Psoriasis is a chronic skin condition that affects millions of people worldwide. It is characterized by the formation of thick, scaly patches on the skin that can be itchy and painful. However, not all types of psoriasis are the same – there are different types of psoriasis, each with its own unique symptoms and characteristics. 

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If you or someone you know has been diagnosed with psoriasis, it’s important to understand the different types in order to properly manage your symptoms and receive the appropriate treatment. 

In this article, we will explore how to tell the various types of psoriasis apart so that you can take control of your health and feel confident in your care plan.

psoriasis word cloud

What is Psoriasis?

Psoriasis is a chronic autoimmune disease that affects the skin. It occurs when the immune system mistakenly attacks healthy skin cells, causing them to grow faster than normal.

As a result, people with psoriasis often experience red, scaly patches of skin on their bodies. These patches can be itchy and painful and may even crack or bleed in severe cases.

Psoriasis can affect anyone at any age, but it typically develops in adults between the ages of 15 and 35. There are several types of psoriasis, including plaque psoriasis (the most common form), guttate psoriasis, inverse psoriasis, pustular psoriasis, nail psoriasis, and erythrodermic psoriasis.

While there is no cure for psoriasis, several treatment options are available to help manage symptoms. These include topical creams and ointments,

Different Types of Psoriasis

1. Plaque Psoriasis

Plaque psoriasis is also known as psoriasis vulgaris. It is the most common type of psoriasis, accounting for about 80-90% of all cases.

In people with plaque psoriasis, the immune system attacks healthy skin cells by mistake, causing them to grow too quickly and form patches that don’t shed normally.

Symptoms of plaque psoriasis include raised, red patches of skin covered with silvery-white scales. The patches usually develop in a symmetrical pattern on the body and can be itchy and painful.

Plaque psoriasis can occur anywhere on the body but is most commonly found on the scalp, trunk, lower back, and limbs, especially elbows and knees.

Available treatment options

According to the National Psoriasis Foundation, treatment options for plaque psoriasis include 

Topical applications

Topical medications are applied directly to the affected area and work by reducing inflammation and slowing down cell growth. 

Some common topical treatments for plaque psoriasis include 

  • Vitamin D analogs
  • Retinoids
  • Corticosteroids
  • Coal tar cream, oil, or shampoo
  • Salicylic acid
  • Immunosuppressive medications like methotrexate or cyclosporine

Phototherapy

Phototherapy involves exposing the skin to ultraviolet (UV) or UVB light on a regular basis under medical supervision. This can be done in a doctor’s office or at home using a specialized light box. UVB therapy is often the preferred phototherapy method.

Oral medications can also be used. Overall, your treatment specifications will depend on the severity of your condition and your medical history.

2. Guttate Psoriasis

Guttate psoriasis is a form of psoriasis that appears as small, drop-like lesions on the skin. It’s most commonly seen in children and adolescents. Guttate psoriasis is also often diagnosed in young adults under 30 years.

It’s the second most common type of psoriasis in children, but overall, it’s very uncommon, with only 8% of people with psoriasis in the USA having it.

The exact cause of guttate psoriasis is not known, but it is believed to be triggered by an upper respiratory tract infection like streptococcal pharyngitis (strep throat). Other triggers may include stress, injury to the skin, or certain drugs.

The symptoms of guttate psoriasis include small red spots on the skin that are usually about 1-10mm in diameter. The spots may be raised and scaly and often appear on the trunk, arms, legs, or scalp. 

Guttate often responds well to topical therapies and phototherapies.

Research shows that 40% of guttate psoriasis cases can develop into chronic plaque psoriasis at some point in life.

Treatment options

The doctor may prescribe a steroid cream, light therapy, or oral medication for treatment.

Treating an underlying cause, such as a throat infection, can also help improve the condition.

3. Pustular Psoriasis

Pustular psoriasis is a rare form of psoriasis that affects the skin and nails. It is characterized by small, pus-filled yellowish blisters or pustules on the skin that are surrounded by red, inflamed areas. The pustules can also occur in the mouth and beneath the nails.

