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Different types of psoriasis explained
Psoriasis is a common chronic inflammatory skin condition. It can cause red, purple, or grayish patches to develop that are covered in silvery scales. There are numerous types of psoriasis, and knowing which type a person has allows medical professionals to develop a treatment plan. Psoriasis is not contagious.
Psoriasis is a common condition that affects over 8 million people in the United States.
There are a number of types of psoriasis, and they often have similar triggers. These triggers can include:
- skin injuries, such as scratches, sunburns, bug bites, and vaccinations
- certain medications, including beta-blockers, antimalarials, and lithium
- illnesses, such as ear infections, bronchitis, tonsillitis, and respiratory infections
- cold weather
This article will discuss different types of psoriasis. For each one, it will list symptoms, locations, and treatment options.
Plaque psoriasis is the of psoriasis.
Symptoms of plaque psoriasis include:
- the appearance of plaques and patches on the skin
- skin inflammation
- scales that appear on the plaques
- itchiness and pain
On light skin, these plaques appear as raised and red. On dark skin, the patches may be purple, grayish, or darker brown in color.
These plaques become covered in a silvery or white buildup of dead skin cells that medical professionals call scales.
See pictures of plaque psoriasis here.
Plaque psoriasis can appear on most areas of the body. However, it most often develops on the:
Topical treatments for plaque psoriasis include:
Other treatments can include phototherapy, biologics, and systemic medications that a person can take orally or via an injection.
Learn more about plaque psoriasis here.
Approximately 8% of people who have psoriasis develop guttate psoriasis. This type of psoriasis can start at any age, but it most commonly starts at an early age, around childhood and young adulthood.
Infections of streptococcal bacteria cause strep throat, which is the of guttate psoriasis.
Guttate psoriasis is a distinct type of psoriasis that appears as small round spots called papules. These are raised and are sometimes scaly.
Inflammation of the skin causes the papules to form. They often appear on the:
However, papules may also develop on a person’s face, ears, and scalp.
The of treatment for mild guttate psoriasis is topical corticosteroids. Other treatment options include phototherapy and oral treatments.
If a person’s symptoms persist, a medical professional may recommend the use of a biologic or a combination of treatments.
Learn more about guttate psoriasis here.
Inverse psoriasis, sometimes called intertriginous psoriasis, affects 21–30% of people with psoriasis.
Inverse psoriasis has similar triggers to plaque psoriasis, including:
- certain medicines
- starting to use and discontinuing medicines
- skin injuries
- friction on deep folds of the skin
Inverse psoriasis appears as lesions on the body. These lesions are purple or brown on dark skin, and bright red on light skin.
The lesions may also appear smooth and shiny. However, they tend to lack the scaling that people may notice with plaque psoriasis.
This type of psoriasis commonly develops in the folds of the skin. It most often affects the following parts and areas of the body:
- the armpits
- under the breasts
- other skin folds on the body
Moisture, rubbing, and sweating can all make inverse psoriasis symptoms worse.
Treatment for inverse psoriasis :
- topical corticosteroids
- topical calcineurin inhibitors
- vitamin D analogs
- oral systemic medications
Learn more about inverse psoriasis here.
Erythrodermic psoriasis is a rare type of psoriasis that is aggressive and can affect the entire body. It can also become very serious and may be life threatening. It affects of people with psoriasis.
This type of the condition has the same general triggers as most other types, including medications, skin injuries, allergic reactions, and stress.
Symptoms of this type of psoriasis can be very serious and include:
- severe redness or discoloration of the skin on large areas of the body
- shedding of large parts of the skin
- exfoliation in large sheets instead of small scales
- a burnt appearance of the skin
- an increased heart rate
- severe itching and pain
- increasing and decreasing body temperature, particularly on days that are very hot or very cold
If a person experiences these symptoms, they should seek emergency medical attention.
Erythrodermic psoriasis disrupts a person’s body temperature and fluid balance. This can cause shivering episodes and swelling due to fluid retention.
A person with this type of psoriasis may also be at a higher risk of infection, pneumonia, and heart failure.
Before treating erythrodermic psoriasis, doctors will first ensure a person is stable. They will start by correcting any fluid, protein, or electrolyte imbalance. They will then treat any secondary infections and protect the person against hypothermia.
