Got skin? If the answer is “yes” — and we certainly hope it is! — you might be interested in or curious about skin health. Psoriasis is among the most common disorders that affect the skin, and it has a bunch of different types.
Psoriasis is a noncontagious autoimmune disorder that causes symptoms on the skin. It tends to appear in “Aaaaargh, get it off me!” flare-ups followed by “ahhhh, wonderful” periods of remission.
Experts don’t yet know the cause, and there’s not a full cure — but it’s possible to manage skin symptoms as they appear and reduce how often you experience flares.
We’ve got you covered for everything you need to know about the different ways psoriasis can affect your skin, including how to spot and manage each type.
Before giving you a guided tour of the different types, we’re going to show you what they look like.
There are five official types of psoriasis. Nail and scalp psoriasis aren’t distinct varieties, but since they’re such common locations for psoriasis to show up, we’re giving them special billing here.
While psoriatic lesions mainly appear on your limbs, they can develop anywhere on your body. And they definitely have some favorite hangouts:
Plaque psoriasis, the most common type, affects 80 to 90 percent of people with the condition.
Plaque psoriasis can cause red, inflamed patches of thickened skin that may be itchy. It may also show up as scabby or peeling plaques with thin, dry, whitish-gray scales.
The plaques can be different sizes and may merge over time to form larger patches (as if you needed them ganging up on you).
The suggested treatment for plaque psoriasis will depend on how severe your case is. But your doc may recommend one or more of the following therapies or personal care practices:
- over-the-counter (OTC) cortisone cream or ointment-based moisturizers
- vitamin D creams like calcipotriene or calcitriol
- topical retinoids such as tazarotene
- coal tar cream, oil, soap, or shampoo
- biologic medications
You can also work with your doc to identify your specific psoriasis triggers.
Guttate psoriasis accounts for about 4 percent of psoriasis diagnoses, which makes it the second most common variety (plaque psoriasis kinda has the market cornered here).
Typically, this form of psoriasis begins during childhood or early adulthood. Guttate psoriasis can become plaque psoriasis in time.
Strep throat or other infections, stress, skin injury, and medication are the most frequent triggers of guttate psoriasis.
Guttate psoriasis can appear suddenly, causing small red/pink and possibly teardrop-shaped bumps on your skin.
Steroid creams, phototherapy, and oral meds are all possible treatments for guttate psoriasis. If your outbreak is triggered by a bacterial infection, your doctor may prescribe antibiotics.
Guttate psoriasis is temporary, generally lasting only a few weeks or months. Once it has cleared up, it might never return. This here-today-gone-tomorrow MO has the medical community scratching its collective head.
Damn you, guttate psoriasis — we just want answers!
Inverse (aka flexural or intertriginous) psoriasis forms in skin-on-skin areas of your body. Sweat and moisture in the skin folds prevents inverse psoriasis lesions from molting.
It’s not a common type at all: Inverse psoriasis may affect 3 to 7 percent of people with psoriasis. Most people who have inverse psoriasis also have another form of the condition elsewhere on their body.
This type of psoriasis is known for:
- appearing as red patches that are often smooth and shiny (no scales!)
- usually appearing on the armpits, groin, and upper inner thighs, between the butt cheeks, and under the boobs (like, everywhere you don’t want psoriasis to be)
- causing discomfort due to friction
People sometimes mistake inverse psoriasis for a fungal or bacterial infection. It’s important to get an accurate diagnosis so you can find the right treatment.
Treatments for inverse psoriasis are similar to those for plaque psoriasis. Your doc may prescribe:
Pustular psoriasis, a very rare form of the condition, represents about 1 percent of all psoriasis cases.
Pustular psoriasis has three subtypes: von Zumbusch (general), palmoplantar pustulosis (PPP), and acropustulosis. (Seriously, subtypes too?) The subtypes can vary in severity and symptoms but may cause:
- swollen, inflamed skin
- yellowish, pus-filled bumps that turn brownish and possibly flaky as they dry out
Pustular psoriasis may develop rapidly. It usually appears only on the hands and feet but can also cover a large percentage of the skin’s surface. The pustules may grow into one another and develop scaling.
This type of psoriasis can be debilitating, making daily tasks too painful to complete. And although it’s not an infection, it can cause flu-like symptoms such as:
Because some people experience a repeating cycle of flare-ups and remission, symptoms may come and go.
Treatment may involve corticosteroid creams, oral medications, phototherapy, or biologics. Extreme cases, such as generalized pustular psoriasis, can be life threatening and usually require medical attention ASAP.
By identifying and addressing your triggers, you may be able to reduce your flare-up frequency. (Good — because those flares are pretty frickin’ tough.)
Erythrodermic (or exfoliative) psoriasis affects only 1 to 2.25 percent of all people with psoriasis. It’s a serious and dangerous form of psoriasis that requires medical attention ASAP.
Most incidents of erythrodermic psoriasis develop in folks who already have another type of psoriasis. They may notice that their known psoriasis is getting worse or not responding to treatment.
The following factors can also trigger erythrodermic psoriasis:
Erythrodermic psoriasis has telltale markers:
- The skin is red and scaly and looks severely burnt.
- The skin flakes off in sizable pieces.
- The lesions can cover most of the body.
- It’s severely itchy.
- A person with this type can look very ill and experience chills, fever, muscle weakness, and a rapid pulse.
If you notice symptoms, get yourself to the hospital immediately — don’t pass go, don’t collect $200.
Hospitalization is critical for a few reasons. Your body might not be able to properly regulate its temperature, which could spark hypothermia. And sometimes, life threatening complications like sepsis or blood clots can develop.
