Psoriasis is a skin disease, often marked by red scaly patches. There are several different types of psoriasis. In most cases, people have one type at a time. Sometimes symptoms go away. Then, another type of psoriasis crops up in response to a trigger. Here is a brief overview of the main types of psoriasis.
Plaque Psoriasis
Plaque psoriasis is the most common type of psoriasis. About eight in 10 people with psoriasis have this type. It is also sometimes known as psoriasis vulgaris.
Plaque psoriasis causes raised, inflamed, red skin covered by silvery white scales. These may also itch or burn. Plaque psoriasis can appear anywhere on your body but often appears in these areas:
- Elbows
- Knees
- Scalp
- Lower back
Rather than coming and going, plaque psoriasis may last for years.
Guttate Psoriasis
Guttate psoriasis often starts suddenly in childhood or young adulthood. It occurs is less than 2% of cases. This type causes small, pink-red spots on the skin. Usually less thick than plaque lesions, they often appear in these areas:
- Trunk
- Upper arms
- Thighs
- Scalp
These things may trigger guttate psoriasis:
- An upper respiratory infection such as strep throat or tonsillitis
- Stress
- Skin injury
- Certain drugs such as beta-blockers
This type of psoriasis may go away within a few weeks, even without treatment. However, some cases are more stubborn and require treatment.
Inverse Psoriasis
Inverse psoriasis appears as bright-red, smooth, shiny lesions. These don't have scales. Inverse psoriasis usually appears in these areas:
- In the armpits
- In the groin
- Under the breasts
- In skin folds around the genitals or buttocks
Because of its location, inverse psoriasis may worsen from sweating and rubbing. For this reason, it can be hard on overweight people or those with deep skin folds. An overgrowth of yeast may trigger this type of psoriasis.
Pustular Psoriasis
Pustular psoriasis is uncommon and mostly appears in adults. Pustular psoriasis causes pus-filled bumps (pustules) surrounded by red skin. These may look infectious, but they are not. Reddening can appear first, followed by scaling and the formation of the pus-filled bumps.
This type of psoriasis may show up in one area of the body such as the hands and feet. Or it may cover most of the body (generalized). Pustular psoriasis can be very serious, so immediate medical attention is needed. Generalized pustular psoriasis can cause:
- Fever
- Chills
- Nausea
- Fast heart rate
- Muscle weakness
These things may trigger pustular psoriasis:
- Topical or systemic medications, especially steroids
- Sudden withdrawal of systemic medications or strong topical steroids used over a large area of the body
- Overexposure to ultraviolet (UV) light without sunscreen
- Pregnancy
- Infection
- Stress
- Exposure to certain chemicals
Erythrodermic Psoriasis
This type of psoriasis is the least common, but it’s very serious. Eyrthrodermic psoriasis affects most of the body and causes widespread, fiery skin redness that may appear burned. In addition, you may have:
- Severe itching, burning, or peeling
- An increase in heart rate
- Changing body temperature
If you have these symptoms, see the doctor right away. You may need to be hospitalized. This type of psoriasis can cause severe illness from protein and fluid loss. You may also develop an infection, pneumonia, or congestive heart failure.
These things may trigger erythrodermic psoriasis:
- Sudden withdrawal from a systemic psoriasis treatment
- An allergic drug reaction
- Severe sunburn
- Infection
- Medications such as lithium, anti-malarial drugs, cortisone, or strong coal tar products
Erythrodermic psoriasis may also occur if you have a long period where it is hard to control your psoriasis.
Nail Psoriasis
Up to half those with psoriasis have nail changes. This is even more common in those who have a type of psoriasis that affects the joints (psoriatic arthritis).
These are common symptoms of nail psoriasis:
- Pitting -- small pits on the surface of the nails
- Tender painful nails
- Separation of the nail from the bed
- Change of color (yellow-brown)
- Chalk-like debris buildups under the nail
With nail psoriasis, you are more likely to also have a fungal infection.
Nails are a more difficult area to treat because the medication doesn't easily penetrate the nail bed. As a result, topical medication doesn’t work well. Steroids can be injected into the nail, light therapy may be needed, or internal medicine may be required. It helps to keep nails trimmed as short as possible.
Psoriatic Arthritis
This is a condition where you have both psoriasis and arthritis (joint inflammation). In 70% of cases, people have psoriasis for about 10 years before developing psoriatic arthritis. About 90% of people with psoriatic arthritis will also have nail changes related to psoriasis.
The most common joint symptoms of psoriatic arthritis are:
- Painful and stiff joints that are worse in the morning and after rest
- Sausage like swelling of the fingers and toes
- Warm joints that may be discolored
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