Psoriasis is a chronic skin disease that affects more than 8 million people in the U.S. Caused by an overactive immune system, skin cells grow more quickly than they are shed, leading to flares of scaly skin that builds up in patches around the body.
While a health care provider like a dermatologist can diagnose you with psoriasis based on a skin exam and medical history, research indicates that there is often a delay in diagnosis—sometimes over the span of years, leading to late treatment and lower quality of life. We asked experts about things we might notice if we have psoriasis; here’s what they said.
Credit: Getty Images. EatingWell Design1. You Have Patches in Hidden or Sensitive Areas
Common psoriasis symptoms include raised, red patches of skin with silvery-white scales, often appearing on areas like the elbows and knees. “In those cases, both patients and clinicians may quickly suspect psoriasis,” says dermatologist Sejal Shah, M.D. But symptoms can be subtle or misdiagnosed as eczema, a fungal infection, dandruff or contact dermatitis, she explains.
However, patches can also be present in oft-missed areas, such as the scalp (which can look like dandruff), behind the ears, nails, genitals, hands, feet and skin folds like armpits, under the breasts and the groin, says Shah.
“Because these areas may not have the classic scaling or may be sensitive or private, patients and even clinicians sometimes miss them,” she explains. Given dermatologists are accustomed to seeing skin on every part of the body, don’t be shy (or ashamed) about pointing out areas of concern on your body.
2. Your Nails Have Changed
Psoriasis can affect the nails in up to half of people with the skin disease. “Psoriatic nails typically present with small indentations we call ‘nail pitting,’ along with ‘oil spots,’ which are clear yellowish discolorations that look like a drop of oil sitting under the nail,” says dermatologist Joel Spitz, M.D. He also notes that the nail plate can thicken. Interestingly enough, nail psoriasis and nail fungus can look similar. For some folks, nail psoriasis occurs without the tell-tale skin symptoms, making diagnosis even trickier.
3. You Have Plaques, But They’re Not Red
Redness is a common feature of psoriasis skin plaques—if you have lighter skin tones. “As with many dermatologic conditions, psoriasis can look quite different depending on a patient’s skin tone,” says Spitz. For example, if you have a darker complexion, “plaques tend to appear as darker, pigmented raised lesions with overlaying scale, often without the obvious redness seen in lighter skin,” he says. This can add to the challenge of diagnosis.
4. You Have Skin Pain & Discomfort
Psoriasis isn’t just something you see—you can feel it, too. “Psoriasis is often thought of as a cosmetic skin condition, but many patients experience burning, stinging, pain, severe itching, cracking or bleeding skin,” says Shah. This can be a detriment to your health and overall well-being in a variety of ways, including by affecting your sleep, mood and daily functioning, she says.
Unfortunately, research suggests that pain associated with psoriasis is often underrecognized and inadequately managed. “Many treatment plans still focus more on visible skin clearance than on symptom burden like pain or sleep disruption,” adds Shah.
Tips for Managing Psoriasis
Psoriasis is treated in a variety of ways, and often a well-rounded treatment plan has both medical and lifestyle components:
- Follow your dermatologist’s recommendations on topicals. There are a variety of topical medications that your derm might suggest based on your symptoms and their severity. Options that may be considered include corticosteroids, synthetic vitamin D or a calcineurin inhibitor.
- Consider systemic medications. Some people with psoriasis benefit from powerful systemic medications (meaning one that travels throughout the bloodstream to treat the whole body) called biologics. “[These] have allowed many patients to achieve and maintain completely clear skin as long as they stay on therapy,” says Spitz.
- Focus on stress. “Stress management is important because emotional stress is one of the biggest triggers and can worsen inflammation and immune responses, leading to flare-ups,” says Shah. This, in turn, can worsen emotional stress from the condition.
- Practice good skin care. Avoid harsh soaps and over-scrubbing, and make sure to moisturize skin regularly and well with a thick emollient, says Shah.
- Maintain a healthy diet. What you eat matters for your skin and overall health, and some people may notice that their skin flares are associated with foods like ultra-processed foods, excess sugar, red meat, dairy or gluten, says Shah. “Anti-inflammatory diets rich in fruits, vegetables and omega-3s may be helpful,” she says. This eating pattern can also help you maintain a healthy weight for your body and reduce inflammation.
Our Expert Take
Psoriasis signs and symptoms can take many forms, including plaques that appear in less obvious or sensitive areas of the body, changes to the nails and other varied characteristics depending on your skin tone. In addition, psoriasis symptoms can also involve itch, pain and sleep disruption. For diagnosis and to develop a treatment plan, see a board-certified dermatologist. Lifestyle management, including a healthy diet and stress reduction, can help reduce flares and improve quality of life.
https://www.eatingwell.com/sneaky-signs-you-might-have-psoriasis-11970790