An individual with this type of psoriasis can also develop sepsis, which can become fatal, so doctors will treat this immediately if it is present.
Once a person’s condition is stable, doctors can treat the erythrodermic psoriasis. They do this using a number of medications, such as cyclosporine, infliximab, methotrexate, or acitretin.
Other treatment options may include topical treatments and biologics that can work alongside the medications described above.
Learn more about erythrodermic psoriasis here.
There are different types of pustular psoriasis, and medical experts categorize them based on where the symptoms appear.
Symptoms and locations
Pustular psoriasis appears as pus-filled bumps called pustules. These pustules might be surrounded by inflamed, discolored skin.
Generalized pustular psoriasis
Generalized pustular psoriasis (GPP) causes widespread pustules to appear in large numbers across large areas of the body.
GPP can develop quickly and can be very serious. Its symptoms can also include fever, chills, severe itching, fatigue, a change in heart rate, and muscle weakness.
If a person suspects they have GPP, they should contact a medical professional right away.
Localized pustular psoriasis
Localized pustular psoriasis, also known as palmoplantar pustular psoriasis, tends to affect the palms of the hands and the soles of the feet.
Acropustulosis affects only the tips of the fingers and the toes. This is very rare and may come after an injury or infection.
Learn more about palmoplantar psoriasis here.
Medical professionals will treat this condition with one of the following:
- topical treatments
- oral medications
Learn more about pustular psoriasis here.
Nail psoriasis affects the fingernails and toenails. It causes changes in them that can lead to discoloration or alterations in the nail bed.
Common symptoms of nail psoriasis include:
- dents in the nail
- discoloration of the nail
- the nail separating from the finger
- crumbling nails
- blood and buildup beneath the nail
Treatment options for nail psoriasis include:
- topical treatments, such as corticosteroids, calcipotriol, and tazarotene
- systemic medications, including methotrexate and cyclosporine
Learn more about nail psoriasis here.
Psoriasis is a common skin condition that causes colored patches of skin to develop. These patches can be red, purple, or grayish, depending on a person’s skin tone. They can also be covered in scales and become itchy and may cause a burning sensation to develop.
There are various types of psoriasis, all of which produce differing symptoms.
Psoriasis can develop all over the body and can affect the scalp, knees, elbows, torso, genitals, face, hands, feet, or fingernails.
There are numerous treatments for psoriasis, including topical treatments, phototherapy, biologics, and systemic medications.
A person should contact a primary care doctor or dermatologist if they suspect they have psoriasis.
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This article was medically reviewed by Caroline Chang, MD, a board-certified dermatologist and member of the Prevention Medical Review Board, on August 8, 2019.
We all get rashes from time to time, whether it’s from exposure to additives, certain metals, plants, or allergens. But what if your rash just doesn’t go away—and is also inflamed, growing scales, and so itchy you can barely sleep? Those symptoms could point to psoriasis, an autoimmune condition in which the body produces new skin cells so rapidly that they pile up on the surface, producing raised, crusty-looking patches in the process.
However, psoriasis can take five different forms: plaque, gutatte, inverse, pustular, and erythrodermic. Some are more common while others are more severe, and it can be difficult to pinpoint which type you are dealing with. That’s because they don’t all look the same (and may look a lot like eczema), can have various causes, and often require different treatments.
Psoriasis is common and impacts more than 8 million Americans—and 125 million people worldwide, according to the National Psoriasis Foundation (NPF). If you think your rash could be something more severe, check out the psoriasis pictures below. Then, make an appointment with a dermatologist to get a physical exam, proper diagnosis, and personalized treatment plan.
Plaque psoriasis is the most common type of psoriasis. In fact, 80 to 90 percent of people with the disease have plaque psoriasis, per the NPF. Look for reddish-pinkish, raised skin lesions (called plaques) that are topped with silvery scales. They might be itchy or sore, and if you scratch them, you may notice pinpoint bleeding.
These plaques can occur anywhere on the body, but some of the areas where they most commonly appear include the elbows, the knees, the lower back, and the scalp. The size of the patches and how much body surface area they cover can vary widely. Patients with plaque psoriasis may also experience nail problems, such as pitted or discolored nails, or nails that fall off.
