Let's Talk About the Signs and Symptoms of Psoriasis
Skin freaking out? We've got the doctor-vetted details to help you determine if you've got the skin condition psoriasis.by Michele Bender Health Writer
So many things can leave your skin red, irritated, raging—not just psoriasis, but contact dermatitis, allergies, eczema, and so forth—that it can feel like you need a Ph.D. in Skin to figure out what’s going on. But certain telltale signs can help your doctor determine whether you’ve developed psoriasis, a chronic, immune-related condition. Or maybe you already have a diagnosis but aren’t sure if your latest symptoms are “normal.” So many questions! So much itchiness! We’re here with the answers you need.
Our Pro Panel
We went to some of the nation’s top experts in psoriasis to bring you the most up-to-date information possible.
April W. Armstrong, M.D.
Professor of Dermatology, Associate Dean for Clinical Research and Psoriasis Program Director
Keck School of Medicine and Department of Dermatology at the University of Southern California (USC)
Los Angeles, CA
Mark Lebwohl, M.D.
Chairman of the Kimberly and Eric J. Waldman Department of Dermatology
Icahn School of Medicine at Mt. Sinai
New York, NY
Gretchen W. Frieling, M.D.
Plaque psoriasis is the type of psoriasis that most people have; it appears as sharply demarcated, red, sometimes silvery patches of skin that have scales on them called plaques. Other types are much less common, even rare—like pustular or erythrodermic psoriasis.
For 90% of people, symptoms can go into remission—for weeks, months, or even years at a time. The other 10% have what’s called “spontaneous remission,” where your skin unexpectedly clears up for good.
While moisturizer won’t heal or get rid of psoriasis, heavy creams may ease the itch. Look on the ingredients panel for vitamin E, shea butter, aloe vera, or hyaluronic acid—all badass hydrators. And make sure any product you use says on the label that it’s free of alcohol and fragrance; these can be drying, and eczema-prone skin needs tall drinks of water, not more parching.
A dermatologist is your best bet. Look for one who specializes in psoriasis at the National Psoriasis Foundation website where you can search by city or zip code. There you can also find a rheumatologist, an expert to consult for psoriatic arthritis.
What Does Psoriasis Look Like, Generally?
A quick summary: Psoriasis is a skin condition that affects about 2-3% of the population. It can cover a small part of your body or emerge as a full-body condition, depending on the type. It can appear in areas that are exposed (face, hands, and knees) or unexposed (think genitals and armpits). In its most common form, you develop thick, red, scaly patches of skin called plaques. They can look silvery and can itch, like, whoa.
Wait, so There Are Different Types of Psoriasis?
Yep, it’s not just one thing. Plaque psoriasis accounts for a whopping 80% of cases—and because celebs like Kim Kardashian and Cyndi Lauper have been open about having the condition, it’s what most people think of when they think psoriasis. But there are actually several types of this skin condition:
There are no blood tests or other tools for a diagnosis, but a dermatologist can often identify psoriasis just by eyeballing your skin. The symptoms of each type—particularly, the kind of topical lesions on your skin—will help your doc determine which type of psoriasis you have.
Do I Have the Signs of Psoriasis?
Let’s go type by type.
The most common type of psoriasis, it’s characterized by thick, red, scaly patches of skin that have clear lines of demarcation called plaques. The plaques can have a silvery hue or scales. It typically appears on the face, elbows, knees, and the intergluteal cleft (the groove at the top of the buttocks).
Though these are some classic spots, plaques can appear anywhere on the body, including your genitals (psoriasis can occasionally be mistaken for herpes, but other parts of the body usually have psoriasis at the same time, telling your M.D. that it’s not an STD). They can itch, burn, or feel sore. For around 90% of those with plaque psoriasis, it’s a chronic condition. It can persist, though it may change in severity, or it can go into periods of remission for days, weeks, months, or even years at a time. Only 10% of people have what’s called “spontaneous remission,” where your skin unexpectedly clears up for good.
Typical remedies for plaque psoriasis include OTC topical medications (like those that contain salicylic acid and tar), prescription topical medications (like corticosteroids and retinoids), biologics (extremely effective Rx treatments made from the cells of animals, humans, or bacteria that are injected or given through an IV; these include Skyrizi and Humira), oral medications (prescriptions like Otezla and Xenjanz), and light therapy.
This occurs in 50% of people with plaque psoriasis but can occur with other types as well. It can also pop up on its own. With scalp psoriasis, the raised, red, or silver scaly plaques appear on the scalp, where they can be itchy and painful. The plaques can shed psoriatic skin on your hair, clothes, and furniture. Because of its flaky appearance and itch factor, scalp psoriasis is often confused with dandruff. Most of us can’t tell the difference between the two, but a super-close look may reveal that the psoriasis that sheds may be more scaly than flaky and have a silvery-white hue, while dandruff is typically white and flaky.
However, unlike dandruff, which can come or go depending on weather, hormones, and the use of dandruff shampoo, scalp psoriasis is a chronic medical condition that requires treatment to clear up. In severe cases, scalp psoriasis appears as thickened, crusty patches of skin that not only crop up on the hairline but on the forehead, back of the neck, and near the ears. (This is still considered scalp psoriasis.) Mild cases can be alleviated or improved with topical products like creams or ointments, while more intense versions may require the use of biologics, oral treatments, and/or light therapy. Sometimes hair loss can accompany some of these treatments, but it’s usually temporary.
