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Types of Psoriasis

What is psoriasis?

Psoriasis is a chronic skin disorder. It’s considered an autoimmune disease. This means your immune system harms your body instead of protecting it. More than 6.7 million people in the United States have this condition.

Psoriasis causes your skin to develop scaly patches that are sometimes silvery or red and can be itchy and painful. The patches can come and go over the course of a few days to over a month.

There are different types of psoriasis and it’s possible to have more than one type. Read on to learn more about these different types and how they are treated.

What does psoriasis look like?

What are the symptoms of psoriasis?

The most common symptoms of psoriasis include:

  • red patches of skin
  • scaly, sometimes silvery, skin patches
  • itchy skin
  • joint swelling, stiffness, or pain

The symptoms of psoriasis also vary based on the type. There are five official types of psoriasis:

  • plaque
  • guttate
  • inverse
  • pustular
  • erythrodermic
  • psoriatic arthritis

Psoriasis can also cause symptoms of mental stress, anxiety, and low self-esteem. Depression is also common with people who have psoriasis.

There are also subcategories of psoriasis types. These appear differently depending on the location of the body. Psoriasis is not contagious regardless of type.

Find out how psoriatic arthritis affects the body »

Plaque psoriasis

Plaque psoriasis, or psoriasis vulgaris, is the most common form of psoriasis. An estimated 85 percent of people with psoriasis have plaque psoriasis. It’s characterized by thick red patches of skin, often with a silver or white scaly layer. These patches often appear on the:

  • elbows
  • knees
  • lower back
  • scalp

Patches are usually 1 to 10 centimeters wide, but can also be larger and cover more of the body. If a person scratches at the scales, the symptoms will often get worse.

Treatments

Your doctor will first recommend applying moisturizers to keep the skin from becoming too dry or irritated. These moisturizers include an over-the-counter (OTC) cortisone cream or an ointment-based moisturizer. Your doctor may also work to identify your unique psoriasis triggers, including stress or lack of sleep.

Other treatments may include:

  • vitamin D creams, such as calcipotriene (Dovonex) and calcitrol (Rocaltrol) to reduce the rate that skin cells grow
  • topical retinoids, to help reduce inflammation
  • medication like tazarotene (Tazorac, Avage)
  • applications of coal tar, either by cream, oil, or shampoo

In some cases, you may need light therapy. This involves exposing the skin to both UVA and UVB rays. Sometimes treatments combine prescription oral medications, light therapies, and prescription ointments to reduce inflammation.

Guttate psoriasis

Guttate psoriasis appears in small red spots on the skin. It’s the second most common type, affecting 10 percent of people with psoriasis. Most of the time it starts during childhood or young adulthood.

The spots are small, separate, and drop-shaped. They often appear on the torso and limbs, but they can also appear on your face and scalp. Spots are usually not as thick as plaque psoriasis, but they can develop into plaque psoriasis over time.

Guttate psoriasis happens after certain triggers. These triggers can be strep throat, stress, a skin injury, an infection, or medication.

Treatments

Treating the underlying cause of a person’s infection can help to clear guttate psoriasis. If a bacterial infection caused the condition, antibiotics may help. Your doctor may also prescribe regular psoriasis prescription steroid creams, light therapy, and oral medications.

Flexural or inverse psoriasis

Flexural or inverse psoriasis often appears in skinfolds, such as under the breasts or in the armpits or groin area. This type of psoriasis is red, and often shiny and smooth.

The sweat and moisture from skinfolds keeps this form of psoriasis from shedding skin scales. Sometimes it’s misdiagnosed as a fungal or bacterial infection. The skin-on-skin contact can make inverse psoriasis very uncomfortable.

Most people with inverse psoriasis also have a different form of psoriasis in other places on the body.

Treatments

The treatments for inverse psoriasis are like plaque psoriasis treatments. This can be topical steroid creams, light therapy, and oral medications. Your doctor may prescribe a lower potency steroid cream to avoid your skin from thinning too much. You may also benefit from taking or applying medications that reduce yeast or bacteria growth.

Pustular psoriasis

Pustular psoriasis is a severe form of psoriasis. It develops fast in the form of many white pustules surrounded by red skin.

Pustular psoriasis may affect isolated areas of the body, like the hands and feet, or cover most of the skin’s surface. These pustules can also join together and scaling occurs.

Some people experience cyclic periods of pustules and remission. While the pus is noninfectious, this condition can cause flu-like symptoms such as:

  • fever
  • chills
  • rapid pulse
  • muscle weakness
  • loss of appetite

There are three kinds of pustular psoriasis

  • von Zumbusch
  • palmoplantar pustulosis (PPP)
  • acropustulosis

Each of the three forms of pustular psoriasis can have different symptoms and severity.

Treatments

Treatment for pustular psoriasis depends on the size of the affected area. Smaller patches are often treated with corticosteroid creams, either OTC or prescription. Larger patches may need treatment with oral medications and light therapy. Identifying and treating the underlying cause may also help reduce reoccurrence of pustular psoriasis.

Psoriatic arthritis

Psoriatic arthritis (PsA) is a painful and physically limiting condition that affects up to one-third of those with psoriasis. There are five types of PsA with varying symptoms. There is also no cure for this type of psoriasis.