Plaque psoriasis treatment might include topical or oral medications, light or laser therapy, or the newest type of treatment: biologic therapy. The type of treatment you receive depends on many factors, like the severity of the psoriasis, your lifestyle, your insurance, what other medical conditions you have, and what medications you’re already taking.
Guttate psoriasis is the second-most common type of psoriasis, after plaque psoriasis. About 10 percent of people who get psoriasis develop guttate psoriasis, according to the NPF. Some people who develop guttate psoriasis will go on to develop plaque psoriasis.
Guttate psoriasis is characterized by small, reddish sores that appear most commonly on the arms, legs, and trunk, causing the body to look dotted. The lesions tend to have silvery scales on top, but they’re generally thinner than plaque psoriasis patches.
This type of psoriasis is more common in children and young adults and is often triggered by a bacterial infection, like strep throat. (Treating the strep throat with an antibiotic can be a way to make the guttate psoriasis disappear.) Guttate psoriasis may appear in a person only once, while others get it over and over again.
“There are a few other conditions that can mimic guttate psoriasis. There’s pityriasis rosea and secondary syphilis, for example. So sometimes we’ll do a biopsy or send patients for blood work to confirm the diagnosis,” says Rhonda Q. Klein, MD, MPH, a dermatologist at Connecticut Dermatology Group. “We’ll often treat it with a topical steroid. If it’s bad, sometimes we’ll do a light box for a short period, or if it’s really bad, sometimes we’ll do an oral medication like cyclosporine just to shut it down.” For patients who repeatedly get strep throat infections, getting a tonsillectomy (surgically removing the tonsils) can be helpful because that makes it a lot harder to get strep throat.
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Inverse psoriasis tends to occur on areas of the body where skin touches other skin, like in the armpits, the groin and genital area, behind the knees, between the buttocks, and under the breasts. With inverse psoriasis, the skin patches are red, inflamed, shiny, and smooth (no silvery scales) and they usually feel sore.
“Inverse psoriasis is more common in people who are overweight and it tends to get worse in the summer when it’s hot and people sweat more. The skin folds are moist areas and often there’s some fungus or yeast there,” says Dr. Klein. “We’ll often treat it with a combination of a topical steroid cream at night and an antifungal powder during the day to keep it dry. You can’t use the cream and the powder together or it’ll create a nasty paste.”
“Pustular psoriasis is pretty rare and occurs mostly in adults,” says Dr. Klein. Sometimes pustular psoriasis appears as patches in small areas like on your hands or feet, and other times, it covers a larger area of skin. The skin becomes red and tender and then tiny blisters filled with white pus form on top of that red skin. It can come on fast and the blisters can feel sore and painful. The blisters may go away after a few days, but they can also come back.
Pustular psoriasis can be caused by many things including infections, the sudden withdrawal of certain medications, pregnancy, overexposure to UV light, or emotional stress. If the pustular psoriasis covers a large portion of the body, you may experience systemic symptoms like fever, chills, muscle weakness, fatigue, loss of appetite, rapid pulse, and itchiness.
“With treatment for pustular psoriasis, you usually need to start with something systemic—maybe an oral medication like cyclosporine—and treat it a little more aggressively than the other types because it can have systemic symptoms and because it can lower your levels of calcium and albumin (a protein made by your liver). You may also need nutritional supplementation,” says Dr. Klein. And if the cause is an infection or a medication, for instance, a dermatologist may need to address those underlying issues.
Erythrodermic psoriasis is the least common form of psoriasis, occurring in only 3 percent of people who have psoriasis during their lifetime, according to the NPF. It’s also the most severe form of psoriasis.
With erythrodermic psoriasis, more than 75 percent of the body becomes covered with a red rash that peels off in sheets, intensely itches, and feels extremely hot and painful. The skin looks like it’s been burned. Erythrodermic psoriasis makes it hard for the patient to maintain a normal body temperature of 98.6 degrees Fahrenheit, so the patient may feel very cold or very hot. “And your heart rate can go up and you can get a fever,” says Dr. Klein.
🚨 If you think that you might have this type of psoriasis, go to a hospital right away for treatment because it can be life threatening.