Of those who have psoriasis, up to 50% will have nail psoriasis. Like scalp psoriasis, it typically occurs with plaque psoriasis but can show up with other types as well. It can also make an appearance on its own. Up to 80% of people who have psoriatic arthritis will have nail psoriasis.
As the name implies, this type of psoriasis involves a variety of changes on the fingernails and/or toenails, such as pits, which are like little golf ball dimples or depressions; ridging; thickening; and color changes, including green, yellow, or brown nails. When it gets bad, nail psoriasis can cause crumbling or detachment of the nail from the nail bed; oral treatments or biologics can help clear it up. If you’ve got a mild case, it can likely be remedied with a prescription topical product or a corticosteroid injection into the nail.
If you’re one of the 10% of those with psoriasis who have the guttate variety, you’re familiar with the scaly, raised, dotty lesions, which are smaller than your fingertip. You can get what appears like hundreds of red dots in large areas of the body like the arms, legs, and/or torso. This type of psoriasis is commonly triggered by infections, like strep throat or an upper respiratory issue, and can be short-lived; once you treat it, it usually goes away and doesn’t come back.
Inverse psoriasis, which affects fewer than 10% of people with psoriasis, shows up on hidden areas or folds of skin, such as those around the groin, underarms, bellybutton, or between the breasts. These are red, inflamed areas but they don’t have scales like plaque psoriasis.
Only 2-3% of people with psoriasis have erythrodermic psoriasis, which causes the body to appear lobster-red from head to toe with skin that is scaling and may peel off. Erythrodermic can come on suddenly, usually triggered by an infection or withdrawal of systemic steroids. It severely compromises the skin’s protective functions—making it hard for the body to hold in heat, water, and electrolytes, which can stress organs like the heart and liver. It also boosts your risk of infection. If you suspect that you have this condition, get medical attention immediately—it can be life-threatening.
This type—the rarest form of psoriasis, and uncommon in the U.S.—consists of pus-filled bumps surrounded by red, inflamed skin and scaling. It can cover your whole body or just your hands and feet, and can show up out of the blue, often as the result of an infection or stopping use of systemic steroids. Although these spots appear infected, they’re not. Like erythrodermic psoriasis, it can come on suddenly and is concerning because it can damage the protective functions of the skin and threaten organs like the heart and liver. Your chance of getting infections rises. As a result, pustular psoriasis can be dangerous, even deadly, so it requires immediate medical attention.
The severity of your psoriasis is often determined by a variety of factors, including what type of psoriasis you have, the location of symptoms, the intensity of symptoms, and how much of your body surface area your psoriasis covers.
Your psoriasis is considered mild if it covers less than 3% of your body
Your psoriasis is considered moderate if it covers 3% to 10% of your body
Your psoriasis is considered severe if it covers more than 10% of your body
By these measures, an estimated 25% of psoriasis sufferers have moderate to severe psoriasis, while 75% have mild cases.
Can Psoriasis Cause Other Health Symptoms?
Unfortunately, the negative impact of psoriasis can be more than skin deep. While it can often affect your self-confidence, psoriasis can put you at a higher risk for other health issues, including:
Certain types of cancer such as lymphoma and nonmelanoma skin cancer, suggesting that people with psoriasis should have regular cancer screenings.
An increased risk of cardiovascular disease and type 2 diabetes among those with serious psoriasis (it’s also been found that one drug used to treat type 2 diabetes may help psoriasis, too).
Psoriatic arthritis. This is the most common secondary ailment for those with psoriasis, with 30% who have the skin condition developing this chronic arthritic issue linked to the immune system. Psoriatic arthritis (PsA) affects the joints and some parts of the body where your ligaments and tendons attach to the bone. If it’s not treated, this damage can be permanent.
Do I Have the Signs of Psoriatic Arthritis?
Symptoms of PsA include stiffness, swelling, and pain in the joints that can come and go.
85% of those who get psoriatic arthritis have skin psoriasis first. Then years, even decades, later, up pops PsA.
15% of people develop psoriatic arthritis first and the skin disease afterward.
If you experience joint symptoms, make sure you tell your M.D. about your skin psoriasis, as this will help him or her make a diagnosis. Although some biologics and oral medications for psoriasis can alleviate psoriatic arthritis symptoms, it’s best to see a doctor who specializes in arthritis, called a rheumatologist, to get the best care and results.
Signs, Symptoms and Treatment Overview: JAMA. (2019). “JAMA Dermatology Patient Page.” jamanetwork.com/journals/jamadermatology/fullarticle/2653218
Pustular Psoriasis: The U.S. National Library of Medicine. (n.d). “Generalized Pustular Psoriasis.” ghr.nlm.nih.gov/condition/generalized-pustular-psoriasis#statistics
Different types of psoriasis:: Annals of the Rheumatic Diseases. (2005). “Psoriasis: Epidemiology, Clinical Features and Quality of Life.” ard.bmj.com/content/64/suppl_2/ii18