The signs and symptoms of psoriasis depend on the type of psoriasis and factors specific to each person. Some people with one type of psoriasis may go on to develop an additional type.
Psoriasis is an autoimmune condition that causes skin symptoms. Researchers have identified many types of psoriasis, including:
Skin changes can look different on different people.
The affected areas may be pink, coral, or red, especially on light skin. On skin of color, 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, where symptoms may lessen or go away. During a flare, the symptoms worsen for a while. There is currently no cure for psoriasis, but treatment can lead to remission for a prolonged time.
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Doctors may classify psoriasis depending on how much of the body it affects and how severe it is. This can include:
Below, we describe how to recognize some types and symptoms of psoriasis.
- Raised, inflamed lesions, called plaques, develop. These are often covered in a silvery white scale.
- The plaques can develop anywhere but are more common on the elbows, scalp, knees, and lower back.
- The plaques may join together.
- They may be itchy, sore, or both.
- Psoriasis lesions on the skin around the joints may crack and bleed.
On lighter skin tones, plaque psoriasis usually appears as pink or red patches with silvery white scales. On skin of color, psoriasis may form purplish or brown patches with gray scales.
Treatment to manage symptoms may help an individual achieve remission.
Inverse psoriasis tends to appear in skin folds, and it is more common among people who have overweight.
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 sweating in the folds occurs.
- 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 darker skin, the lesions may be purple, brown, or a darker color than the surrounding skin. On lighter skin tones, they may be bright red.
According to research published in 2016 that focused on the Nurses Health Study (I and II) and the Health Professionals Follow-Up Study, data suggests that
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 of nail psoriasis:
- 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, either 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
- blood under the nail plate
Nail changes can also be a sign of a type of arthritis called psoriatic arthritis. If a person notices nail changes, they may need to talk with a doctor.
Guttate psoriasis is sometimes known as “tear drop” or “raindrop” psoriasis.
Here are some of the features:
- Lesions usually appear quickly, within a few days.
- The lesions are small, round spots, or papules — unlike 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,
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 occurs.
Below are some common features:
- Reddish pus-filled bumps appear.
- 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 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
- Pustules develop rapidly across a wide area of skin.
- They may be severely itchy, tender, and inflamed.
- Other symptoms, such as fever, chills, fatigue, nausea, changes in heart rate, muscle weakness, nail abnormalities, jaundice, arthritis, may develop.
- Pustules typically develop on the trunk and limbs.
Localized, or palmoplantar
There are two types of localized palmoplantar psoriasis.
Palmoplantar pustular psoriasis
Acrodermatitis continua of Hallopeau, a rare type of psoriasis, affects only the fingertips or tips of the toes, or both. It can also affect the nails.
The following can occur:
- Pustules can appear on the soles of the feet or the palms of the hands.
- They form round, brown, scaly spots that eventually dry and peel off.
- Pustules may reappear every few weeks or even within days.
- The person may have difficulty walking or using their hands.
Acrodermatitis continua of Hallopeau may occur more commonly in people who work with chemicals or detergents, such as farmers and manual laborers.
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 skin is less able to protect the body. The person’s temperature may fluctuate, and they may start to lose proteins and fluid. This can lead to dehydration and heart failure.
Other symptoms include:
- chills, a fever, and a general feeling of being unwell
- muscle weakness
- a rapid pulse
- swelling (edema), especially in the lower legs
Anyone with a painful, widespread rash needs urgent medical treatment.
Some people with psoriasis also develop a type of arthritis called psoriatic arthritis. In many people with both conditions, psoriasis develops first. However, arthritis symptoms can also 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
Below are some commonly asked questions about psoriasis.
What are the warning signs of psoriasis?
There are no specific warning signs of psoriasis. However, dry, thick, and raised patches on the skin are common symptoms of psoriasis.
Also, psoriasis may present differently initially depending on the type and severity of psoriasis, and the person’s skin color.
How does psoriasis usually start?
Many people’s psoriasis symptoms usually start due to a certain event, known as a ‘trigger’.
Potential triggers of psoriasis include an injury to the skin, a throat infection, and using certain medicines.
Can psoriasis go away on its own?
Psoriasis tends to come and go unexpectedly. Treatment may lead to clear skin and no psoriasis symptoms. This is known as ‘remission’.
However, even if a person experiences remission, it will likely return at some stage.
Left untreated, psoriasis can affect a person’s quality of life significantly. Treatment, therefore, is crucial to manage psoriasis and prevent the development of other related conditions.
Psoriasis is an autoimmune condition that causes skin symptoms.
The most common type is plaque psoriasis, which forms plaques 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. Psoriatic arthritis can develop before the skin changes of psoriasis, though usually the skin changes happen first.
It’s recommended that anyone noticing unusual skin, nail, or joint changes contact a healthcare professional. Various treatments can help manage psoriasis symptoms. For severe cases, a person may need emergency medical care.