Auspitz Sign in Psoriasis: What Does Pinpoint Bleeding After Scratching Mean? | MyPsoriasisTeam

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Auspitz Sign in Psoriasis: What Does Pinpoint Bleeding After Scratching Mean?

Medically reviewed by Kevin Berman, M.D., Ph.D.
Written by Emily Brown
Posted on March 12, 2024

Have you noticed tiny spots of blood after scratching a patch of skin and wonder what this means? What looks like pinpricks of blood after scratching a psoriasis plaque may indicate the Auspitz sign. The Auspitz sign is often used in the diagnosis of plaque psoriasis, although it doesn’t show up in everyone with psoriasis and may be a sign of other conditions.

Scratching, picking, or scraping off psoriasis scales or lesions can cause the Auspitz sign to occur. Bleeding is usually minimal, but it’s important to try not to scratch lesions and damage your skin.

Learn more about the symptoms of the Auspitz sign, what causes it, and how it can be treated to promote skin healing and prevent it from happening in the future.

Pinpoint Bleeding Indicates the Auspitz Sign

The Auspitz sign, named after Heinrich Auspitz, a 19th-century Austrian dermatologist, is a dermatological sign of psoriasis. It’s characterized by pinpoint bleeding (tiny dots) in areas where silvery psoriasis scales were scratched, scraped, or picked off.

The Auspitz sign is the name for tiny, pinpoint-size areas of bleeding that may appear after scratching off or removing psoriasis plaques. (CC BY-SA 4.0/Bose S. et al.)


The scaly patches of skin prone to pinpoint bleeding when prematurely removed are associated with plaque psoriasis, the most common type of psoriasis. Rupioid psoriasis, a rare type of plaque psoriasis, also involves scaly patches that could be tested for the Auspitz sign.

Rupioid psoriasis is a rare type of psoriasis that may show the Auspitz sign if scales are removed. (Dr. Ian McColl)

Not Everyone With Psoriasis Has the Auspitz Sign

The Auspitz sign is a common symptom of psoriasis, but not everyone with psoriasis will have it. For example, a 1990 study found that the Auspitz sign was present in only 41 of 234 people with psoriasis (about 17 percent). The Auspitz sign isn’t a guaranteed symptom of psoriasis, so it’s not usually needed for diagnosis.

More research is needed to better understand how common (or uncommon) the Auspitz sign is in people with psoriasis and whether it’s present only in plaque psoriasis or other types of psoriasis too.

The Auspitz Sign Results From Skin Damage

The characteristic bleeding of the Auspitz sign is caused by broken capillaries (tiny blood vessels) in the skin underneath psoriatic scales. Psoriasis is an autoimmune disease in which an overactive immune system causes abnormal skin cell growth. Skin cells grow and pile up faster than they can be shed, and this leads to hard, thick, scaly plaques of skin.

When psoriasis scales are scraped or scratched off, the skin and capillaries underneath are more prone to damage. If the capillaries break, tiny dots of blood appear on the surface of the skin. Because the capillaries are so tiny, bleeding is usually minor and resembles a bunch of pinpricks.

Scratching and Picking Can Lead to the Auspitz Sign

The Auspitz sign is prompted by some sort of damage that causes the skin to break, such as scratching itchy psoriasis plaques. “Honestly, I was ripping my skin off, it was so itchy,” one MyPsoriasisTeam member wrote.

“My feet itch so very bad … they bleed,” another member said.

Bleeding may also occur if a scale is scraped off by other means, such as by scrubbing or picking at it. Be sure to talk to your doctor about removing psoriasis scales so they can advise you on how to do it safely.

The Auspitz Sign Is Useful but Sometimes Unreliable for Diagnosis

Your doctor or dermatologist might use the Auspitz sign to help diagnose psoriasis. They may conduct a Grattage test, gently scraping off superficial scales of psoriasis plaques to see if pinpoint bleeding occurs. If it does, they would label it as a positive Auspitz sign.

Although the Auspitz sign is associated with psoriasis, it can also occur with other skin conditions, including actinic keratosis and Darier’s disease. Also, because the Auspitz sign isn’t always present in people with psoriasis, a negative Auspitz sign (its absence) doesn’t necessarily rule out psoriasis. On its own, the Auspitz sign isn’t always a reliable diagnostic tool for psoriasis. A clinical exam and skin biopsy (removing a bit of skin tissue to be examined in a lab) are more useful for an accurate diagnosis.

Given the uncertainty around the prevalence of the Auspitz sign in people with psoriasis, more research is needed to better understand its usefulness in diagnosing psoriasis. Talk to your doctor if you have any questions about the Auspitz sign or think you have it as part of your psoriasis.

Treating the Auspitz Sign Focuses on Healing the Skin

Treatment for the Auspitz sign focuses on preventing infections and healing the affected skin. When bleeding occurs after you scratch, pick, or scrape a scale, it’s important to clean that area of skin to help prevent infections.

In addition, to help the skin heal, your doctor or dermatologist may prescribe a topical treatment like an antibiotic ointment or unmedicated emollient. They might also suggest other treatment options to target plaque psoriasis, such as biologics, oral treatments, or phototherapy to help prevent itchiness and scratching.

Managing Itchiness and Scratching To Prevent the Auspitz Sign

Itchiness is a common and frustrating symptom of psoriasis that can greatly affect your quality of life, especially if you have chronic plaque psoriasis. Treating plaque psoriasis directly can help reduce itchiness and other symptoms. It can also minimize the chances of scratching off scales and damaging the skin.

In addition, you can take steps to manage itchiness at home, such as during a flare-up, to help you resist the urge to scratch or peel off itchy scales that could cause the Auspitz sign.

The American Academy of Dermatology shares recommendations to reduce itchiness:

  • Moisturize your skin immediately after showering, bathing, or washing your hands, when your skin is warm and moist.
  • Apply a thick moisturizer when your skin itches (and don’t scratch).
  • Take shorter showers and baths, using warm (not hot) water to avoid drying out your skin.
  • Try an over-the-counter anti-itch cream containing menthol or pramoxine.
  • Place a cold compress or damp, cool washcloth on itchy areas.

Ask your doctor about other treatments and home remedies for itchy plaques so they can help you manage persistent itchiness and prevent bleeding.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you been told you have the Auspitz sign? What do you do to manage itchiness and keep plaques from bleeding? Share your experience in the comments below, or start a conversation by posting on your Activities page.

    Posted on March 12, 2024
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    Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
    Emily Brown is a freelance writer and editor, specializing in health communication and public health. Learn more about her here.

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