Getting diagnosed with psoriasis—a chronic condition that drops patches of itchy redness around your body—can leave you not just scratching your skin, but your head. What the heck is going on?!? We asked top psoriasis experts for the most common questions they hear from patients. Their explanations will help you navigate your confusion and get on your way to clearer, less irritated skin. (As for that silent “p”? Blame the ancient Greeks.)
We went to some of the nation's top psoriasis experts to bring you the most scientific and up-to-date information possible.
April W. Armstrong, M.D.Professor of Dermatology, Associate Dean for Clinical Research and Psoriasis Program Director
Mark Lebwohl, M.D.Chairman of the Kimberly and Eric J. Waldman Department of Dermatology
Gretchen W. Frieling, M.D.Dermatopathologist
What Does Psoriasis Look Like?
There are five official types of psoriasis, which are determined by the appearance of lesions. (There are also subtypes, designated by where they appear on the body.)
Plaque psoriasis has thick, sharply demarcated red patches with what appear as loose, scales called plaques—on lighter skin, they look silvery; on darker skin, purplish. This is the most common form of psoriasis. At least 50% of scalp and nail psoriasis—which many docs consider their own psoriasis categories—happens with plaque psoriasis.
Inverse psoriasis can look the same as plaque, but it’s hidden in the folds of skin, in areas like the groin, armpits, and buttock crease.
Guttate psoriasis has small, raised, and scaly dots that are smaller than the size of your fingertip. They can appear in the hundreds, usually on your arms, legs, and torso.
Pustular psoriasis is when you have widespread pus-filled bumps surrounded by inflammation and scaling. It’s rare and usually develops suddenly, but because your skin begins to lose its protective function, it can even be deadly, so see a doctor immediately.
Erythrodermic psoriasis is large, lobster-red areas from head to toe that can shed and peel in sheets. It only affects 2% of those with psoriasis, but it can be dangerous—get medical attention right away.
When you see a rash, it’s understandable to wonder if you can get it from hugging someone, using the same towel, sleeping in the same bed, etc. And psoriasis lesions sure can look angry during a flare-up. But no matter where they are on the body—and no matter which of the five types of psoriasis someone has, even the type with pus bumps—they’re not infected or infectious.
We repeat: Psoriasis is not contagious, so you can't "catch” it from anyone else or pass it on. To be crystal clear, that means it can’t be spread in a pool or bath, through sexual contact, or by touching someone who has the skin condition.
Although stress is not technically a cause of psoriasis, it is considered a trigger, though experts aren’t clear on why it impacts this skin condition. What especially sucks is the cyclical nature: Stress can make a psoriasis flare worse, which leads to even more stress—especially if the flare is in a visible spot and extensive. Imagine how this feels when you’re anxious about a big event like a job interview, wedding, or public speech.
Ten percent of people with psoriasis experience what’s known as spontaneous remission—for them, the skin condition goes poof, never to be seen from again. But for the other 90%, psoriasis is indeed a life partner. An overactive immune system leads your body to grow skin cells more quickly than they should.
That said, you can reduce the severity of psoriasis, and there may also be time periods—weeks, months, even years—during which your skin is totally clear, thanks to the array of treatment options available and a few lifestyle changes. For example, if you notice that your skin worsens when you take certain medications, your M.D. can recommend other options (say pills are prompting bad side effects; you may then move to biologics).
Will My Children Inherit Psoriasis If I Have It?
If only you could write it out of the will! But alas, psoriasis is very much linked to genetics. If you have psoriasis, your offspring’s chances of developing it are 14%. If both parents have it, the child’s likelihood rises to 40%.
Silver lining? If your kids do end up with psoriasis, you’ll know what they’re going through, because you’ve lived it; your insight can be invaluable to them.
What's the Difference Between Psoriasis and Eczema?
Psoriasis and eczema are skin conditions that can be red, itchy, and annoying, and both are rooted in a family history. But the similarities essentially stop there. Here are a few key ways they’re different:
Psoriasis is usually thick, scaly, and raised, and sometimes silvery or purplish. Eczema looks more like dry flaky skin.
Eczema—often called atopic dermatitis, its most common type—is more prolific, affecting more than 7% of adults and 8-12% of children. Only around 3% of the population has psoriasis, and it usually appears later in life rather than during childhood.
Psoriasis is an autoimmune condition that can lead to more debilitating health issues, such as psoriatic arthritis, while eczema is just about skin.
Eczema can often be remedied with over-the-counter treatments and creams, but psoriasis often requires Rx medications and sometimes injections and laser therapy.
What Kind of Doctor Should I See for My Psoriasis?
A dermatologist is an expert in skin, so that’s a good place to start. Even better, there are derms who specialize in the treatment of this particular skin condition, which can boost your chances of a better outcome. The National Psoriasis Foundation offers a list of specialists that you can search by city.
What Happens to Psoriasis During Pregnancy?
Some women say they have a nine-month reprieve from their psoriasis symptoms (either partial or complete skin clearing) when they are pregnant. But if your symptoms don’t subside during pregnancy or you are one of the 10-20% of women whose psoriasis worsens at this time, finding relief can be challenging.
Some of the medicines you may have been using to control your condition aren’t safe for the fetus, and others can lead to miscarriage. Methotrexate, Soriatane (acitretin), oral retinoids and Tazorac (tazarotene), and some biologics shouldn’t be used, for example.
There are plenty of safe options, though, so talk with your ob/gyn and dermatologist to determine what’s best for you, and have that conversation as soon as you begin thinking about getting pregnant. Some meds take time—even years—to get out of your system.
Is Psoriasis Painful?
While there are exceptions, psoriasis lesions can itch, sting, burn, or feel sore. About 30% of people with psoriasis also develop psoriatic arthritis, a chronic immune condition that affects the joints and other areas of the body. Joints can swell and feel stiff and, in bad cases, you can end up with permanent joint damage.
What's the Difference Between Contact Dermatitis and Psoriasis?
Psoriasis is a chronic skin condition caused by genetics and a hyperactive immune system, and it can flare at any time. Once you have these red, scaly patches of skin, you usually have 'em for good.
While contact dermatitis can also be itchy, red, swollen, and sore, it isn’t raised and thick like psoriasis most often is. It’s also not chronic: As its name implies, contact dermatitis only occurs when your skin comes into contact with a substance that causes a reaction. This can include anything from laundry detergent to jewelry made with nickel.
What's the Difference Between Dandruff and Psoriasis?
Plaque psoriasis can appear on the scalp as loose, silver-colored scales that can shed on your hair, clothing, or furniture. Like psoriasis on other areas of the body, this is a chronic condition that usually requires topical prescription products or oral medication.
Although dandruff also appears on the scalp and manifests in dry flakes that can be itchy, the flakes of psoriasis tend to be white. Dandruff is not considered a medical condition and doesn't typically require M.D. attention except in severe cases or if it doesn’t clear up with over-the-counter dandruff shampoo.