Psoriasis is an inflammatory skin condition caused by an overactive immune system. There are five main types of skin psoriasis, plus psoriatic arthritis — which affects the joints. Health care providers identify psoriasis types by their symptoms. It is possible to have multiple types of skin psoriasis at one time, or one type of psoriasis may change into another type. Psoriatic arthritis can also develop alone or with skin psoriasis.
Different types of psoriasis can form on any area of the body. The location of psoriasis determines the kinds of treatments your dermatologist will prescribe.
Facial psoriasis is common, affecting around 50 percent of people with the condition. Facial psoriasis can be found on the upper forehead, around the eyes and eyebrows, and on the skin between the nose and upper lip.
Psoriasis can also occur in and around the ear. In some cases, scaling can build up in the ear canal and lead to hearing loss. If this occurs, do not use objects to remove the scaling and consult your doctor.
Scalp psoriasis affects 45 percent to 56 percent of people living with psoriasis. It commonly forms along the hairline, and on the scalp, forehead, skin around the ears, and back of the neck. Scalp psoriasis can look like dandruff or appear as thick plaques that cover the scalp.
Scalp psoriasis may also be mistaken for seborrheic dermatitis — however, plaques from seborrheic dermatitis are greasy and yellowish, whereas scalp psoriasis is white and more flakey.
Psoriasis can also form on the skin covering the hands and feet — known as palmoplantar psoriasis (PPP). About 12 percent to 16 percent of people living with psoriasis will develop psoriasis on their hands or feet. PPP can have a great impact on quality of life, as expected for a disease affecting hands and feet.
Nail psoriasis is also a common condition, affecting around 50 percent of those with psoriasis. It typically affects the fingernails more than the toenails, and can even be an indicator of psoriatic arthritis.
Genital psoriasis typically develops in people who have psoriasis on other parts of their body. Almost two-thirds of people with psoriasis will have genital psoriasis at some point in their lives. The skin in this area is extremely sensitive, so it is important to find a safe, effective treatment with the help of your dermatologist.
Genital psoriasis can affect several areas around the genitals, including:
There are five main types of psoriasis — plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Each type can be found in various locations on the body and is treated differently.
The most common type of psoriasis — plaque psoriasis — makes up 80 percent of psoriasis cases. Also called psoriasis vulgaris, plaque psoriasis typically affects the elbows, knees, back, torso, and scalp, but may appear elsewhere. The condition is characterized by thick patches (plaques) of skin that can crack or bleed where the skin bends at joints.
On lighter skin, plaques are often covered with silver or white scales caused by the buildup of dead skin cells. On darker skin, plaques may be thicker with gray, purple, or brown coloring. Plaques can become inflamed, causing intense itching, burning, and soreness.
Topical therapies like creams, ointments, and moisturizers are commonly used to treat plaque psoriasis. These contain anti-inflammatory active ingredients, such as:
Topicals are usually the starting point of treatment. In more severe cases that are spread over large areas of the body, oral or injected immunomodulating drugs (known as biologics) may be necessary to control plaque psoriasis.
Read more about plaque psoriasis.
In guttate psoriasis, patches of rash are small and scaly and have a round, oval, or teardrop shape. Lesions may look red or pink on people with pale skin and darkened on people with darker skin. Guttate psoriasis can affect any part of the body except the palms of the hands and soles of the feet, but it is commonly confined to the arms, legs, chest, and scalp. In some people, guttate psoriasis causes itching.
Guttate psoriasis is most common in childhood, adolescence, and early adulthood. Some people experience recurrent bouts of guttate psoriasis, but others only have one episode that never repeats. Bouts are often triggered by bacterial or viral infections, such as strep throat caused by a streptococcal infection. Unlike infections, guttate psoriasis is not contagious and will not spread to others. Topical steroids and other treatments are usually effective for controlling guttate psoriasis, but it may also respond to phototherapy or systemic medications.
Read more about guttate psoriasis.
Also called flexural or intertriginous psoriasis, inverse psoriasis causes smooth patches of red skin that feel painful. The characteristic silvery, scaly patches of psoriasis are often not seen in this form. Inverse psoriasis is more common in overweight people and usually appears in skin folds where sweat and friction occur — such as the armpits, genitals, and under the breasts. Other causes include infections, taking certain medications, and stress.
Treating inverse psoriasis can be challenging because the areas it appears tend to be extremely sensitive. Medication also absorbs more effectively there, increasing the likelihood of side effects. Some treatments that work for other types of psoriasis tend to irritate inverse psoriasis. It is often misdiagnosed as a fungal infection because it can look like jock itch. Your health care provider may also recommend powders to help keep the moist areas dry.
Read more about inverse psoriasis.
Pustular psoriasis, an uncommon form of the disease, causes intensely red or darkened skin with sterile, pus-filled blisters (pustules). The skin around the blisters may be prone to cracking and peeling. After the blisters form, they merge and burst, leaving crusty skin.
There are two subtypes of pustular psoriasis. Palmoplantar pustulosis (PPP), also called acropustulosis, is limited to the palms of the hands and soles of the feet. Generalized pustular psoriasis (GPP), also referred to as von Zumbusch psoriasis, is widespread. Pustular psoriasis is very painful and can be debilitating. In particular, GPP can be life-threatening, requires urgent medical treatment, and may require hospitalization.
Pustular psoriasis can occur at any age. Flares-ups can come on rapidly and be accompanied by fever and malaise. Pustular psoriasis can be difficult to treat and prone to flares. If topical treatment fails, systemic treatment such as methotrexate or cyclosporine may be required. Psoralen + UVA treatment — which uses ultraviolet light — can also be helpful.
Read more about pustular psoriasis.
Erythrodermic psoriasis, also called exfoliative psoriasis, is the rarest type of psoriasis. This highly inflammatory form can affect the whole body, causing a bright red rash that itches, burns, and peels off in sheets. Skin affected by erythrodermic psoriasis can look similar to a sunburn. Approximately 2 percent of people with psoriasis experience a bout of erythrodermic psoriasis at least once during their lives. Erythrodermic psoriasis may accompany a flare of generalized pustular psoriasis.
Other symptoms include:
Erythrodermic psoriasis can be life-threatening. It requires immediate medical treatment and hospitalization to help your body regulate fluid balance and temperature. Treatment usually involves a combination of systemic immunomodulators, topicals, and oral treatments.
Psoriatic arthritis can cause inflammatory pain, swelling, and progressive damage in any joint in the body. Researchers estimate that about 30 percent of those with skin psoriasis will develop psoriatic arthritis. It is possible to have psoriatic arthritis without skin psoriasis. Typically, psoriatic arthritis develops between the ages of 30 and 50, but it can occur earlier, even in children.
Symptoms of psoriatic arthritis can include:
Treatment of psoriatic arthritis includes pain management as well medications that halt the progression of joint damage.
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