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How to Recognize Different Types of Psoriasis

Learn about the less common symptoms of this chronic inflammatory skin disorder.

How to Recognize Different Types of Psoriasis

The most common form of psoriasis is plaque psoriasis, which causes thickened, red patches of skin that are described as having a silvery, scaled texture. These patches are called plaques, and can appear on any area of the body, though the most common areas are the outsides of the elbows and knees, as well as on the scalp, face, lower back, the palms of the hands, and the soles of the feet.

Although plaque psoriasis accounts for up to 90 percent of psoriasis cases, there are other types, and the type of psoriasis a person has can change over time. It is also possible for a person to have more than one type of psoriasis at the same time (though this is not common).

The symptoms vary depending on the type of psoriasis a person has. Here, we look at the different types of psoriasis and the symptoms they cause.

Guttate psoriasis
This is the second most common type of psoriasis. The lesions caused by guttate psoriasis are described as small, red, and scaly, and are either round or shaped like droplets. The arms, legs, and trunk of the body are the most common areas affected. Guttate psoriasis is most common in children, teens, and young adults, and the onset may be triggered by an illness or infections, such as strep throat or a respiratory infection.

Inverse psoriasis
Inverse psoriasis tends to affect areas of the body where skin folds against skin. The armpits, under the breasts, behind the knees, the buttocks, and the genitals are areas where this type of psoriasis may occur. Friction and sweat aggravate symptoms and irritate lesions, which have a smooth, shiny, bright red appearance. Because the skin in areas affected by inverse psoriasis is thinner and more sensitive than skin in other areas of the body, it can present different challenges to treat. Also, because it affects intimate areas of the body, it can be challenging for patients to bring up during healthcare appointments.

Pustular psoriasis
As the name implies, this rare type of psoriasis causes blister-type lesions, or pustules. These pustules form on inflamed patches of skin. The inflamed skin can appear red or darkened, depending on a person’s skin color. The pustules are filled with white blood cells, can appear white or yellowish, and will peel and crust over. Though it may have the appearance of an infection, pustular psoriasis—just like all other forms of psoriasis—is not contagious in any way. Pustular psoriasis can cause symptoms across the body, but there are also rare subtypes where lesions form on the hands and feet.

Erythrodermic psoriasis
While extremely rare, erythrodermic psoriasis is extremely severe. It only affects an estimated 3 percent of people who have psoriasis, and usually people who have unstable plaque psoriasis. It causes an inflammatory response that affects 75 percent or more of the surface area of the body. During a flare of erythrodermic psoriasis, a person may experience intense pain and itching, redness over large areas of the body, blisters, skin that sheds in sheets, increased heart rate, and fluctuations in body temperature. Fluid loss and protein loss are concerns, as are infection and heart failure. Erythrodermic psoriasis is a medical emergency. It can be triggered by allergic reactions to medications, sudden withdrawal of psoriasis medications, severe stress, alcoholism, infections, and injuries to the skin such as a severe sunburn.

Psoriatic nail disease
While not technically a subtype of psoriasis, it is worth mentioning that the nails on the fingers and toes can also be affected by psoriasis. This is sometimes called psoriatic nail disease, or PND, and occurs alongside skin psoriasis symptoms. When a person has PND, the nails can become thickened, pitted, discolored, fragile, and separate from the nail bed. This can make any type of task performed with the hands painful.

Psoriatic arthritis
It is also worth mentioning psoriatic arthritis, a type of arthritis that affects an estimated 30 percent of people who have psoriasis. Psoriatic arthritis causes inflammation in the joints, which results in pain, swelling, and stiffness, and can lead to permanent joint damage. Any joint pain should be discussed with a healthcare provider.

Medically reviewed in December, 2019.

Sources:
National Psoriasis Foundation. "Plaque Psoriasis."
UpToDate. "Patient education: Psoriasis (Beyond the Basics)."
PlaquePsoriasis.com. "What Are the Different Types of Psoriasis?"
Catherine H. Smith and J. N. W. N. Barker. "Psoriasis and its management." BMJ, 2006.
National Psoriasis Foundation. "About Psoriasis."
National Psoriasis Foundation. "Guttate Psoriasis."
MedicalNewsToday. "Inverse psoriasis: What you need to know."
National Psoriasis Foundation. "Genital Psoriasis."
Kristen M. Beck, Eric J. Yang, Isabelle M. Sanchez, and Wilson Liao. "Treatment of Genital Psoriasis: A Systematic Review." Dermatology and Therapy, Aug. 2018. Vol. 8, No. 4.
MedicalNewsToday. "Pustular psoriasis: What you need to know."
National Psoriasis Foundation. "Erythrodermic Psoriasis."
Rasnik K. Singh, Kristina M Lee, et al. "Erythrodermic psoriasis: pathophysiology and current treatment perspectives." Psoriasis: Targets and Therapy, 2016. Vol. 6.
UpToDate. "Erythrodermic psoriasis in adults."
Alka Dogra and Amanjot Kaur Arora. "Nail Psoriasis: The Journey So Far." Indian Journal of Dermatology, Jul-Aug 2014. Vol. 59, No. 4.
UpToDate. "Patient education: Psoriatic arthritis (Beyond the Basics)."
National Psoriasis Foundation. "About Psoriatic Arthritis."

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