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Have you noticed tiny spots of blood after scratching or picking at a psoriasis plaque? This pinpoint bleeding is called the Auspitz sign. The bleeding is usually minor and may be a sign of plaque psoriasis.
However, the Auspitz sign isn’t unique to psoriasis. It can also appear with some other skin conditions, including actinic keratosis and Darier’s disease.
Here, we’ll explain what this sign means in psoriasis and what you can do to help your skin heal and prevent more bleeding.
The Auspitz sign happens because the skin beneath a psoriasis plaque contains tiny blood vessels called capillaries. When the silvery scales covering the plaque are scratched or removed, these delicate vessels can break and bleed. This leaves pinprick-size spots of blood known as the Auspitz sign.
The Auspitz sign refers to tiny spots of bleeding that may appear after psoriasis scales are scratched or removed. (CC BY-SA 4.0/Bose S. et al.)
This sign is most often associated with plaque psoriasis, the most common type of psoriasis, which affects about 80 percent to 90 percent of people with psoriasis. The Auspitz sign may also occur with rupioid psoriasis, a rare form of plaque psoriasis that causes thick, crusty scales. Removing the scales from either type may reveal pinpoint bleeding underneath.
Rupioid psoriasis causes thick, crusty plaques that may bleed if the scales are removed. (Dr. Ian McColl)
You can have psoriasis even if you’ve never noticed these tiny spots of blood. In one study of 234 people with psoriasis, only 41 — about 18 percent — had pinpoint bleeding when scales were removed.
More research is needed to understand how common it is across different types of psoriasis.
In psoriasis, the immune system causes skin cells called keratinocytes to multiply too quickly. Instead of shedding normally, skin cells build up and form thick, scaly plaques or papules (smaller bumps). At the same time, tiny blood vessels grow close to the skin’s surface beneath these scales.
Scratching or picking off the scales can break these delicate capillaries. The blood that reaches the skin’s surface creates the small dots associated with the Auspitz sign.
Psoriasis can be intensely itchy, making it difficult to leave plaques alone, as one MyPsoriasisTeam member shared: “It itches, I scratch. It burns. It hurts. But now it’s beginning to bleed and leave tiny dots in its wake.”
Picking or scrubbing psoriasis lesions can cause injury and bleeding. Rather than trying to remove scales yourself, talk with your dermatologist about ways to manage scaling and itching without damaging your skin.
Scratching can do more than make psoriasis bleed. Skin injuries sometimes trigger new psoriasis patches in the affected areas. This reaction is called the Koebner phenomenon.
Avoiding repeated scratching, picking, and rubbing can help prevent further damage to already-sensitive skin.
Because the Auspitz sign isn’t enough to confirm or rule out psoriasis, doctors don’t rely on it alone to make a diagnosis.
Diagnosing psoriasis usually involves examining your skin, scalp, and nails. A dermatologist or other doctor may look at the appearance and location of psoriasis plaques and ask about your symptoms. They might also ask about risk factors such as a family history of psoriasis, as well as nail changes and any joint problems.
If the diagnosis is unclear, a skin biopsy (a small skin sample examined under a microscope) may help distinguish psoriasis from another skin condition, such as eczema.
If scratching or picking a psoriasis plaque causes pain or bleeding, gently clean the area with mild soap and water. Apply a thin layer of plain petroleum jelly and cover it with a clean bandage. This keeps the injured skin moist and protected while it heals.
Antibiotic ointments usually aren’t needed for minor skin injuries unless your doctor recommends one. Contact your healthcare provider if you notice worsening discoloration, warmth, swelling, pain, or pus, which may be signs of infection.
Itching can be one of the most frustrating symptoms of chronic plaque psoriasis and may affect your quality of life. Scratching may bring temporary relief, but it can damage lesions, remove scales, and cause bleeding.
One MyPsoriasisTeam member shared, “My doctor told me about the Auspitz sign and asked me to stop scratching the scales, no matter how itchy or painful it gets. I feel you all.”
The American Academy of Dermatology recommends several ways to soothe itchy psoriasis:
For people with itchy or bleeding plaques, the goal is to control the psoriasis, calm the itch, and protect the skin from further damage. Treatment may include topical medications applied directly to the skin, along with moisturizers and other at-home measures.
People with severe psoriasis may need additional treatment, such as phototherapy (light therapy), oral medications, or injectable biologics prescribed by a dermatologist.
It can also help to notice what triggers your flare-ups and find ways to resist scratching or picking at itchy plaques. Your dermatologist can help you build a treatment plan that combines medication, skin care, and changes to your daily routine.
If your psoriasis plaques keep itching, breaking open, or bleeding, let your dermatologist know. Frequent bleeding may mean your symptoms aren’t well controlled and that your current skin care or treatment plan needs adjusting.
Also mention any new symptoms, such as nail changes or joint pain, swelling, or stiffness. Psoriasis can affect more than the skin, and joint symptoms may be a sign of psoriatic arthritis.
Tracking when your symptoms worsen can also be helpful. Note where new lesions appear and how often itching or bleeding occurs. This information can help your dermatologist understand your flare-ups and decide whether changes to your treatment or daily skin care may help.
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Oh boy, this question about ,Is it OKAY to take a shape object, like a fingernail, & RIP OFF this Ugly, itchy, unsightly growth on my : example= knee, scalp, side hips, buttocks, ears, inside & out… read more
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