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Types of psoriasis: Can you have more than one?


You can have one type of psoriasis for years and later develop a second type of psoriasis.
Psoriasis is a disease that can show up in various ways. Some types of psoriasis develop on the skin. One type of psoriasis affects the nails, and another type involves the joints.

It’s possible to get more than one of these types. For example, psoriasis can begin on your skin and later develop on your nails. You could also get nail psoriasis and see psoriasis on your skin in the future.

A few people live with one type of psoriasis on their skin for years and then get a second type on their skin, so they have two types of psoriasis on their skin.

The type of psoriasis you have on your skin can also change.

How do people get a second type of psoriasis on their skin?

While there’s no way to predict who will develop a second type of psoriasis, some people may be more susceptible. For example, having severe psoriasis that isn’t well controlled, stopping a strong medication too quickly, or getting strep throat may increase your risk.

The following explains how people who have plaque (plack) psoriasis, the most common type of psoriasis, can develop a second type of psoriasis on their skin.

You’ll also find out how plaque psoriasis can turn into a different type of psoriasis.

Inverse (in-verse) psoriasis: Many people gain a lot of weight after getting plaque psoriasis. Researchers aren’t sure why this happens, but they have discovered that extra pounds can increase your risk of developing inverse psoriasis.

Inverse psoriasis only forms in areas where skin touches skin, such as the armpits, groin, or underneath the breasts. It causes smooth, bright-red patches of raw-feeling skin.

Guttate (gut-tate) psoriasis: Some people with plaque psoriasis have developed guttate psoriasis after getting an infection, such as strep throat. Guttate psoriasis causes spots on the skin that are small, pink to salmon-colored, and scaly. These spots are often widespread, appearing on the torso, legs, and arms.

Erythrodermic (ē-rith-row-derm-ic) psoriasis: Some people who have severe plaque psoriasis see their plaque psoriasis turn into erythrodermic psoriasis. This can happen when:

  • Severe plaque psoriasis isn’t well-controlled

  • A trigger, such as getting a serious sunburn or having an allergic reaction, turns severe plaque psoriasis into erythrodermic psoriasis

  • You stop taking a medication, such as a corticosteroid pills or cyclosporine, too quickly

When erythrodermic psoriasis develops, it causes redness that develops on most of the skin. The skin may look as though it’s been badly burned. Chills, a fever, and dehydration are also common. These symptoms can be life-threatening, making emergency medical care necessary.

Pustular (pus-choo-lar) psoriasis: This type of psoriasis causes pus-filled bumps to develop on the skin. Most often, the bumps appear on the hands, feet, or both.

When the bumps cover larger areas of skin, a person has generalized pustular psoriasis.  This usually occurs after someone already has another type of psoriasis, such as plaque psoriasis, on the skin.

If you already have plaque psoriasis and develop generalized pustular psoriasis, a trigger is often the cause. Possible triggers include getting an infection or stopping corticosteroid pills too quickly.

Different ways that psoriasis can affect the nails

From left to right: 1) Lots of nail pits, 2) a few nail pits and the nail is starting to lift away, and 3) discoloration and lifting.

Who gets nail psoriasis?

After developing a type of psoriasis on your skin, it’s common for psoriasis to affect the nails. Nail psoriasis becomes more common with age. It’s also more common if you’ve had psoriasis on your skin for some time or have severe psoriasis.

Signs of nail psoriasis include tiny dents in your nails (nail pits), discoloration under one or more nails, and a nail lifting away from the nail bed so that it’s no longer completely attached. Some people have a buildup of skin under one or more of their nails, which can also cause a nail to lift up.

Who gets psoriasis that affect the joints?

Years after developing psoriasis on their skin, some people get a type of arthritis called psoriatic (sore-ē-at-ic) arthritis, which affects the joints. It’s also possible to develop psoriatic arthritis before getting psoriasis on your skin.

It’s not possible to predict who will get psoriatic arthritis. For this reason, it’s important for people who have psoriasis to pay attention to their joints.

Without treatment, psoriatic arthritis can worsen and damage joints. This damage is irreversible and can cause a lifelong disability. Treatment can prevent psoriatic arthritis from worsening.

Early warning signs of psoriatic arthritis include:

  • A swollen and tender joint, especially within a finger or toe

  • Heel pain

  • Swelling on the back of your leg, just above your heel

  • Stiffness in the morning that fades during the day

What can prevent someone from getting a second type of psoriasis?

Most types of psoriasis cannot be prevented.

That said, if you already have plaque psoriasis, it may be possible to reduce your risk of developing another type of psoriasis on your skin. Dermatologists recommend taking the following precautions:

  • Protect your skin to prevent sunburn

  • Take medication as directed and speak with your dermatologist before stopping a medication

  • Treat your psoriasis so that it’s well-controlled

  • Watch your weight so that you stay at a weight that’s recommended for your age and height

Watching your weight may help prevent inverse psoriasis. This type of psoriasis is more common in people who are 20 or more pounds overweight.

What should you do if you develop another type of psoriasis?

Life-threatening signs and symptoms, such as redness that covers most of your body, fever, and chills, require immediate medical care.

When signs and symptoms are not life threatening, you should see a board-certified dermatologist for a diagnosis. You’ll find pictures of the different types of psoriasis and learn more about the possible signs and symptoms at Psoriasis: Signs and symptoms


Images
Image 1: Getty Images Image 2: J Am Acad Dermatol 2013;69:245-52.

References
Brummer GC, Hawkes JE, et al. “Ustekinumab-induced remission of recalcitrant guttate psoriasis: A case series.” JAAD Case Rep. 2017; 3(5): 432–5.

Egeberg A, Thyssen JP, et al. “Prognosis after hospitalization for erythroderma.” Acta Derm Venereol. 2016;96(7):959-92.

Gottlieb A, Korman NJ, et al. "Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 2. Psoriatic arthritis: Overview and guidelines of care for treatment with an emphasis on the biologics.” J Am Acad Dermatol 2008;58:851-64.

Gudjonsson JE and Elder JT. “Psoriasis.” In: Wolff K, Goldsmith LA, et alFitzpatrick’s Dermatology in General Medicine(seventh edition). McGraw Hill Medical, New York, 2008:178-81.

Khosravi H, Siegel MP, et al. “Treatment of Inverse/Intertriginous Psoriasis: Updated Guidelines from the Medical Board of the National Psoriasis Foundation.” J Drugs Dermatol. 2017;16(8):760-6.

Martin BA, Chalmers RJ, et al. “How great is the risk of further psoriasis following a single episode of acute guttate psoriasis?” Arch Dermatol. 1996;132(6):717-8.

Menter A, Gottlieb A, et al. “Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics.” J Am Acad Dermatol2008;58:826-50.

Navrotski BRF, Nihi FM, et al. “Wet wrap dressings as a rescue therapy option for erythrodermic psoriasis.” An Bras Dermatol. 2018;93(4):598-600.

Robinson A, Van Voorhees AS, et al. “Treatment of pustular psoriasis: from the Medical Board of the National Psoriasis Foundation.” J Am Acad Dermatol. 2012;67(2):279-88.

Trettel A, Spehr C, et al. “The impact of age on psoriasis health care in Germany.” J Eur Acad Dermatol Venereol. 2017;31(5):870-5.

van de Kerkhof PCM and Schalkwijk J. “Psoriasis.” In: Bolognia JL, et alDermatology. (second edition). Mosby Elsevier, Spain, 2008:119.


All content solely developed by the American Academy of Dermatology.

Supported in part by Novartis.

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