Some common causes include getting a bad sunburn, having another type of psoriasis, and taking a corticosteroid or another medication. “The causes of erythrodermic psoriasis are similar to the causes of pustular psoriasis and we treat it similarly, usually with the oral medication cyclosporine. In fact, pustular can sometimes turn into erythrodermic,” says Dr. Klein.
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Jane BianchiJane Bianchi is a writer and editor with more 13 years of experience specializing in health; she formerly worked as a health editor at Family Circle, and her work has appeared in Men’s Health, Women’s Health, Esquire, and more.
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Images of Psoriasis
Psoriasis is a noncontagious, lifelong skin condition that affects about 2–3% of the population of the United States. People with psoriasis have thickened, red, and often scaly patches on their skin. Psoriasis is very likely to run in families, but it can also be triggered by certain situations, such as emotional stress, injury to the skin, infection, as well as taking certain medications. The exact cause of psoriasis is unknown, but it seems to be caused by errors in how the immune system functions.
Who's at risk?
Psoriasis can develop at any age, but it is usually diagnosed in those aged between 15 and 25 years. Thirty percent of people with psoriasis have a family member with psoriasis. The condition affects men and women fairly equally, with women tending to show signs at a younger age than men. As stated above, certain medications can trigger flares of psoriasis. These include beta blockers, NSAIDS (eg, ibuprofen, naproxen), lithium, antimalarial drugs, and oral steroid withdrawal. Approximately 10–30% of people with psoriasis also develop psoriatic arthritis, an inflammatory arthritis that causes painful, swollen joints.
Signs and Symptoms
The typical lesions of psoriasis are red, raised patches that often have a silver or grey scale on top of them. These patches are frequently seen on the elbows, knees, back, buttocks, and scalp, and they are usually seen on both sides of the body. Areas of rubbing or friction are particularly likely to develop psoriasis lesions. Most people also experience itching, but some may not.
Psoriasis can be graded as:
- Mild – Few, scattered, small areas of involvement (about two-thirds of people have mild disease)
- Moderate – More widespread disease affecting larger areas, sometimes affecting the joints
- Severe – Most of the skin surface is affected, sometimes affecting the joints
The nails may also be affected in psoriasis. There may be tiny pits or indentations, yellow-brown spots, and lifting up of the nail from the finger underneath (onycholysis).
Because psoriasis is a lifelong condition for which there is currently no cure, the goal of therapy is to decrease the number of lesions and improve symptoms, such as itching and irritation.
- Bathe daily to help remove scale and moisten the skin. Avoid harsh soaps; soap substitutes are milder for your skin.
- Apply moisturizers to all scaly psoriasis patches after any water exposure or bathing. Heavier oil-based moisturizers help to retain water in the skin better than water-based moisturizers.
- Apply hydrocortisone cream (0.5 or 1%), available over the counter, to help reduce itch and redness.
- Use products with salicylic acid (shampoos, cleansers, and ointments) to help soften and remove heavy scale.
- Small doses of natural sunlight may be helpful, such as 10–15 minutes 2 or 3 times a week. Avoid too much sun, however, and protect your healthy skin from sun exposure.
There is also an increased risk of nonmelanoma skin cancer and lymphoma in people with psoriasis. For this reason, monthly skin self-exams and regular visits to your doctor are important.
The National Psoriasis Foundation is a useful resource that has additional information on treating your psoriasis. Their Web site is http://www.psoriasis.org/.
When to Seek Medical Care
See your doctor if you have severe psoriasis or if self-care measures are not helpful.
Treatments Your Physician May Prescribe
There are many prescription-strength treatments that are helpful at controlling psoriasis. For mild or moderate cases, medicines applied directly to the skin (topical treatments) may be prescribed:
- The mainstay of therapy for psoriasis is topical steroids, either in creams or ointment form. Higher-potency topical steroids are used for the body or scalp, and lower-potency topical steroids are best for the face and skinfold areas. Steroid solutions or liquids can be used on the scalp. Use should be limited to 1–4 weeks at a time because long-term use of steroids can lead to stretch marks (striae) and thinning of the skin.
- Calcipotriene (Dovonex®) is a vitamin D derivative cream that works as well as steroids, and it is even more effective when combined with topical steroids.
- Tazarotene (Tazorac®) is a vitamin A-based cream that may be prescribed. Women of childbearing age should be counseled to avoid pregnancy while using tazarotene because this treatment may cause birth defects.
