The signs and symptoms of psoriasis depend on the type of psoriasis and factors specific to each person. The most common type is plaque psoriasis, which causes patches of raised skin to form.
The changes to the skin can look different on different people. The affected areas may be pink, coral, or red, especially on light skin.
On dark skin, the areas may instead be purple, violet, or gray. Or, they may be the same color as the surrounding skin, making the changes more difficult to see. This can contribute to challenges and inequities in diagnosis and treatment.
Most people with psoriasis have flares and periods of remission. During a flare, the symptoms worsen for a while.
Below, we describe how to recognize some types and symptoms of psoriasis.
A person with plaque psoriasis may experience these changes:
- Raised, inflamed lesions, called plaques, develop. These are often covered in a silvery white scale.
- The plaques can develop anywhere. They are more common on the elbows, scalp, knees, and lower back.
- The plaques may join together.
- They may be itchy, sore, or both.
- The skin around the joints may crack and bleed.
On white skin, plaque psoriasis usually appears as pink or red patches with silvery white scales. On black skin, psoriasis may form purplish or brown patches with gray scales.
Inverse psoriasis tends to appear in skin folds, and it is more common among people who have excess weight.
A person with the condition may find that:
- Patches of skin become inflamed and smooth, but there is no scaling.
- These patches become itchy or painful.
- Symptoms can worsen if the skin rubs together, or there is sweating in the folds.
- It is most likely to develop in the armpits, groin, between the buttocks, beneath the breasts, and belly folds, if a person has these.
On brown or black skin, the lesions may be purple, brown, or a darker color than the surrounding skin. On white skin, they may be bright red.
Around 21–30% of people with psoriasis develop inverse psoriasis, according to the National Psoriasis Foundation.
Nail psoriasis can affect the fingernails and toenails. It may develop with another type of psoriasis.
Severe symptoms can make it hard to use the hands and feet, as the American Academy of Dermatology notes.
Here are some of the features:
- white, yellow, or brown discoloration that may resemble a drop of oil or blood under the nail plate
- pits in the nails
- lines across the nails, usually from side to side rather than top to bottom
- light areas on the nail plate
- thickening of the skin under the nail
- loosening, separating, lifting, and detaching of the nail
- crumbling, as the nail weakens
- small black lines running from the tip of the nail to the cuticle
- spotting or reddening of the “half moon” at the base of the nail
- possibly, an infection in the area
People with psoriatic arthritis can experience nail changes if the arthritis affects their fingers.
Guttate psoriasis is sometimes known as “teardrop” or “raindrop” psoriasis.
Here are some of the features:
- Lesions form, and these are usually small, scaly, and slightly raised.
- They usually appear quickly, within a few days.
- The lesions are small, round spots, or papules — unlike the patches of plaque psoriasis.
- They often develop on the arms, legs, and trunk, but they may form on the face, ears, and scalp, too.
- The papules do not hurt but may itch.
Guttate psoriasis can occur after tonsilitis, strep throat, or another infection. A skin injury or stress may also trigger it. According to the National Psoriasis Foundation, around 8% of people with psoriasis develop guttate psoriasis at some time.
Scalp psoriasis can occur alone or together with plaque psoriasis.
- Areas of thick, silvery white scales appear, and the scales may look like dandruff.
- The areas may itch.
- They often form on the back of the scalp, but they can develop on other parts of the head.
- In some cases, hair loss results.
The National Psoriasis Foundation notes that 45–56% of people with psoriasis develop scalp psoriasis and that it often affects Black people.
Pustular psoriasis is less common than other forms of psoriasis. There are different types of pustular psoriasis, depending on what area of the body is affected.
Below are some common features:
- Scaly bumps appear, and these contain pus.
- The pustules can develop anywhere on the skin, including in the mouth or under a nail.
- They tend to join together and burst around 24–48 hours after they form.
- As the pus dries, the skin becomes glazed and often painful.
- New pustules can form in the same area, and the cycle of joining and bursting can repeat.
If these pustules affect widespread areas of the body, the person needs immediate medical attention to prevent life threatening complications.
Here are two types of pustular psoriasis:
Generalized, or Von Zumbusch
- The pustules develop rapidly across a wide area of skin.
- They may be severely itchy.
- Other symptoms may develop, such as a fever, chills, fatigue, changes in heart rate, and muscle weakness.
Localized, or palmoplantar
The following can occur:
- Pustules can appear on the soles of the feet or the palms of the hands.
- The pustules form round, brown, scaly spots that eventually dry and peel off.
- They may reappear every few weeks or even within days.
- The person may have difficulty walking or using their hands.
The symptoms include:
- widespread inflammation
- severe discoloration of the skin, such as redness
- a burned appearance to the skin
- intense itching and pain
- shedding of skin in large sheets rather than smaller scales
As the skin becomes damaged, it loses its barrier function, which means that the body is less protected by the skin. The person’s temperature may fluctuate, and they start to lose proteins and fluid. This can result in dehydration and heart failure.
Other symptoms include:
Anyone with a painful, widespread rash needs urgent medical treatment.
Some people with psoriasis also develop a type of arthritis called psoriatic arthritis. In most people with both conditions, psoriasis develops first. However, the arthritis symptoms can appear before the skin symptoms.
Symptoms of psoriatic arthritis include:
- stiffness, especially just after waking up
- redness, swelling, and pain around the joints and tendons
- swollen fingers or toes, known as “sausage digits”
- pain in the heel, lower back, or in a swollen finger or toe
- a reduced range of movement in the affected joint
- symptoms of nail psoriasis
- flaking, silver patches of skin
- inflammation under the skin, which can lead to color changes
- inflammation in the eyes, which can cause pain, redness, and sensitivity to light
Psoriasis is an autoimmune condition that causes skin symptoms. The most common type is plaque psoriasis, which forms patches of raised, scaly skin. The symptoms differ for each type, and a person can have more than one type at a time, such as nail psoriasis and plaque psoriasis.
Also, some people with psoriasis develop a type of arthritis called psoriatic arthritis. The arthritis can develop before the skin issues, though usually the skin changes happen first.
Anyone with unusual skin, nail, or joint changes should contact a healthcare professional. Various treatments can help manage psoriasis symptoms. For severe cases, a person may need emergency medical care.