What are the different types of psoriasis?

Types

Psoriasis is a skin condition that causes skin cells to form too quickly. Because these grow faster than the body can shed existing skin cells, thick, scaly patches form.

On lighter skin tones, psoriasis usually appears as pink or red patches with silvery-white scales. On darker skin, psoriasis is more likely to appear as purple patches with gray scales or as a dark brown color.

There are several types of psoriasis. Most types of psoriasis tend to be mild to moderate in severity. However, some types of psoriasis can be severe.

Types of the condition include:

• plaque psoriasis
• psoriasis of the scalp
• guttate psoriasis
• inverse psoriasis
• pustular psoriasis
• erythrodermic psoriasis
• psoriasis of special sites, including the oral mucosa, nail, and flexural

People with psoriasis may initially develop more than one type of psoriasis, but can later develop another type.

General symptoms

While a person’s symptoms will vary with the type of psoriasis they have, most people with psoriasis will experience some combination of:

• itchy skin
• burning, sore, or painful areas on the skin
• patches of thick skin with visible scales
• small scaly spots
• swollen or stiff joints

Psoriasis can be a lifelong condition, and symptoms tend to be cyclical. This means that they may increase in intensity at certain periods and lessen at others. People refer to these periods of heightened symptoms as flares.

Flares can vary in severity and duration.

Plaque psoriasis

Plaque psoriasis, also known as psoriasis vulgaris, causes areas of plaque buildup on the skin and is the most common form of psoriasis. Around 80 to 90% of people with psoriasis develop plaque psoriasis.

Plaque is a thickened area of skin. On lighter skin types, it often has a white or silvery, scaled appearance, and on darker skin types, it may appear as purple patches with gray scales.

Plaque psoriasis tends to be mild to moderate, but it can also be severe. Mild psoriasis only affects a small part of the body, such as less than 3%.

Symptoms

Symptoms of plaque psoriasis vary from person to person. These symptoms can include:

• areas of dry skin lesions covered with silvery scales
• plaques that itch or burn
• problems that affect the nails

Areas of plaque may appear anywhere on the body, but the scalp, lower back, hands, and feet are common areas.

Treatment

Treatment of mild or moderate plaque psoriasis will vary depending on a person’s individual symptoms. However, treatment will typically include the application of topical ointments to affected areas and, in some cases, exposing the skin to ultraviolet light.

Treatment may also depend on the percentage of the body surface area affected by psoriasis.

Scalp psoriasis

Scalp psoriasis typically occurs on a person’s scalp. However, it can also appear on the forehead, back of the head, down the neck, and behind the ears.

Scalp psoriasis is a common manifestation of psoriasis. In the United States, approximately 45 to 56% of people living with psoriasis have scalp psoriasis.

A person with scalp psoriasis may also experience psoriasis on other parts of their body simultaneously.

Symptoms

Scalp psoriasis shares many symptoms with plaque psoriasis, but may also result in:

• patches of thick skin on the scalp
• dandruff-like flakes on the scalp
• itching and bleeding scalp
• a dry scalp
• temporary hair loss during flares

Treatments

Treatment for scalp psoriasis often involves more than one method at a time. As with plaque psoriasis, a doctor will tailor a treatment program to a patient’s needs.

Treatment options for scalp psoriasis include:

• medicated shampoos and ointments
• UV light therapy
• injections

Guttate psoriasis

Guttate psoriasis has red, purple, or dark spots that are spread throughout the skin. The dots and spots are not as thick as plaques in plaque psoriasis.

This type of psoriasis typically begins in childhood or young adulthood and can develop after an infection.

Symptoms

Guttate psoriasis typically causes spots to appear on the legs, arms, and torso. However, these may also appear on the face, scalp, and ears.

In severe cases of guttate psoriasis, hundreds of these spots may appear, covering the majority of an affected area.

Treatments

Doctors typically recommend topical creams and ointments as the initial treatment for guttate psoriasis. These treatments may help reduce swelling and alleviate itching.

As the condition can appear following infections such as strep throat, a doctor may recommend antibiotics to treat the infection, while also addressing the symptoms of psoriasis. In some cases, they may also suggest a patient undergo light therapy.

Inverse psoriasis

Inverse psoriasis appears as patches of discoloration that are most commonly found in skin folds, such as the armpits and groin. People with inverse psoriasis may have other forms of psoriasis elsewhere on their bodies.

