Psoriasis: Signs and symptoms

Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.

While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:

  • Type of psoriasis you have
  • Places psoriasis appears on your body
  • Amount of psoriasis you have

Types of psoriasis

The following pictures show what each type psoriasis can look like on the skin. You’ll also see how psoriasis can affect your nails and joints.


psoriasis-on-kneesPlaque (plack) psoriasis: About 80% to 90% of people who have psoriasis develop this type1. When plaque psoriasis appears, you may see:

  • Patches of thick, raised skin called plaques
  • Scale (a dry, thin, and silvery-white coating) covers some plaques
  • Plaques of different sizes
  • Smaller plaques joining together to form larger plaques

Plaques usually form on the scalp, elbows, knees, or lower back — but they can develop anywhere on the skin. It’s common for plaques to itch, but try not to scratch. Scratching can cause the patches to thicken. To stop the itch, dermatologists recommend treating the psoriasis.


guttate-psoriasisGuttate (gut-tate) psoriasis: When someone gets this type of psoriasis, you often see tiny bumps appear on the skin quite suddenly. The bumps tend to cover much of the torso, legs, and arms. Sometimes, the bumps also develop on the face, scalp, and ears. No matter where they appear, the bumps tend to be: 

  • Small and scaly
  • Salmon-colored to pink
  • Temporary, clearing in a few weeks or months without treatment

When guttate psoriasis clears, it may never return. Why this happens is still a bit of a mystery. Guttate psoriasis tends to develop in children and young adults who’ve had an infection, such as strep throat. It’s possible that when the infection clears so does guttate psoriasis.

It’s also possible to have:

  • Guttate psoriasis for life
  • See the guttate psoriasis clear and plaque psoriasis develop later in life
  • Plaque psoriasis when you develop guttate psoriasis

There’s no way to predict what will happen after the first flare-up of guttate psoriasis clears.


inverse-psoriasis-2 Inverse psoriasis: This type of psoriasis develops in areas where skin touches skin, such as the armpits, genitals, and crease of the buttocks. Where the inverse psoriasis appears, you’re likely to notice:

  • Smooth, red patches of skin that look raw
  • Little, if any, silvery-white coating
  • Sore or painful skin

Other names for this type of psoriasis are intertriginous psoriasis or flexural psoriasis.

 


pustular-psoriasis Pustular psoriasis: This type of psoriasis causes pus-filled bumps that usually appear only on the feet and hands. While the pus-filled bumps may look like an infection, the skin is not infected. The bumps don’t contain bacteria or anything else that could cause an infection.

Where pustular psoriasis appears, you tend to notice:

  • Red, swollen skin that is dotted with pus-filled bumps
  • Extremely sore or painful skin
  • Brown dots (and sometimes scale) appear as the pus-filled bumps dry

Pustular psoriasis can make just about any activity that requires your hands or feet, such as typing or walking, unbearably painful.


generalized-pustular-psoriaisis Pustular psoriasis (generalized): Serious and life-threatening, this rare type of psoriasis causes pus-filled bumps to develop on much of the skin. Also called von Zumbusch psoriasis, a flare-up causes this sequence of events:

  1. Skin on most of the body suddenly turns dry, red, and tender.
  2. Within hours, pus-filled bumps cover most of the skin.
  3. Often within a day, the pus-filled bumps break open and pools of pus leak onto the skin.
  4. As the pus dries (usually within 24 to 48 hours), the skin dries out and peels (as shown in this picture).
  5. When the dried skin peels off, you see a smooth, glazed surface.
  6. In a few days or weeks, you may see a new crop of pus-filled bumps covering most of the skin, as the cycle repeats itself.

Anyone with pustular psoriasis also feels very sick, and may develop a fever, headache, muscle weakness, and other symptoms. Medical care is often necessary to save the person’s life.


erythrodermic-psoriasis Erythrodermic psoriasis: Serious and life-threatening, this type of psoriasis requires immediate medical care. When someone develops erythrodermic psoriasis, you may notice:

  • Skin on most of the body looks burnt
  • Chills, fever, and the person looks extremely ill
  • Muscle weakness, a rapid pulse, and severe itch

The person may also be unable to keep warm, so hypothermia can set in quickly.

Most people who develop this type of psoriasis already have another type of psoriasis. Before developing erythrodermic psoriasis, they often notice that their psoriasis is worsening or not improving with treatment. If you notice either of these happening, see a board-certified dermatologist.


nail-psoriasis Nails

While many people think of psoriasis as a skin disease, you can see signs of it elsewhere on the body. Many people who have psoriasis see signs of the disease on their nails.

Nail psoriasis: With any type of psoriasis, you may see changes to your fingernails or toenails. About half of the people who have plaque psoriasis see signs of psoriasis on their fingernails at some point2.

When psoriasis affects the nails, you may notice:

  • Tiny dents in your nails (called “nail pits”)
  • White, yellow, or brown discoloration under one or more nails
  • Crumbling, rough nails
  • A nail lifting up so that it’s no longer attached
  • Buildup of skin cells beneath one or more nails, which lifts up the nail

Treatment and proper nail care can help you control nail psoriasis.


Joints

When psoriasis affects the joints, it causes a disease known as psoriatic arthritis.

psoriatic-arthritis-toe Psoriatic arthritis: If you have psoriasis, it’s important to pay attention to your joints. Some people who have psoriasis develop a type of arthritis called psoriatic arthritis. This is more likely to occur if you have severe psoriasis.

Most people notice psoriasis on their skin years before they develop psoriatic arthritis. It’s also possible to get psoriatic arthritis before psoriasis, but this is less common.

When psoriatic arthritis develops, the signs can be subtle. At first, you may notice:

  • A swollen and tender joint, especially in 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

Like psoriasis, psoriatic arthritis cannot be cured. Treatment can prevent psoriatic arthritis from worsening, which is important. Allowed to progress, psoriatic arthritis can become disabling.

You’ve just seen how psoriasis can affect your skin, nails, and joints. Psoriasis can also affect other parts of your body. To find out how, go to:

Can psoriasis affect more than my skin?

Do you have a greater risk of getting psoriasis? Some people are more likely to get psoriasis than others. You can find out if you have a higher risk at:

Psoriasis: Who gets it and causes


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1,2 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 Dermatol. 2008; 58:826-50.

Images 
Plaque psoriasis, pustular psoriasis: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides. 
Guttate psoriasis: Photograph used with permission of the Journal of the American Academy of DermatologyJ Am Acad Dermatol. J Am Acad Dermatol. 2008;58:826-50. 
Inverse psoriasis: Photograph used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2004:51:731-8. 
Pustular psoriasis (generalized) Photograph used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2013; 68:e187-9. 
Erythrodermic psoriasis: Photograph used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2008;58:826-50. 
Nail psoriasis: Photograph used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2013;69(2):245-52. 
Psoriatic arthritis: Photograph used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2011; 65(1):137-74.

References 
Bergstrom KG and Kimball AB. “100 questions and answers about psoriasis.” Sudbury, MA: Jones and Bartlett Publishers; 2005. 
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. 
Habif TP, Campbell JL, Jr., et al. In: Dermatology DDxDeck. 2006. China. Mosby Elsevier. Card #37: “Psoriasis: Lesions.”

 


Medical reviewers 
Meet the board-certified dermatologists who reviewed this content. Each has conducted research that gives us a better understanding of psoriasis.