Common Signs and Symptoms of Psoriasis

Some common signs and symptoms of psoriasis are raised plaques and scales on the skin. These occur because the immune system malfunctions and causes inflammation throughout the body, which leads to skin cell overgrowth. 

According to a study published in 2021 in the journal JAMA Dermatology, psoriasis affects 7.5 million American adults. Anyone can have psoriasis, regardless of age, gender, or skin color. 

Different types of psoriasis affect different body areas. These types present with different symptoms. 

This article will cover the types of psoriasis, the areas they affect, what psoriasis looks like, and more. 

Types of Psoriasis

Knowing your psoriasis type can help your healthcare provider create a treatment plan. Most people experience one type at one time, but it is possible to have more than one type of psoriasis.

Plaque Psoriasis

Plaque psoriasis is the most common type of psoriasis, affecting 80–90% of people with psoriasis worldwide. It causes red lesions and silvery scales that can occur on any skin area. Plaque psoriasis is sometimes a painful condition. 

Guttate Psoriasis

Guttate psoriasis affects about 8% of people with psoriasis. It primarily affects children and young adults.

Guttate psoriasis causes small, red, scaly spots on the arms, legs, and torso. The skin lesions typically develop after a bacterial infection. 

The condition is not contagious and often clears after treatment. Some people who get guttate psoriasis might later develop plaque psoriasis. 

Inverse Psoriasis

Inverse psoriasis affects 21–30% of people with psoriasis, according to a study reported in 2016 in the journal Clinical and Experimental Dermatology. It causes patches of red, inflamed skin in body fold areas, including the armpits, under the breasts, and around the genitals. Symptoms worsen with friction and sweating.

It is sometimes confused with fungal infection because of the location in skin folds. You might also develop a secondary infection with yeast and bacteria.

Pustular Psoriasis

Pustular psoriasis is a rare type of psoriasis, affecting less than 1% of people with psoriasis. It tends to affect older adults after age 50, but anyone can get the condition. 

This psoriasis type causes the skin to become red, inflamed, and covered with pus-filled bumps. It can come on quickly and become severe and life-threatening.

If you develop pustular psoriasis, you will need immediate medical treatment. It is typically treated in a hospital. 

Erythrodermic Psoriasis

Erythrodermic psoriasis affects 1–2.25% of people with psoriasis. It causes a red rash that resembles a burn over most of the body.

This type of psoriasis can be life-threatening and cause fever, chills, and dehydration. If you develop symptoms of erythrodermic psoriasis, you should seek medical attention right away. 

Erythrodermic psoriasis is a manageable condition that requires lifelong treatment. Proper management decreases the risk of complications. 

Nail Psoriasis

Nail psoriasis causes damaged, discolored, pitted (small dents in the nails), split, and lifted nails. It accounts for up to 23% of psoriasis cases.

Nail psoriasis often co-occurs with plaque psoriasis. If it occurs alone, it might be harder to diagnose. It might be confused with other nail conditions, such as onychogryphosis (a condition that causes nail overgrowth) or fungal nail infections.  

Psoriatic Arthritis

Psoriatic arthritis (PsA) is a type of inflammatory arthritis affecting people with psoriasis. PsA can also occur independently. Both PsA and psoriasis are types of psoriatic disease.  

According to the National Psoriasis Foundation, up to 30% of people with psoriasis will also have PsA. PsA causes inflammation of the joints and entheses, the areas where tendons and ligaments meet bone. 

PsA causes pain, swelling, stiffness of the joints, and swelling of the entheses. It is a lifelong condition without a cure, but it is treatable and manageable. 

Psoriasis Symptoms

Each type of psoriasis has its distinct skin symptoms. The most common symptoms of psoriasis are thick, raised patches on the skin. The patches are often covered with itchy, silvery scales.

Additional symptoms of psoriasis include:

• Dry, cracked skin that may bleed
• Itchy skin
• Burning skin pain
• Red patches of skin
• Pitted or thickened nails 
• Rapid heartbeat, chills, and fever in more severe types of psoriasis
• Peeling skin 
• Heel pain and joint swelling related to PsA
• Swelling of the fingers and toes related to PsA
• Chronic fatigue 
• Eye inflammation: Psoriasis sometimes causes an inflammatory eye condition called uveitis

The symptoms of psoriasis and PsA will come and go. Most people experience times when their symptoms are worse, called flares, and periods of remission with few or no symptoms. 

