms tend to come and go. When symptoms get worse for a period, doctors refer to this as a flare.
Lesions can also affect the color of the skin.
- Black skin may become darker or turn purplish, and there may be a gray scale.
- Brown skin may become coral colored with a silvery white scale.
- White skin may become red or pink with a silvery white scale.
After a flare heals, patches of lighter or darker skin may remain. These may be more visible on brown or Black skin than on white skin and may result in stress and embarrassment.
A lack of guidance on how psoriasis affects skin of different colors can mean that it takes longer for people with dark skin to get a correct diagnosis and appropriate treatment.
According to the National Psoriasis Foundation, when people with Black or brown skin visit a doctor, their skin patches are often thicker than they are for a person with white skin. This makes them harder to treat. This is one reason that getting an early diagnosis is essential.
- seborrheic dermatitis
- pityriasis rosea
- secondary syphilis
- mycosis fungoides, which is a type of lymphoma
This section covers some different types of psoriasis in more detail and provides some images to illustrate how they can present.
Plaque psoriasis affects 80–90% of people with psoriasis. It commonly affects the scalp, elbows, knees, face, lower back, soles of the feet, and palms of the hands.
On white skin, the patches may be pink, silvery, and scaly. On Black skin, the patches may be purple or darker than the surrounding area. There may also be a grayish scale. On brown skin, the patches may be coral colored.
The skin can become thick, dry, and pitted. The lesions are often flaky. The plaques can be painful and itchy, and they may crack and bleed.
The rash usually has well-defined edges, unlike those associated with eczema, which can resemble plaque psoriasis in other ways.
Guttate psoriasis affects around 8% of people with psoriasis. It often begins in childhood or early adulthood, and the lesions it causes are small and numerous.
It can appear suddenly. Triggers include tonsillitis, stress, upper respiratory infections, and skin injuries. Streptococcus infections, especially strep throat, are among the most common triggers.
Guttate psoriasis can occur alongside other types of psoriasis, such as plaque psoriasis.
Inverse psoriasis lesions are flat and shiny. They are large and uniform and typically appear in skin folds, such as the armpit, the area under the breasts, and the groin.
These lesions are not usually scaly because the moist environment of skin folds reduces dryness. Inverse psoriasis affects 21–30% of people with psoriasis and often affects people who have deep skin folds, such as those with obesity.
As skin rubs on skin, it can lead to irritation, triggering symptoms. Infections, such as yeast infections, can also develop.
Pustular psoriasis produces numerous tiny white blisters on red skin.
In a cycle of symptoms, the skin changes color, and pus-filled blisters develop. The pustules can join together, forming shiny plaques. The pus is not infectious.
There are several subtypes of pustular psoriasis, including:
- Von Zumbusch: This appears suddenly and is painful. Pustules tend to develop within a few hours. They usually dry up within a day or two, leaving shiny, smooth skin. It can cause dehydration and fevers and may be life threatening. It requires swift medical care.
- Acropustulosis: This causes lesions on the fingertips and sometimes the tips of the toes. It may appear after a skin infection or injury, and the lesions can be painful. Without treatment, there may be damage to the nails or even the bones.
- Palmoplantar pustulosis: This involves blisters on the soles of the feet, palms of the hands, sides of the heels, and thumbs. Pustules form, change color, peel, become crusty, and flake off, then the cycle starts again.
Nail psoriasis can occur with any type of psoriasis but is most common with plaque psoriasis. Around 50–80% of those with nail psoriasis have psoriatic arthritis.
Some symptoms include:
- skin plaques on the fingers or hands
- thick, discolored, and pitted nails
- nails separating from the nail beds
- nail pain
- ridges and lines in the nails
- psoriasis scales under the nails
In erythrodermic psoriasis, skin changes are widespread, with crusty and inflamed pustules. The borders of the lesions are not well-defined and can be intensely painful. The skin sheds in sheets rather than flakes.
This form of psoriasis can reduce the skin’s ability to protect the body. It can lead to dehydration, an increased heart rate, itching, shivering, and sudden changes in body temperature.
Erythrodermic psoriasis is rare but requires urgent medical treatment. A person may need to spend time in the hospital.
This type may occur alongside Von Zumbusch pustular psoriasis.
Psoriasis does not only affect the skin. It is a multisystem condition that can have other effects.
Around 30–33% of people with psoriasis develop psoriatic arthritis, which involves inflammation, pain, and swelling in the joints. Psoriatic arthritis can also cause fatigue.
Also, without treatment, psoriasis can lead to permanent joint damage.
A person with psoriasis is more likely to experience other inflammatory conditions, including cardiovascular disease, diabetes, and obesity. Current guidelines recommend regular screening for these issues. They are also more likely to experience depression.
The exact cause of psoriasis is unclear, but it appears to involve both genetic and environmental factors. Even if a person inherits these genetic factors, they may never develop psoriasis unless they encounter a trigger.
The factors below can both trigger the initial appearance of psoriasis and cause existing symptoms to flare:
- strep throat
- an injury to the skin
- certain medications
- a skin infection
- alcohol consumption
- cold weather
Psoriasis is not contagious. One person cannot pass it to another.
Treatment will depend on the type of psoriasis, the severity of symptoms, the impact on the individual, and any complications there may be.
Topical treatments can often manage mild symptoms, but experts recommend the long-term use of biologic or systemic drugs to manage flares and reduce the impact of more severe symptoms.
Other treatment options include:
- topical steroids in the form of ointments or creams
- immunosuppressive agents, such as methotrexate and cyclosporine
- oral agents, such as acitretin
- skin products containing other ingredients, such as coal tar and salicylic acid
- moisturizers and emollients
- phototherapy, which usually involves exposure to UV light
- lifestyle changes, such as avoiding or quitting smoking and limiting alcohol intake
- complementary therapies, such as herbal remedies and stress management
- an anti-inflammatory diet
A doctor will discuss the treatment options and help determine the best choices.
Getting a psoriasis diagnosis is the first step toward receiving effective treatment. It is also important to seek medical attention when symptoms change.
A person should contact a doctor if:
- There are new or worsening symptoms.
- They begin to experience joint pain.
- Seemingly unrelated symptoms occur, especially fevers, weakness, chills, or intense pain.
- There are symptoms of infection, such as oozing pus.
- Red lines spread from the lesions, as this may indicate a rapidly spreading infection.
- There are symptoms of erythrodermic or guttate psoriasis.
- Skin changes are widespread.
- Treatment is not working or is causing serious side effects.
Also, a person should consult a doctor about any changes in the pattern of their psoriasis symptoms. For example, if a flare usually lasts for 1 week, they should contact a doctor if their symptoms persist for longer than 2 weeks.
Psoriasis causes skin and nail symptoms. Depending on the type, it may also lead to changes in skin thickness and color. The lesions can be itchy and uncomfortable, and they can affect a person’s quality of life.
Treatment is available to help reduce the risk of flares and manage the symptoms. Getting an early diagnosis can help a person start appropriate treatment that can reduce the impact of the condition on the individual.