Signs and Symptoms of Plaque Psoriasis

Plaque psoriasis is primarily characterized by skin symptoms that cyclically worsen or improve over time. However, psoriasis can also take a psychological toll on people who have the disease. The many diseases that are more common in people with psoriasis can also cause additional symptoms.  

Psoriasis is mainly characterized by its skin symptoms. Plaque psoriasis is a subtype of psoriasis that causes a specific type and distribution of rash. It is sometimes painful and sore and often very itchy. In fact, “psoriasis” is named from the Greek word “psora,” which means “itchy.” Some people find the itch of psoriasis the most difficult symptom to manage.

Understanding Plaques

The skin changes associated with psoriasis are very specific. The word “plaque” in plaque psoriasis is named for the dermatological term “plaque.” In medical language, a plaque is a lesion with an easy to see boundary. Plaques are also elevated from the surrounding skin, solid, and greater than 1 cm in diameter.

Initially, these skin changes occur in smaller areas, as small red bumps on the skin. But over time these small regions coalesce to form larger areas (i.e., plaques). They are generally irregular but roughly round to oval in shape.

Psoriasis plaques are usually dry and pink to reddish. They are also usually covered with a sort of silvery, flaky scale. If the scale is lifted away, the plaque will usually start to bleed. Sometimes these plaques crack, fissure, and bleed, which can be painful.

Affected Body Parts

Plaque psoriasis most often occurs on specific parts of the body such as:

• Elbows
• Knees
• Trunk
• Buttocks
• Scalp

Less commonly, psoriasis can affect other areas of the body, like the face, hands, feet, genitals, or inside your mouth. Usually, these plaques affect both sides of your body in a symmetrical pattern.

Most people with psoriasis have only mild to moderate disease, affecting less than five percent of their body surface. Some people might have only a few small spots of skin affected. At the other extreme, some people have psoriasis that affects large areas of their skin.

Many people who initially only have skin symptoms later develop nail problems. This can cause fingernail or toenail changes like the following:

• Separation of the nail from its bed
• Little depressions in the nails (nail pitting)
• Yellow or brown spots on the nail
• Other changes in nail shape

A significant minority of people with plaque psoriasis also develop symptoms of psoriatic arthritis. Psoriatic arthritis can cause pain, swelling, tenderness, and stiffness of the joints. Almost any joint can be affected, but joints in the hands and feet are common sites.

Usually, joints are affected in an asymmetrical pattern. A person can have mild skin disease from psoriasis but severe psoriatic arthritis, or the reverse. Some people have joint symptoms and then later develop psoriasis, and some people with psoriasis later develop symptoms of psoriatic arthritis.

We used to think of psoriasis as being just a skin disease. However, it has become clearer that people with psoriasis have an increased risk of a number of other medical conditions.

Some of these include:

• Cardiovascular disease
• Obesity (especially around the waist)
• High blood pressure
• Type 2 diabetes and prediabetes
• Inflammatory bowel disease (such as Crohn’s disease)

These other associated diseases come with their own sets of symptoms. For some people, the disease can have a large emotional toll. If you have symptoms like low mood and negative thoughts about yourself, these are just as important to deal with as your skin disease. Don’t be ashamed to ask for additional help if you are struggling.

Symptoms of psoriasis can begin at any age, but psoriasis most commonly begins in adolescence.

The symptoms of psoriasis often wax and wane over time. A period in which the disease is worse is sometimes called a disease “flare.” Some people find that certain environmental trigger might cause their disease to flare up, like smoking, heavy drinking, or cold weather. Then after a while, your symptoms may lessen.

Though they may diminish temporarily, symptoms of psoriasis don’t usually go away permanently without treatment. With treatment, your health provider should be able to help dramatically reduce your symptoms.

Psoriasis is not a medical emergency. However, you should see your doctor if your symptoms are not improving as expected after treatment. You should see a doctor about any particularly severe symptom, like chest pain.

Psoriasis is not an infection. It is not contagious, and you cannot spread it to others. However, people with psoriasis may be more likely to get skin infections like cellulitis, especially if their skin is actively irritated. People taking certain types of psoriasis medications are also more likely to get some kinds of infections. Call your doctor if you have unusual symptoms like skin warmth and swelling or other symptoms like fever.

Some people with plaque psoriasis may have a higher risk of skin cancer, particularly if they have had large amount of PUVA light therapy treatments. See your health care provider promptly if you notice any skin changes unlike your normal pattern of psoriasis.