Symptoms of Psoriasis

When it comes to describing the symptoms of psoriasis, most people think about those related to plaque psoriasis, which is characterized by a rash made up of scaly plaques over areas of reddened skin. But there are other types of psoriasis, each having a distinct appearance and other symptoms, such as nail pitting, teardrop-shape bumps, smooth rashes, and pus-filled lesions.

 Certain types of psoriasis can easily be mistaken for other conditions, so it can be helpful to understand these differences—and important to see a doctor for a formal diagnosis, should you notice any symptoms.

Frequent Symptoms

Because there are so many different types of psoriasis, it's almost impossible to generalize about symptoms of the disease. What can be said is that, first and foremost, each type of psoriasis is characterized by a rash with a specific appearance, in most cases accompanied by other associated symptoms.

One of the more distressing features of psoriasis is the occasional sudden and severe worsening of symptoms, often without any obvious cause. Treating these outbreaks, or flares, can be challenging, but most can be handled with psoriasis medications and other treatments such as phototherapy.

Here's an overview of the main symptoms of the various types of psoriasis.

Plaque Psoriasis

A rash caused by plaque psoriasis will consist of patches of silvery scales atop a base of reddened skin. These patches can appear anywhere on the body but are most common on extensor surfaces—areas that are opposite a joint, such as the inside of an elbow or the back of a knee. The rash also can show up on the scalp, face, and around or inside of the ears.

Sometimes the plaques widen and blend together into large patches, and although the scales on the surface of skin tend to shed easily, the ones below may stick together. If they're scratched off, they can cause pinpoint bleeding, otherwise known as Auspitz sign. Surrounding skin can be dry, cracked, itchy, or painful.

When plaque psoriasis affects the scalp, it can easily be mistaken for dandruff (seborrheic dermatitis). To distinguish between the two, note that while seborrheic dermatitis appears oily, scalp psoriasis has a dry, silvery sheen. Psoriasis on the scalp may be mild, with small patches on the back of the head and neck, or generalized, affecting the whole head.

Psoriasis also can show up on the face. The most common areas are the eyebrows, the skin above the upper lip, and the top of the forehead and hairline. Very rarely, psoriasis can appear inside the nose or the mouth, on the gums, tongue, and insides of the cheek or lips. Lesions in these areas are usually white or grey and can interfere with chewing and swallowing.

Psoriasis in and around the ear can be problematic because the plaques can slough off and accumulate inside the ear canal. Psoriasis in the ear can cause symptoms ranging from pain and itching to ear wax blockage and even hearing loss.

Nail Psoriasis 

About 55 percent of people with skin psoriasis also have nail psoriasis, while 5 percent of people who have nail psoriasis do not have skin psoriasis, according to the National Psoriasis Foundation (NPF). It makes sense, then, to discuss the symptoms of nail psoriasis separately.

  • Pitting: The most common characteristic of psoriasis of the nails is pitting—small dents or pits on the surface of fingernails or toenails that are most easily seen when the light is shining directly on the nail.
  • Distal onycholysis: This complicated term refers to a lifting of the nail away from the skin that can occur when psoriasis develops underneath the nail. It can be painful and cause nails to easily catch on clothing.
  • Oil drop spots: These look like small orange splotches under the nail.

When at its worst, nail psoriasis causes the whole nail to become thick, discolored, and crumbly. This can be very distressing, leading to pain with daily activities, embarrassment, and even difficulty walking. 

Guttate Psoriasis

This is a rash made up of small, pale pink bumps shaped like teardrops (the Latin word for drop is gutta). It appears suddenly on the torso, arms, and legs, usually following a viral or bacterial infection such as strep throat, chickenpox, or the common cold. It also can be triggered by a skin injury, stress, or certain medications, such as drugs for malaria or high blood pressure. 