What Parts of the Body Does Psoriasis Affect?

Psoriasis skin symptoms can appear anywhere on the body. Some types are more likely to occur in certain body areas than others. Psoriasis flares will appear on more than one body area.

Face

Psoriasis can appear on the eyebrows, the skin between the nose and upper lip, and the hairline. Psoriasis might also appear on the eyelids and causes scales over the eyelashes and red, crusty eyelids.

Genitals

Inverse psoriasis can affect the genital area and inner and upper thighs. It is called genital psoriasis when it affects these body areas. 

Hands and Feet

Pustular psoriasis can cause pus-filled blisters on the hands and feet. It can cause itching and pain and can affect your ability to perform daily tasks. It might cause pain when walking and throw off your gait (the way you walk).

Knees and Elbows

The knees and elbows are common locations for psoriasis. Lesions will appear as large, thickened areas of skin covered in scales. Plaques might appear red or salmon-colored on light skin tones and purple on brown or black skin.

Nails

Many people with plaque psoriasis might also have nail psoriasis on both the hands and feet. Nail involvement leads to pitting, thickening, discoloration, and nailbed separation. 

Scalp

On the scalp, psoriasis appears as small patches with scales or as a crusty covering over the entire scalp. Symptoms might extend to the forehead, the back of the neck, and around the ears.

Trunk

Guttate psoriasis can appear on the trunk, arms, and legs as small, scaly bumps. Some people also experience papules on the face, ears, and scalp.

Under the Arms and Breasts

Inverse psoriasis can affect the underarms and the area under the breasts. Other types of psoriasis typically do not appear in these areas.

What Does Psoriasis Look Like?

How psoriasis looks depends on your type of psoriasis and where it appears on the body.

• Plaque psoriasis appears as raised, thickened skin plaques covered with silvery scales. Plaques can appear anywhere on the body but typically on the lower back, scalp, knees, and elbows. 
• Guttate psoriasis causes many tiny, scaly spots over the trunk and arms.
• Inverse psoriasis appears as shiny, smooth patches. Skin areas are bright red, and the skin is painfully sore.
• Pustular psoriasis develops as painful pus-filled blisters on the hands and feet. The skin might also appear thick and scaly and crack easily.
• Erythrodermic psoriasis causes large areas of the skin to appear burnt. 
• Nail psoriasis causes pitting, crumbling, discolored nails, and nails that have separated from the fingers or toes.
• Psoriatic arthritis is known for causing dactylitis—severe swelling of the fingers and toes and sometimes visible swelling of the Achilles tendon, connecting the calf muscle to the heel. In PsA, inflamed joints, including the knees and elbows, might appear red or swollen. 
  

When to Seek Care

Psoriasis shares symptoms similar to those of other skin conditions, including eczema. Most skin conditions resembling psoriasis are not autoimmune diseases, so they are treated differently. Therefore, it is crucial to find out precisely what is causing your skin symptoms and get an accurate diagnosis. 

A diagnosis of psoriasis is possible with a physical exam. Your healthcare provider might request bloodwork or a biopsy (taking a sample to analyze in the lab) to make a definitive diagnosis or to rule out other conditions. 

If you are diagnosed with psoriasis, and your skin symptoms get worse, don't respond to treatment, cause pain or lead to joint swelling, let your healthcare provider know. 

Summary 

Psoriasis is an autoimmune skin disease that causes skin cell overgrowth, which leads to scaly, red, itchy patches on the skin. There are different types of psoriasis, but the most common is plaque psoriasis. Some types of psoriasis are life-threatening and require immediate medical care. 

Psoriasis can affect any skin area, including the knees, elbows, scalp, and trunk. The disease commonly occurs in periods of flare-ups and remission. 

Contact a healthcare provider if you experience a skin rash that lasts longer than a few days. They can assess and determine the cause of your skin's symptoms.