Within 24-48 hours after the pustules appear, they join together and burst open. As the pus dries, the area becomes red, appears glazed or crusted, and can be painful and itchy. New pustules may form in the same area, which can again join together and burst open.

The pustules can be painful and itchy and may break open, causing crusts to form.

There are two types of pustular psoriasis: generalized pustular psoriasis (GPP) and localized pustular psoriasis (LPP). GPP is a more severe form of the condition that can affect large areas of the body, while LPP typically affects smaller areas like the hands and feet.

GPP often requires immediate medical care. Symptoms may include fever, chills, dehydration, muscle weakness, fatigue, dehydration, swollen legs, and a rapid pulse.

The exact cause of pustular psoriasis is not known, but certain triggers like stress, ultraviolet exposure, infection (streptococcus and staphylococcus), or reaction to medications can also exacerbate symptoms.

Treatment options

Treatment for pustular psoriasis often focuses on clearing the pustules, relieving pain and itchiness, and preventing further infections if the pustules break.

This may result in various treatment modalities, including:

  • Topical medications like creams and ointments
  • Oral medications 
  • Biological treatments
  • Phototherapy

Individuals with pustular psoriasis need to work closely with their healthcare provider to find an effective treatment plan. They should also avoid triggers as much as possible and practice good self-care habits like moisturizing regularly, avoiding harsh soaps or detergents, managing stress effectively, and avoiding any trigger that causes symptoms.

4. Inverse psoriasis

Inverse psoriasis is also known as hidden psoriasis; as the name suggests, this type is not always visible. This is because it forms between skin folds or where skin rubs against each other.

An example of such regions includes the neck, underarms, under breasts, between belly folds, the buttocks, inner thighs, or the groin area.

The rash usually occurs in small patches, and it’s often smooth, shiny, and red in color. The rash may sometimes appear dark purple, brown, or darker than the surrounding skin.

The affected areas may often become moist, which can cause itching and irritation. It can also increase the risk of yeast infection due to high moisture retention in these areas.

Unlike other forms of psoriasis that present with raised skin, scales, pustular spots, and crusts, the skin in inverse psoriasis is neither dry nor raised.

However, people with this psoriasis may also have other types, like plaque psoriasis in other body parts.

Like other forms of psoriasis, the cause has something to do with the immune system, however, sweating (moisture) and friction can trigger the symptoms. Skin injuries like cuts, scrapes, surgery or emotional stress, or streptococcal infections can also trigger the symptoms.

Treatment options

Inverse psoriasis has no cure, but treatment can help relieve the symptoms while avoiding triggers can minimize the risk of flare-ups.

Overall, the goal of treatment is to reduce inflammation and irritation. Common medications used include:

  • Topical applications

Topical creams are often the first line of management. These are often applied in the morning after a shower and before going to bed in the evening.

A good example of common creams used is steroid-containing ones. These can be very effective but need to be used under close monitoring with the doctor since they can easily thin the skin and increase irritation. A doctor will be able to notice signs of thinning and adjust the dosage accordingly.

  • Oral mediations like cyclosporine and methotrexate
  • Biological therapies

5. Erythrodermic

Erythrodermic psoriasis is a rare and severe form of psoriasis that affects the entire body. It can be life-threatening and requires immediate medical attention. This condition is characterized by red, inflamed skin covering the entire body surface. 

The symptoms of erythrodermic psoriasis include peeling skin, intense itching, burning, and pain in the skin. The skin may become thickened, scaly, or cracked, with oozing or bleeding in some areas. The nails may also become abnormal with pitting or separation from the nail bed.

Erythrodermic psoriasis is caused by a flare-up of an existing case of psoriasis, which can be triggered by certain factors such as medication changes, sunburns, infections, stress, or alcohol consumption.

Treatment options

Treatment for erythrodermic psoriasis usually involves hospitalization because it’s a serious condition that needs to be monitored closely. Medications often used include corticosteroids and biological therapies to reduce inflammation and manage symptoms.

There are no known ways to prevent erythrodermic psoriasis from occurring but managing your existing case through regular check-ups with your dermatologist will help keep this condition under control.