Because psoriasis is an autoimmune disease, it can trigger the body to attack the joints and the skin. It can affect many joints and often becomes quite severe in the hands. Skin symptoms usually appear before joint symptoms.

Read more: What do you want to know about PsA? »

Treatments

Treatments for psoriatic arthritis can include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen sodium (Aleve). NSAIDs can help reduce the incidences of swelling and pain associated with psoriatic arthritis.

Prescription medications, such as prednisone, an oral corticosteroid, may also help to reduce inflammation that leads to psoriatic arthritis. Prescription topical medications used to treat psoriatic arthritis include salicylic acid, calciopotriene, and tazarotene. Light therapy may also help reduce symptoms.

A unique category of medications known as disease-modifying antirheumatic drugs (DMARDs) can help reduce inflammation and joint damage. A subcategory of DMARDs called biologics may also be prescribed to reduce inflammation at a cellular level.

Erythrodermic psoriasis

Erythrodermic psoriasis, or exfoliative psoriasis, is a rare psoriasis type that looks like severe burns. The condition is serious, and can be a medical emergency. You may need hospitalization because your body may not be able to control body temperature.

This form of psoriasis is widespread, red, and scaly. It may cover large portions of the body. Exfoliation often occurs in larger pieces than the small scales typical to most psoriasis.

Erythrodermic psoriasis can develop from:

  • pustular psoriasis
  • widespread, poorly controlled plaque psoriasis
  • a bad sunburn
  • infection
  • alcoholism
  • significant stress
  • abrupt discontinuation of a systemic psoriasis medicine

Treatments

A person with this condition often needs hospital attention. At the hospital, you’ll receive a combination of therapies. This can include an application of medicated wet dressings, topical steroid applications, and prescription oral medications until symptoms have improved.

Make an appointment with your doctor if you think you have erythrodermic psoriasis.

Nail psoriasis

Although not an official type of psoriasis, nail psoriasis is a manifestation of psoriasis. The condition can often be confused with fungal infections and other infections of the nail.

Nail psoriasis can cause:

  • nail pitting
  • grooves
  • discoloration
  • loosening or crumbling of the nail
  • thickened skin under the nail
  • colored patches or spots under the nail

Sometimes the nail can even crumble and fall off. There is no cure for psoriatic nails, but some treatments may improve the health and appearance of nails.

Treatments

Treatments for nail psoriasis are like the ones used for plaque psoriasis. It may take time to see the effects of these treatments as nails grow very slowly. Treatment options include:

  • phototherapy
  • oral medications, such as methotrexate
  • biologics, which are available via injection or intravenous infusion

Scalp psoriasis

Scalp psoriasis is common in people with plaque psoriasis. For some people, it may cause severe dandruff. For others, it can be painful, itchy, and very noticeable at the hairline. Scalp psoriasis can extend to the neck, face, and ears in one large patch or many smaller patches.

In some cases, scalp psoriasis can complicate regular hair hygiene. Excessive scratching can cause hair loss and scalp infections. The condition may also cause feelings of social stress.

Treatments

Topical treatments are most commonly used for scalp psoriasis. They may require an initial two months of intensive applications, plus permanent, regular maintenance. Treatment options include:

  • medicated shampoos
  • steroid-containing lotions
  • tar preparations
  • topical application of vitamin D, known as calciopotriene (Dovonex)

Light therapy and oral medications also may be recommended depending upon the responsiveness to treatment.

Self-care for psoriasis

Although there is no one cure for any form of psoriasis, remission and significant healing is possible. Your doctor will work with you to create a treatment plan that helps manage your condition. You can also take steps at home to manage psoriasis.

Tips

  1. Take daily baths with lukewarm water. Skin-softening ingredients like colloidal oatmeal, bath oils, or Epsom salts may all help to keep the skin from drying out.
  2. Apply skin oils and moisturizers to protect your skin. You may need to apply moisturizers more than once per day in the winter.
  3. Reduce potential triggers for psoriasis, such as stress, smoking, and infections.
  4. Alternative therapies, such as fish oil supplements or applications of aloe vera may help improve symptoms.

Physicians may slowly build up to the most effective treatment plan for your psoriasis symptoms. Most start with a topical or light therapy treatment and only progress to systemic medications if the first line of treatment is unsuccessful.

Coping and support

Stress, anxiety, depression, and other mental health disorders can be side effects of psoriasis. You may benefit from therapy or support groups where you can meet other people experiencing similar issues or concerns. You can also talk with your healthcare provider about seeing a therapist who has experience with psoriasis. They’ll be able to help identify ways to cope.

You can also visit the National Psoriasis Foundation for more information on how to manage your psoriasis. They’ll also have the latest information on research, events, and programs.

Takeaway

There are different types of psoriasis that present different symptoms. Talk to your doctor if you’re concerned about your skin. The type of psoriasis you have will determine your treatment.

While there’s no cure for psoriasis, treatment can help relieve and manage your symptoms.

Many people believe that psoriasis is contagious, but it won’t spread from person to person. Researchers believe that a combination of genetics, and environmental and immune system factors cause psoriasis.

Thanks to the advocacy work of dozens of psoriasis activists and organizations, psoriasis is also slowly gaining more support and awareness. Talk to your doctor if you believe you have psoriasis. They’ll be able to provide treatment options and coping methods.

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