How Do You Know It’s Psoriasis? Here Are The Signs And Symptoms You Should Look For

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If you’ve struggled with itchy, irritated skin, you’ve probably sought out various creams, lotions or ointments to treat it. But if you feel like you’ve tried everything and still suffer from dry and irritated skin, you may have an underlying condition that has gone untreated.

And you’re not alone. More than 125 million people worldwide - including 8 million Americans - have psoriasis, and more than 31 million Americans have some form of eczema. It’s not uncommon for the two conditions to be confused, which is why we’ll be diving into the signs and symptoms of psoriasis in the guide below. Be sure to talk to your dermatologist or primary care physician if you have any skin health concerns that require treatment.

What Is Psoriasis?

Psoriasis is a chronic condition that causes dry, thick, and raised patches on the skin with a white coating (called scale). Psoriasis is an immune-mediated inflammatory disease (IMID) and occurs when your body’s immune system starts overacting, rapidly producing skin cells.

Unfortunately, there’s no one specific cause of psoriasis, but a number of factors are suspected of playing a role, including genetics, stress, injury to skin, illness, weather (especially cold weather), allergies and more.

The Signs And Symptoms Of Psoriasis

Psoriasis typically develops on the outer surface skin that will be stretched tight (versus the creases and folds of the skin like eczema).

Some placements may include:

• Knees
• Elbows
• Scalp
• Buttocks
• Chest and stomach
• Palms and soles

Symptoms can vary, but common ones include:

1. Patches of red skin with silvery-white scales
2. Itching or burning
3. Dry skin that cracks or bleeds
4. Crumbling nails and dents on the fingernail bed (called “nail pits”)
5. Buildup on the scalp

Eczema, on the other hand, is a skin condition that appears as a rash within the skin folds on the neck, elbow, wrists, legs or ankles. The rash is incredibly itchy, and if scratched, can ooze clear fluid from the irritated areas.

Types Of Psoriasis

There are many different types of psoriasis, and the placement, appearance and symptoms can vary. It's important to note that individuals may experience more than one type of psoriasis simultaneously or at different times in their lives. Proper diagnosis and treatment by a dermatologist is crucial for managing the condition effectively.

1. Plaque psoriasis

Plaque psoriasis is the most common form, with about 80 to 90 percent of people with psoriasis having this type.

On pale skin, symptoms of plaque psoriasis appear as raised, scaly patches of skin with the white buildup of dead skin cells. On skin of color, the patches may appear darker and thicker, and purple, gray or dark brown in color.

Outbreaks can be triggered by certain medications, infections, stress or other causes.

2. Guttate Psoriasis

Guttate psoriasis appears as small, dot-like lesions, sometimes triggered by a Strep infection. The round spots (called papules) are raised and sometimes scaly. This type of psoriasis often appears on the arms, legs and torso, but can also develop on the face, scalp and ears.

3. Inverse Psoriasis

Inverse psoriasis, also known as flexural or intertriginous psoriasis, is a variety of plaque psoriasis that occurs in skin folds (such as the armpits and groin) and appears as smooth, red, and inflamed patches. Unlike the white scales in the other forms, the surface appears moist, smooth and shiny.

On skin of color, the lesions will appear purple, brown or darker than the surrounding skin in the body folds. Common triggers include starting or stopping medicines, infections, stress, skin fold friction, tobacco or alcohol use, or skin injury.

4. Psoriatic Arthritis

Psoriatic arthritis is a form of inflammatory arthritis that affects some people with psoriasis. Similar to rheumatoid arthritis (RA), psoriatic arthritis affects the small joints, such as in the fingers and toes, and can cause them to be inflamed and painful. In some cases, psoriatic arthritis can even lead to deformed joints. Lack of activity can also contribute to stiff joints and muscle weakness.

5. Pustular Psoriasis

Pustular psoriasis is characterized by white or yellow, pus-filled, painful pustules surrounded by red skin. The pus isn’t contagious. This is often seen in older adults with psoriasis, and may be triggered by certain medicines, exposure to too much ultraviolet light (UV), infections and stress.

There are a couple of different types of pustular psoriasis.