Inverse Psoriasis 

Also known as intertriginous psoriasis, the rash from this relatively rare type of psoriasis is found in skin folds, such as behind the ears, in the armpits, under the breasts, in the groin, and in the crease between the buttocks. Because these areas tend to be moist, patches of inverse psoriasis are smooth, deep red, and glistening rather than scaly. It's most common in people who are overweight and sometimes is confused with a yeast infection called intertrigo

Pustular Psoriasis 

As the name suggests, this type of psoriasis is characterized by a rash made up of pus-filled lesions rather than plaques. The pus consists of white blood cells and lymph fluid and isn't contagious.

There are several subtypes of pustular psoriasis. In the focal form of the condition, the rash appears only on small areas of the body, such as the palms of the hands, soles of the feet, or the fingers or toes.

However, pustular psoriasis also can cover large areas of the body, as in Von Zombusch psoriasis, a generalized form of the disease that usually begins with the sudden development of tender, painful, reddened skin all over the body. 

After a few hours, the white pustules appear, usually in flexural areas (the backs of the knees, the insides of the elbows, the armpits, and the groin). They'll continue to spread and ultimately join to form lakes of pus that rupture easily and can become infected. Within 24 to 48 hours, the pustules dry up, leaving skin looking smooth and glazed.

Other symptoms associated with Von Zomzusch psoriasis include fever and chills, severe itching, dehydration, rapid pulse, exhaustion, anemia, weight loss, and muscle weakness. The condition must be treated immediately as it can be fatal if it spreads to the bloodstream. 

Erythrodermic Psoriasis

The symptoms of this rare type of psoriasis include severe redness and shedding of skin from all over the body, often in large sheets rather than smaller scales. The skin may look as if it's been burned. 

Besides skin symptoms, a person having a flare of erythrodermic psoriasis also may have severe itching and pain, an increase in heart rate, fluctuations in body temperature, and loss of protein and fluid that can lead to severe illness.

Erythrodermic psoriasis can be very dangerous; some people become so sick they require hospitalization or develop serious complications such as pneumonia or heart failure.

Complications

In addition to the aforementioned concerns related to specific types of this condition, psoriasis in general is associated with a few other complications.

Eye Problems 

These may be directly related to psoriasis flare-ups around the eyes. For example, scales and dryness may cause the edges of the eyelids to curve up or down, which may produce drying of the cornea (the clear layer on the front of the eye) or allow the eyelashes to actually scrape the cornea.

Psoriasis is also associated with uveitis and iritis. Uveitis is inflammation of the uvea, the middle layer of the eye's surface. The uvea includes the iris, which makes up the colored area at the front of the eye. When uveitis is localized at the front of the eye, it's called iritis (or anterior uveitis).

Symptoms of uveitis include:

  • Redness of the eye (conjunctivitis)
  • Sensitivity to light
  • Blurred vision
  • Floaters (small spots or squiggly lines in a person's field of vision)
  • Pain in the eye

Early detection and treatment are vital to preventing complications related to psoriatic eye disease. Untreated uveitis can cause irreversible damage to the delicate eye tissue. People who have uveitis associated with psoriasis are more likely to have recurrent problems with uveitis than those who do not have psoriasis or other autoimmune disorders.

Psoriatic Arthritis

With psoriatic arthritis, the characteristic skin rash is accompanied by inflammation of the joints. In addition, psoriatic arthritis can cause fingers to take on a sausage-like shape, changes in nails, and conjunctivitis (inflammation of the conjunctiva, the clear part of the eye, that causes the white of the eye to appear pink or red). Psoriatic arthritis has been linked to cardiovascular issues, including heart attacks, and also can affect eye health.

When to See a Doctor

If you suspect you have psoriasis—you've noticed any of the above symptoms and they have persisted and, perhaps, worsened—see your doctor for an examination.

In particular, talk to your doctor if your skin concerns:

  • Progress beyond the nuisance stage, causing you discomfort and pain
  • Make doing routine activities difficult
  • Cause you worry or embarrassment about your appearance
  • Lead to joint problems, such as pain or swelling
View Article Sources