Psoriatic arthritis is a lifelong condition that can cause inflammation in the joints. People with the condition may experience pain or stiffness in affected places. Psoriatic arthritis can happen in people who already have psoriasis, an autoimmune condition that can cause different types of skin rashes.
A person can live with both psoriasis and psoriatic arthritis (PsA) at the same time. People usually develop PsA around 10 years after they first develop psoriasis. A person can also develop PsA before psoriasis. PsA affects the joints, nails, and internal organs. Rashes in people with PsA can present differently depending on a person’s skin tone.
This article will explain some of the skin-related symptoms that can occur with psoriatic arthritis. It will go over their appearance, causes and triggers, and treatment options.
Plaque psoriasis can appear as inflamed, flushed skin with raised, silvery scales. On different skin tones, this can appear as purple inflamed skin and grey scales. The plaques happen due to a buildup of skin cells. The inflammation can be painful and itchy.
Plaque psoriasis can also present as nails and nail beds showing pitting or lifting up from the skin. Joints can be swollen and painful. Individual or multiple fingers or toes can become visibly swollen.
Causes and triggers
PsA is an autoimmune condition where the body’s own cells attack themselves. Children can develop the condition, but people aged between 30–50 years are more likely to develop PsA.
Causes and triggers can include:
- genetics, such as having a close relative with the condition
- injury to the skin or joint
Treatment for plaque psoriasis
Treatment can include topical medication, including creams or ointments, oral medication, anti-inflammatory medication, biologics, physical therapy, or surgery.
Guttate psoriasis can appear as raised, oval-shaped patches. In dark skin tones, it can appear as pink patches, which have a redder color in light skin. It can cover areas such as the trunk or limbs. Guttate PsA can cause swollen joints, fingers, or nail issues.
Causes and triggers
Causes and triggers of guttate psoriasis include:
- strep throat
- infections including flu, coughs, colds, or sinus infections
- skin injury
- some medications, including anti-malarials or beta-blockers
Treatment of guttate PsA is similar to that of other forms, including:
- topical creams, including corticosteroids and vitamin D analogues
- oral medicine, such as methotrexate
Inverse psoriasis can appear in skin folds, sometimes alongside a fungal infection. A person with PsA can be living with swollen joints, swollen fingers or toes, and nail issues alongside the skin condition.
The condition does not have scales but instead has lesions that are red, shiny, and inflamed. On other skin tones, the lesions can be purple, brown, or darker than the surrounding skin.
Causes and triggers
Causes and triggers of inverse psoriasis include:
- chafing skin
- psoriasis elsewhere on the body
- some medications
- injury to the skin
- use of alcohol or cigarettes
A healthcare professional may prescribe a combination of treatments if inverse PsA is more severe or involves a fungal infection. A person should not cover affected skin folds unless a healthcare professional recommends that.
Using powder may help keep lesions dry. Treatments may include topical treatments or systemic medication.
People with localized pustular psoriasis can develop pus-filled blisters which can cause painful and thick, scaly skin. Despite the pus, there is no skin infection.
Palmoplantar psoriasis, which affects the palms of the hands and soles of the feet, is associated with pustular psoriasis. This condition has
Generalized pustular psoriasis can affect the whole body causing red, dry, and tender skin which turns to pus-filled blisters. Other symptoms include:
If a person thinks that they may be developing this condition, they should see a healthcare provider immediately.
A person living with this type of psoriasis can also have arthritis symptoms.
Causes and triggers
The following events may trigger pustular psoriasis:
- some types of medication
- taking a new medication or stopping an old one
- exposure to an excess of ultraviolet (UV) light
Treatment can include topical treatments such as creams or ointment, phototherapy, oral medications, or biologics. Treatment is usually individualized to each person.
Erythrodermic psoriasis is a rare form of psoriasis which can cover over
This condition can disrupt the body’s fluid balance and normal temperature. A person may experience edema or swelling from fluid retention in parts of their body. They might have a fever. They have a higher risk of developing infections, pneumonia, and heart failure.
Appearance and symptoms
Erythrodermic psoriasis may present with the following symptoms:
- flushed or discolored skin
- skin that appears burned
- large areas of the body shedding skin as “sheets” rather than small scales
- increase in heart rate
- variable body temperature which could cause fever or chills
- severe itching and pain
- previous history of psoriasis which worsens or does not improve with treatment
Triggers for EP
- environmental triggers, including:
- injury to the skin
- emotional stress
- allergic reaction
- starting a new medication or stopping a medication
- systemic illness, including:
- medication, including:
A person undergoing an erythrothrodermic psoriatic flare should immediately contact a healthcare professional for advice and treatment. The aim of treatment should be to bring body temperature and fluid balance back under control.
If a person has severe symptoms, they may need hospitalization. Once severe symptoms are addressed, then treatment may include topical treatments, medication, or biologics to help manage the psoriasis.
PsA and psoriasis
Treatment may depend on the severity of PsA. Doctors may treat the skin rashes with topical creams, while physical therapy will help improve joint movement and range. Skin rashes may require topical medication, including creams or ointments. More severe skin rashes may require oral medication.
Other medical treatment can include:
- nonsteroidal anti-inflammatory drugs (NSAIDS), including ibuprofen
- disease-modifying anti-rheumatic drugs (DMARDS), including methotrexate and sulfasalazine
- physical therapy to help maintain range of movement for joints
- surgery for severe joint damage
At-home therapy should complement medical treatment, not replace it. The ideal home treatment for psoriatic conditions should be accessible, inexpensive, and effective.
If a person is experiencing flares, they should talk to a healthcare professional before trying home remedies. Some at-home tips include:
- Use a soap-free cleanser: Use a cleanser that does not contain soap to prevent skin drying out.
- Try a salt bath: Have a soak in a bath and add a little table salt.
- Use coal tar: Use a shampoo with coal tar to reduce scalp psoriasis.
- Apply moisturizer: Use a thick moisturiser to help prevent a psoriasis flare.
- Reduce stress: Find some activities to help reduce stress, including yoga, walking, going for a bike ride, or baking.
- Spend time in the sun: Spending 5–10 minutes three times a week in the sun may help both your mood and your skin. However, remember to use sunscreen or clothing on areas not affected by psoriasis.
- Consider supplements: If considering using herbs or supplements for anti-inflammatory properties, seek guidance, preferably from a dermatologist.
- Get enough sleep: A person should get at least 7–8 hours of sleep per day.
- Stay active where possible: Follow the recommended 30 minutes of exercise a day.
Learn more natural ways of treating psoriatic arthritis here.
Different types of psoriasis can appear alongside psoriatic arthritis (PsA). It is possible to have two or more types at once. Rashes may present with patches of flushed skin, silvery patches, small bumps, or blisters.
Some systemic treatments may treat both psoriasis and PsA. It is important to treat PsA to avoid damage to the joints.
A person can complement prescribed treatment with at-home remedies, but they should always consult a healthcare professional first.