• Generalized pustular psoriasis (GPP): Accompanied by fever, chills, itching, fatigue, muscle weakness and change in heart rate, this can affect large areas of the body. GPP flare ups can be life-threatening if left untreated.
• Palmoplantar Pustular Psoriasis (PPPP): The most common form of pustular psoriasis, symptoms appear on the palms, soles or both.
• Acrodermatitis continua of Hallopeau (ACH): Usually localized to the tips of fingers or toes and the nails. People who have ACH may lose all or part of their affected nails. If left untreated, it can lead to a severe impairment of the fingers and toes, and even damage to the bone.

6. Erythrodermic Psoriasis

Erythrodermic psoriasis is a rare but severe form that causes widespread, fiery redness over most of the body (at least 75% of the body surface area). This can be life-threatening.

Erythrodermic psoriasis flareups can be triggered by allergic reactions, certain medicines, infection, sunburn, stress and alcohol use.

7. Nail Psoriasis

Nail psoriasis affects fingernails and toenails, and can cause pitting, discoloration, buildup and blood under the nail, and separation from the nail bed. Nail changes can also be a sign of psoriatic arthritis. Treatment can include topical medications, injections, or laser.

8. Scalp Psoriasis

Scalp psoriasis is a chronic, non-contagious skin condition that appears as red, itchy, scaly patches on the scalp. Some notice dandruff-like flaking, itching, burning sensations, bleeding or temporary hair loss.

Between 45-56% of people living with psoriasis may experience these symptoms affecting the scalp, hairline, forehead, back of the neck and around the ears.

Treatment includes use of over-the-counter products, topicals, phototherapy/light therapy, and prescription drugs.

9. Palmoplantar Psoriasis

Palmoplantar psoriasis affects the palms of hands and soles of feet, but is not to be confused with palmoplantar pustulosis (PPPP) discussed earlier. Signs include red, dry and thickened skin, often with painful cracks on the palms and/or soles. It may be commonly associated with nail psoriasis and psoriatic arthritis symptoms.

Treatments may include topicals, creams, coal tar, salicylic acid, steroids and phototherapy.

10. Sebo-psoriasis

Sebo-psoriasis is a combination of seborrheic dermatitis and psoriasis, typically affecting the scalp and face. Because psoriasis can cause a very scaly scalp, the irritation by seborrhoeic dermatitis can aggravate psoriasis and lead to this condition.

Symptoms can be mild flaking to inflamed, scaly areas. On the face, it may appear around the nose, cheeks and creases of the skin.

Psoriasis Treatment Options

Because there are so many types of psoriasis (and sometimes, a combination of types), treatment options will vary. Unfortunately, there’s currently no way to completely get rid of psoriasis, but there are options to help control and reduce your symptoms.

1. Topicals

Topical treatment options include medications applied to the skin and are usually the first line of defense. Topicals can slow down, or even normalize, excess cell reproduction and reduce inflammation, according to Psoriasis.org.

Topical treatment types include:

• Steroids: Corticosteroids control inflammatory responses and can help reduce swelling and redness. Strengths vary from mild to very strong.
• Non-steroids: Non-steroidal treatments are still prescription treatments, but may contain active or synthetic ingredients like vitamin D3, vitamin A derivatives, or anthralin, a man-made version of a natural substance found in goa powder.
• Over-the-counter (OTC): These lotions, foams, tars, bath solutions, shampoos and other products don’t require a prescription and can help with some of the itching and scaling symptoms. Ask your dermatologist for the best product recommendation.

2. Phototherapy

Phototherapy, or light therapy, is a treatment option that uses certain types of light. This may not work for all types of psoriasis, so be sure to check with your doctor before starting any treatment plan.

Those prescribed this treatment may see slowing growth of skin cells, reduced inflammation and reduced itch associated with psoriasis.

3. Injection or Infusion Prescriptions

Also known as systemic treatments, these prescription drugs may be considered by those who do not respond to topical treatments or light therapy. They can be taken by mouth, injection or IV infusion.

These prescriptions can have side effects like chapped lips and skin, increased sensitivity to light, headache, upset stomach or even some long term damage to certain organs. It’s not to be considered lightly, so be sure to explore all options with your doctors.

4. Lifestyle Changes

Diet, exercise, physical therapy and acupuncture aren’t going to be a cure-all, but could certainly help in the maintenance of healthy living. Certain therapies can be built into your treatment plan as appropriate for you. Be sure to consult with your health care provider on short and long-term lifestyle changes that could help control your psoriasis symptoms.

The Weather Company does not provide medical advice, diagnosis, or treatment. Talk with your doctor before starting any new medicine, supplement, weight loss or exercise regimen.

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