6. Nail psoriasis

Nail psoriasis is a chronic condition that affects the nails of around 50% of people with psoriasis. It causes changes in the appearance and texture of nails, making them thickened, discolored, and brittle.

The symptoms of nail psoriasis vary from person to person but may include:

  • Pitting or small depressions on the surface of the nail
  • Thickening or crumbling of the nail
  • Yellowish-brown discoloration
  • Separation of the nail from its bed (onycholysis)
  • Redness or swelling around the nail

The exact cause of nail psoriasis is unknown. However, researchers believe that genetics plays a role in its development. Environmental factors such as stress, injury to nails, and infections can trigger flare-ups.

Treatment options

There is no cure for nail psoriasis yet. However, treatment options aim to manage symptoms and prevent further damage to your nails. Some common treatments include:

  • Topical medications: Creams or ointments containing corticosteroids or vitamin D analogs that are applied directly to affected areas.
  • Systemic medications: These include prescription drugs taken orally or by injection that work throughout your body to reduce inflammation.
  • Phototherapy: Exposure to controlled amounts of ultraviolet light from special lamps. In some cases, your doctor may combine a certain drug (psoralen) with ultraviolet A (PUVA) or ultraviolet B (UVB).
  • Laser therapy: Here, your healthcare provider may use a pulsed dye laser (PDL) to target blood vessels under the nails. This is often done every 6 months.

7. Psoriatic arthritis

Psoriatic arthritis is a chronic autoimmune form of arthritis that develops in about 20% of patients with psoriasis. It commonly affects adults between the age of 35 and 55 but can occur at any age. It also affects men and women equally.

Psoriatic arthritis is characterized by joint pain, swelling, and morning stiffness and can vary from mild to severe. It can affect four or fewer joints (oligoarticular) and four or more joints (polyarticular). The commonly affected joints include those of the knees, ankles, hands, and feet.

However, in some cases though less common, the spine, hips, and shoulders can be affected.

Psoriatic arthritis is believed to be caused by an abnormal immune system response in combination with genetic factors.

The treatment often includes the combination of medications, exercise, heat and cold therapy, splinting, joint protection and energy conservation, and surgery if joint damage has become severe.

Diagnosing Different Types of Psoriasis

Plaque Psoriasis

To diagnose plaque psoriasis, doctors typically perform a physical examination and ask questions about your medical history. They may also use a dermatoscope to examine your skin more closely. In some cases, they may take a small sample of skin (biopsy) to confirm the diagnosis.

Guttate Psoriasis

To diagnose guttate psoriasis, doctors will look for characteristic “drop-like” lesions on the trunk, arms, legs, or face during a physical exam. Blood tests can rule out other conditions that can cause similar symptoms.

Inverse Psoriasis

Diagnosing inverse psoriases requires careful observation and evaluation by an experienced doctor or dermatologist because it can mimic other inflammatory conditions like fungal infections.

If your doctor suspects you have inverse psoriasis but needs further confirmation, they may take a small sample of skin from the affected area for analysis under a microscope.

Erythrodermic Psoriasis

A dermatologist will start by examining your skin for signs of erythrodermic psoriasis, such as redness, scaling, and peeling on most or all parts of your body.

Blood tests may also identify infection or other underlying health issues.

Nail psoriasis

A dermatologist can diagnose nail psoriasis by examining your na ils and asking about any other symptoms you may be experiencing. They may also take a sample of your affected nails (biopsy) for analysis under a microscope.

Psoriatic arthritis

A diagnosis of psoriatic arthritis is usually made based on the patient’s medical history, physical exam, blood tests, and X-rays of the affected joints. In unusual circumstances, MRI may be needed.

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Final Thoughts

Psoriasis is a chronic skin condition that affects millions of people worldwide. It can manifest in various types and forms, each with its distinct characteristics and symptoms. 

Identifying the type of psoriasis is crucial to determine the most appropriate treatment plan. 

Furthermore, early diagnosis and management can significantly improve the quality of life and reduce complications associated with the disease. 

By familiarizing yourself with the different types and symptoms of psoriasis, you can work with your healthcare provider to develop an effective treatment strategy tailored specifically to your needs.

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