What is Psoriasis? Understanding the Different Types and Symptoms of This Rare Skin Condition

"Psoriasis is a chronic, auto-immune skin condition where you have red, scaly patches on the skin," Dr. Saakshi Khattri, a Dermatologist/Rheumatologist at Mount Sinai Health System, tells SurvivorNet. "It is a long-term condition, which can ebb and flow. You can have good days and bad days." Dr. Saakshi explains that while anyone can develop psoriasis, the disease is more common in people between the ages of 30 and 50. Researchers believe genetics, as well as environmental factors, may play a vital role in the development of this disease.

Dr. George Han, a Dermatologist at Northwell Health/Lenox Hill Hospital, tells SurvivorNet that psoriasis is also connected with many internal comorbidities. "The most obvious of which is psoriatic arthritis, which is an inflammatory arthritis that if left untreated is quite debilitating…as well as a number of other comorbidities that we are learning more and more about, such as inflammatory bowel disease and metabolic syndrome. So, there are a lot of different connections, also with psychiatric comorbidities."

What are the Symptoms of Psoriasis?

Psoriasis can often be asymptomatic (without symptoms), so people who have the disease will not be dealing with constant outbreaks or 'flare-ups'.

"Some patients report itching [or a] burning sensation, but that does not tend to be the norm. It certainly can and does happen," Dr. Khattri explains. "Then if you have psoriasis in the genital area, it can feel uncomfortable just because it is in a very sensitive part of the body. But for the most part, it tends to be asymptomatic, generally speaking."

Dr. Han says he sees many patients with itching. "It is interesting because if you look at the older dermatology textbooks, there was this concept that psoriasis is not supposed to itch. And so they made this distinction between the itchy rash, which is eczema dermatitis and psoriasis, which is supposed to be not itchy," Dr. Han says. "But if you actually ask patients and in some of the modern literature now, upwards of 80% to 90% of patients do have itching associated with their psoriasis."

Generalized symptoms associated with the disease include the following:

• Red patches of skin covered with silvery-like scales
• Small scaling spots
• Dry, cracked skin that may bleed or itch
• Itching, burning sensation, or soreness
• Thickened or ridged nails
• Swollen or stiff joints

Dr. Khattri recommends seeing a dermatologist if you notice red, scaly spots on the body so a specialized practitioner can make a proper diagnosis and treatment action plan. Psoriasis patches can vary in how their appearance and location on the skin. The disease may present as just a few spots with dandruff-like scaling or as rashes that cover large parts of the body. The most commonly affected areas are the lower back, elbows, knees, legs, soles of feet, scalp, face, and palms.

Dr. Han says most types of psoriasis can be diagnosed clinically, meaning your healthcare team can determine psoriasis on sight. With more atypical (not typical; rare) forms of psoriasis, a biopsy may be needed.

What are the Different Types of Psoriasis?

There are several different types of psoriasis, with plaque psoriasis being the most common. The types differ in how they present and what they are caused by.

• Plaque psoriasis: This is the most common form of the disease and causes dry, raised skin patches that may be covered in scales. The patches may be itchy and tender.
• Nail psoriasis: This disease can affect fingernails and toenails and might cause nails to loosen from the nail bed.
• Guttate psoriasis: This disease typically affects young adults and children and is often caused by a bacterial infection, like strep throat.
• Inverse psoriasis: This type of psoriasis mainly affects skin folds, so it will often present in areas such as the groin, buttocks, or breasts, and can worsen with friction or sweating.
• Pustular psoriasis: This is an atypical (rare) form of psoriasis that causes pus-filled blisters to develop in widespread patches across the body.
• Erythrodermic psoriasis: This is also a rare form of the disease. It can cover the entire body with a red, peeling rash that may itch or burn intensely.
• Psoriatic arthritis: With this form of the disease, joints may become swollen, irritated, and painful. Sometimes, joint pain is the first or only symptom, while other times other symptoms like nail changes will occur for some people.

The treatment approach will depend on the type of psoriasis a person has, and what kind of symptoms they present with. Dr. Khattri notes that for some people, symptoms may resolve with over-the-counter (OTC) creams or ointments, while others with moderate to severe disease may need a more systemic approach.

"It is hard to generalize and say whether it will be progressive for everybody or whether this will just be like a lesion here and there, which sort of self resolves with some over-the-counter (OTC) or topical treatment options," she says. "The one thing that I would say as a Rheumatologist is that everybody should know that psoriasis is just not limited solely to the skin. You can have a joint involvement in about a third of patients…with psoriasis you can even go on to developing psoriatic arthritis."

If a patient has developed rashes or scaly patches of skin and also begins noticing other symptoms, such as stiffness or joint pain, Dr. Khattri suggests seeking medical attention right away rather than trying to resolve the issue with mild over-the-counter (OTC) treatments. "If you have psoriasis on the skin or what looks like psoriasis on the skin, along with the onset of joint pain or tenderness, whether it is sort of stiffness in the lower back or a swelling of the finger or a toe that is inexplicable, do think of psoriatic arthritis and then certainly reach out to healthcare providers sooner rather than later."

Moving Forward – Questions to Ask Your Doctor

• Could my symptoms be related to another condition?
• What treatment options do I have?
• Are there any lifestyle adjustments I should make?
• How often should I be monitored?
• How does psoriasis usually progress? Can it come and go?
• How often can flare-ups occur?

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