Symptoms

On white skin, inverse psoriasis presents as bright red or pink marks. On black or brown skin, it may appear as red, purple, or darker than the surrounding area.

Areas of the body that are most likely to develop inverse psoriasis include:

• armpits
• groin
• under the breasts
• behind the knee

Treatment

The areas of the body that are most often affected by inverse psoriasis tend to have thinner skin than other areas. This can make treating this type of psoriasis more difficult.

A doctor will typically recommend topical steroid ointments to reduce inflammation. As skin folds are common sites of yeast infection, they may also suggest a person take anti-yeast and antifungal treatments as well.

Pustular psoriasis

Pustular psoriasis is a severe, rare type of psoriasis. It causes widespread inflammation of the skin, resulting in white or yellow blisters that contain pus.

Symptoms

Pustular psoriasis blisters can exist in a single area of the body or appear more widespread. Once the blisters have gone away, the skin may become scaly.

A person with pustular psoriasis may also experience:

• fever
• extreme tiredness
• muscle weakness
• other forms of inflammation throughout the body

A specific type of pustular psoriasis, known as palmoplantar pustulosis, causes blisters to form on the palms and soles of the feet. These blisters form in a studded pattern. Over time, the blisters turn brown and develop a crusty texture.

Treatment

Due to the rarity of the condition, there is a lack of evidence-based treatment guidelines. As a result, medical professionals may recommend a combination of topical ointments, oral medications, and therapies.

They may also cycle between medications and therapies to find the most effective option and reduce the risk of side effects.

A person with mild pustular psoriasis may be able to treat the condition with prescription topical ointments. However, those with more extensive symptoms may require hospital treatment.

Erythrodermic psoriasis

While most forms of psoriasis tend to be mild or moderate, erythrodermic psoriasis is severe and can be a life threatening medical emergency.

This type of psoriasis, characterized by inflammation, can cover most of the body. It causes an extremely painful, peeling rash that looks like a burn.

Erythrodermic psoriasis is a rare condition and affects around 2% of people with psoriasis.

Symptoms

Unlike the symptoms of mild psoriasis, the symptoms of erythrodermic psoriasis tend to be more severe. They may include:

• widespread area of inflamed, discolored skin
• skin that peels off in sheets
• severe itching, pain, or burning
• faster heart rate
• fever or lower body temperature
• swelling in feet or ankles

Individuals with erythrodermic psoriasis are at a higher risk of infection. They may also experience other serious problems, including heart failure and pneumonia.

Treatments

People with erythrodermic psoriasis are usually hospitalized and may require emergency treatment. This may include fluid replacement and systemic medications that affect the entire body.

Depending on the severity of the condition, a medical professional may recommend oral retinoids, which are medications derived from Vitamin A that can slow skin cell growth and reduce swelling, and immunosuppressive drugs, which reduce the body’s immune system response.

Biologic therapy is also a potential treatment option. Biologics target cytokines, which are signaling molecules that assist in the movement of cells to sites of inflammation. By suppressing or inhibiting these signals, biologics can reduce the severity of inflammation from erythrodermic psoriasis.

In mild cases, focused treatment for the symptoms of erythrodermic psoriasis may include topical steroid creams and ointments, wet dressings, and oatmeal baths.

Outlook

Most types of psoriasis tend to be of mild to moderate severity. This exception is erythrodermic psoriasis, which can be a life threatening medical emergency.

Psoriasis varies in its appearance and symptoms, but most treatment approaches are similar. Typically, people with mild psoriasis can manage their symptoms using topical treatments, according to treatment guidelines.

However, if a person has moderate to severe symptoms, a doctor may prescribe new biologic therapies. These can help treat the underlying cause of skin changes and may reduce the frequency and severity of symptoms.

Individuals who suspect they have psoriasis should consult their doctor before starting treatment. People with symptoms of erythrodermic psoriasis should seek immediate medical attention.

Frequently asked questions

Summary

Various types of psoriasis exist, ranging in severity, location, and appearance on the body. Most types of psoriasis symptoms include scaly skin, plaques, itching, and flares that occur throughout a person’s life.

Treatment depends on the different types of psoriasis, with some types requiring mild topical ointments or creams, while others can be life threatening and necessitate hospital treatment.