- Topical immunosuppressants such as tacrolimus (Prograf®) and pimecrolimus (Elidel®) may also be used, but they can cause skin burning and itching and are expensive. These treatments may possibly increase your risk for skin cancer and lymphoma.
- Coal tar-based therapies and anthralin creams are sometimes used, but they are used less frequently than other treatments because they have an odor, cause skin irritation, and can stain clothing and because neither is any more effective than calcipotriene.
For more extensive psoriasis:
- If a large percentage of your skin is affected, ultraviolet (UV) light therapies may be considered. These include UVB phototherapy and PUVA (psoralen [a photosensitizer] and UVA therapy). PUVA may increase your risk for non-melanoma skin cancers.
- Oral medications may be used for extensive psoriasis, including acitretin (made from vitamin A), methotrexate, and cyclosporine. If you are prescribed any of these medicines, you will need to see your doctor regularly so he or she can monitor for possible side effects such as liver and kidney damage.
- Biologics are the newest medicines to be used for psoriasis. These are proteins that treat psoriasis by blocking certain actions of the immune system. These medications include etanercept (Enbrel®), alefacept (Amevive®), and infliximab (Remicade®). These are very costly and may have serious side effects, including infection, immunosuppression, and cancer.
Trusted LinksMedlinePlus: Psoriasis
National Psoriasis Foundation
Clinical Information and Differential Diagnosis of Psoriasis
Pack Health: Free one-to-one psoriasis health coaching
Bolognia, Jean L., ed. Dermatology, pp.125-146. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.407, 1393-1394. New York: McGraw-Hill, 2003.
Luba KM, Stulberg DL. Chronic plaque psoriasis. Am Fam Physician. 2006;73(4):636-644. PMID: 16506705.
Pardasani AG, Feldman SR, Clark AR. Treatment of psoriasis: an algorithm-based approach for primary care physicians. Am Fam Physician. 2000;61(3):725-733, 736. PMID: 10695585.
Psoriasis pictures of
WHAT IS PLAQUE
IMPORTANT SAFETY INFORMATION
What is the most important information I should know about SKYRIZI® (risankizumab-rzaa)?
SKYRIZI may cause serious side effects, including infections. SKYRIZI is a prescription medicine that may lower the ability of your immune system to fight infections and may increase your risk of infections. Your healthcare provider should check you for infections and tuberculosis (TB) before starting treatment with SKYRIZI and may treat you for TB before you begin treatment with SKYRIZI if you have a history of TB or have active TB. Your healthcare provider should watch you closely for signs and symptoms of TB during and after treatment with SKYRIZI.
- Tell your healthcare provider right away if you have an infection or have symptoms of an infection, including:
- fever, sweats, or chills
- muscle aches
- weight loss
- warm, red, or painful skin or sores on your body different from your psoriasis
- diarrhea or stomach pain
- shortness of breath
- blood in your mucus (phlegm)
- burning when you urinate or urinating more often than normal
Before using SKYRIZI, tell your healthcare provider about all of your medical conditions, including if you:
- have any of the conditions or symptoms listed in the section “What is the most important information I should know about SKYRIZI?”
- have an infection that does not go away or that keeps coming back.
- have TB or have been in close contact with someone with TB.
- have recently received or are scheduled to receive an immunization (vaccine). Medications that interact with the immune system may increase your risk of getting an infection after receiving live vaccines. You should avoid receiving live vaccines right before, during, or right after treatment with SKYRIZI. Tell your healthcare provider that you are taking SKYRIZI before receiving a vaccine.
- are pregnant or plan to become pregnant. It is not known if SKYRIZI can harm your unborn baby.
- are breastfeeding or plan to breastfeed. It is not known if SKYRIZI passes into your breast milk.
Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.
What are the possible side effects of SKYRIZI?
SKYRIZI may cause serious side effects. See “What is the most important information I should know about SKYRIZI?”
The most common side effects of SKYRIZI include upper respiratory infections, feeling tired, fungal skin infections, headache, and injection site reactions.
These are not all the possible side effects of SKYRIZI. Call your doctor for medical advice about side effects.
Use SKYRIZI exactly as your healthcare provider tells you to use it.
SKYRIZI is available in a 150 mg/mL prefilled syringe and pen.
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