Your healthcare team will administer a mix of treatments consisting of medicated wet wraps, topical steroid ointment, biologics, and/or oral medications. The therapies will change as your symptoms improve.
Psoriasis on the nails isn’t an official type of psoriasis — it falls into the category of palmoplantar psoriasis (PPP). An estimated 12 to 16 percent of people with psoriasis have PPP, and about half experience nail changes.
Nail psoriasis can result in:
- pitting, grooves, or ridges in nails
- white, yellow, or brown discoloration of the nail or the skin beneath it
- nails that loosen, crumble, or fall off
- atypical nail growth
- thickening of skin under the nail
- buildup under the nail
- blood under the nail
Nail psoriasis is often misdiagnosed as an infection of the nail. A correct diagnosis is key to getting the right treatment.
The first plan of attack is to treat nail psoriasis with on-nail remedies like corticosteroids, calcipotriene (vitamin D), or tazarotene (retinoids). Your doc may also suggest traditional plaque psoriasis treatments like:
- laser or light therapy
- oral medications such as biologics, methotrexate, retinoids, cyclosporine, or apremilast
Nails grow pso pslowly — maybe even more so with the challenges of nail psoriasis. It may take a while to see the effects of your treatment.
Doctors sometimes prescribe multiple treatments at the same time, which may speed up the progress of your treatment.
If you have plaque psoriasis, you may experience psoriasis symptoms on your head. They can occur on or near your hairline, forehead, neck, and ears. More than 45 percent of people with psoriasis experience scalp symptoms.
For some people, scalp psoriasis may cause:
- severe flaking that looks like intense dandruff
- skin with a silvery, powdery appearance
- noticeable redness and/or thickened plaques
- one big patch or several smaller patches
Topical treatments like these are the go-to treatment for scalp psoriasis:
- medicated shampoos
- steroidal lotions
- black tar formulations
- vitamin D cream
- cortisone injections (for stubborn plaques)
The next level of treatment may lean on phototherapy or oral medications. It really depends on how you respond to the topical therapies. If these don’t work, your doc might prescribe biologics like Humira — drugs that interact with your immune system.
As with nail psoriasis treatments, it may take a couple of months to see the results of scalp psoriasis treatments, because hair can grow more slowly than molasses on a cold New England day. After a period of initial intensive treatment, you’ll likely need to continue with maintenance treatment indefinitely.
Consider asking your doc about psoriatic arthritis (PsA) as well — psoriasis increases your risk for this serious condition.
Psoriasis can be a pain in the… everywhere. Here’s how to make any of the types suck less.
While there’s no cure for psoriasis, significant healing — even almost complete skin clearing! — and remission are possible. Together, you and your healthcare team will create an effective, sustainable treatment regimen to better manage your condition.
Self-care and lifestyle
You can make adjustments to your self-care routines and lifestyle to help manage your symptoms and triggers. These might include:
- keeping your skin moisturized and hydrated
- avoiding products that irritate your skin (and instead coddling your skin with gentle, nourishing products)
- wearing softer, looser clothes that won’t irritate your psoriasis
- exercising, meditating, or practicing relaxation breathing techniques to cut down stress
- getting plenty of high quality rest
- eating a nutritious, balanced diet
- limiting or avoiding alcohol (ixnay on the alcoholhay)
- ditching the smokes
Coping and finding support
Who said living with a chronic disorder was fun or easy? No one, ever. Psoriasis can have real psychological side effects, such as stress, anxiety, depression, social difficulties, and self-esteem issues.
Fortunately, you never have to deal with this alone! There are loads of ways to get the TLC and mental wellness help you deserve, including trained counselors, peer support groups, and your compassionate family and friends.
There’s bound to be an approach that fits your needs. (You can even connect with resources virtually if IRL isn’t your thing!)
Also, consider asking your doctor for a referral to a therapist who specializes in helping people with psoriasis.
If you’ve got psoriasis, it can be pretty helpful to know the things that could set off a flare-up. With a little knowledge, you might be able to prevent, minimize, or ease your psoriasis breakouts.
While every person is a unicorn — and what triggers psoriasis in one person may not set it off in someone else — there are some common culprits.
Here are some of those usual suspects:
- certain medications, particularly steroids
- infections or illness
- overexposure to ultraviolet (UV) light and sunburn
- skin injury or damage, including getting tattoos, piercings, or hair removal
- environmental factors like exposure to certain chemicals or toxins
- foods, especially ones that promote inflammation (like red meat, refined sugar, processed foods, and dairy)
- frequent or excessive alcohol consumption
- tobacco use
- low blood calcium
- weather or climate, especially cold, dry conditions (including too much time spent draped over that AC!)
- having another form of psoriasis
Some types of psoriasis are more susceptible to certain triggers than others.
Psoriasis is a noncontagious inflammatory skin disease. There are several types and manifestations of psoriasis, and each has its own symptoms, triggers, and treatments.
Plaque psoriasis is the most common. Pustular and erythrodermic psoriasis are the most serious and need medical attention pronto. Psoriasis commonly pops up under the nails and on the scalp too.
Many treatments can address the different types and severities of psoriasis. Plus, there are tons of resources to help you care for mental health needs related to living with psoriasis.
Psoriasis can also affect your mental well-being. Therapists, support groups, and caring family and friends can provide support and help with your emotional health while you cope with flare-ups.
Think you might have psoriasis? Go talk with your doctor! Get on the treatment bandwagon and start on the path to reducing your symptoms.