Getting the correct diagnosis as soon as possible is key when you have ongoing skin irritation. Psoriasis is a lifelong condition but can be managed with the right treatment plan.
Because psoriasis shares characteristics with other skin conditions, a doctor might not always identify it when they first perform an examination. Here’s more about psoriasis, its symptoms, and what to do if you think you’ve been misdiagnosed.
Psoriasis is a common autoimmune disease in the United States. Approximately 7.5 million adults age 20 years or older have psoriasis — a 3% prevalence rate (occurrence of a condition).
By race and ethnicity, the prevalence rates are:
- 3.6 percent of white people
- 3.1 percent of non-Hispanic, including multiracial people
- 2.5 percent of Asian people
- 1.9 percent of Hispanic, including Mexican American people
- 1.5 percent of Black people
But this data may not tell the entire story. Patients of color may be disproportionately undertreated and misdiagnosed. This is because psoriasis isn’t always recognized on darker skin tones as it is for those who have lighter skin tones.
Psoriasis typically begins to appear in people between ages 15 and 35, but it can start at any age. Many people may carry the genetic predisposition to develop psoriasis, but it does not always express itself. Instead, different triggers can unexpectedly cause the symptoms to surface. The triggers can include:
Psoriasis can manifest in different ways and varying severities. It can also affect different parts of your body.
The primary symptoms can include:
- patches of inflamed or discolored skin
- gray or silvery scales on the skin
- dry skin
- cracked skin
- bleeding skin
- pitted nails
- thick nails
- stiff joints
- inflamed joints
Psoriasis rashes can present differently based on skin types:
- on light or fair skin tones, psoriasis tends to be pink or red with a silvery-white scale
- on medium skin tones, psoriasis appears as salmon-colored with a silvery-white scale
- on dark skin tones, psoriasis can be violet with a gray scale, or it can appear dark brown and be difficult to see
Beyond basic symptoms, there are many types of psoriasis:
Plaque psoriasis is the most common of all types. You could experience the general symptoms on different parts of your body. You may even notice patches inside your mouth and nose.
Nail psoriasis affects the fingernails and toenails. They may become loose or even fall off with time.
Scalp psoriasis is also localized. The scales reach beyond your hairline. You may notice flaky skin after scratching your scalp.
Guttate psoriasis can happen after bacterial illnesses, such as strep throat, and it usually affects children and young adults. The sores you’ll find with this type are shaped like water drops and are concentrated on the following:
Inverse psoriasis creates areas of smooth, colored rash in skin folds, especially:
- under the armpits
- around the breasts
- around the groin
- on the genitals
Pustular psoriasis is uncommon, but it may give you more than just skin symptoms. You’ll typically get a fever, chills, and diarrhea with the red rash. Blisters filled with pus accompany the patches or irritation.
Erythrodermic psoriasis is the least common type of psoriasis. It causes large areas of your skin to peel, itch, and burn.
A primary care doctor may refer you to a dermatologist for a diagnosis of psoriasis. They’ll likely ask whether you have a family history of the disease and ask about different triggers that may have set off your symptoms.
From there, they will perform a physical examination that includes a complete skin exam. They will look at your skin for signs of psoriasis. In some cases, you may need to undergo a skin biopsy.
Your doctor will use a general anesthetic and obtain a small sample of your skin to study under a microscope. If the sample exhibits characteristics of psoriasis histologically, this is often enough information to make the diagnosis.
There is limited research and information about managing and diagnosing psoriasis in BIPOC (Black, Indigenous, and People of Color). This means thatpatients of color may be disproportionately misdiagnosed.
Several skin conditions share characteristics with psoriasis. Knowing their symptoms, causes, and other characteristics may help you identify your own skin issues.
If your rash is concentrated on oily parts of your skin, it might be seborrheic dermatitis. With this condition, you may experience itchy and scaly skin on your upper chest and face. You can also develop dandruff on your scalp.
The immune system can trigger lichen planus. The lesions you’ll see are violaceous and flat. These can often form rows on your arms and legs. You may also experience itching or burning. White lines may appear over the irritated areas.
Rashes that have a ring shape might be caused by ringworm or dermatophytosis. This fungal infection affects the top layer of your skin. You can contract the infection through soil carrying the fungi or close contact with people who have ringworm.
If you have pityriasis rosea, you’ll likely get a single spot in the first stage. This skin condition is common and may eventually take on the appearance of pine branches. You’ll typically notice the rash on your stomach, chest, or back before it spreads.
Other skin conditions
Psoriasis can also be confused with:
- atopic dermatitis
- pityriasis rubra pilaris
- secondary syphilis
- tinea corporis
- tinea capitis
- cutaneous T-cell lymphoma
- certain drug reactions
If you’re concerned about being misdiagnosed, consider seeing a dermatologist. You may even want to request a skin biopsy to get a more definitive diagnosis. Also, you might try to think of information that may help with identification, such as:
- Do I have a family history of psoriasis?
- How long have I noticed symptoms?
- Where is the affected area located?
- Are there any triggers that might have produced my symptoms? If so, what are they?
- Do I have signs that align with any of the look-alike conditions?
- Are there any other symptoms, like swollen joints, bothering me?
If you still aren’t satisfied after your appointment, seek a second opinion. You can ask a primary care doctor for a referral to a dermatologist. A dermatologist is usually your best bet for getting the most accurate skin condition diagnosis.
Treating psoriasis involves healing the areas of discomfort and slowing skin growth. Depending on your symptoms and the type of psoriasis, your doctor may try different topical therapies, like topical vitamin D or corticosteroids.
Phototherapy, also known as ultraviolet light therapy, can also be effective in certain cases. More advanced flare-ups may be treated with medications like methotrexate, cyclosporine or tacrolimus, biologics, acitretin, or apremilast.
Before prescribing anything, your doctor will consider the severity of your condition, your medical history, and potential drug interactions.
There isn’t a cure for psoriasis, but knowing you have it may help a doctor diagnose other health issues. People with psoriasis are at a higher risk of developing other conditions such as psoriatic arthritis, metabolic syndrome, and cardiovascular disease.
There are many possible reasons for your skin irritation. If you’re concerned about psoriasis, a correct diagnosis and treatment plan may be your answer. If you may have been misdiagnosed, consider seeing another doctor for a second opinion.
Your doctor will use all the information you provide to help target a diagnosis and treatment plan.