What Psoriasis Looks Like

There are five types of psoriasis. Each has its own unique signs
(what is seen) and symptoms (what is felt by the person):

Plaque Psoriasis
About 80% of people living with psoriasis have plaque psoriasis, which also is called “psoriasis vulgaris.” “Vulgaris” means “common.”

How to recognize plaque psoriasis:

• Raised and thickened patches of reddish skin, called “plaques,” which are covered by silvery-white scales.

• Plaques most often appear on the elbows, knees, scalp, chest, and lower back. However, they can appear anywhere on the body, including the genitals.

• Plaques vary in size and can appear as distinct patches or join together to cover a large area.

• In the early stages, the psoriasis may be unnoticeable. The skin may itch and/or a burning sensation may be present.

• Plaque psoriasis usually first appears as small red bumps. Bumps gradually enlarge, and scales form. While the top scales flake off easily and often, scales below the surface stick together. The small red bumps develop into plaques (reddish areas of raised and thickened skin).

• Skin discomfort. The skin is dry and may be painful. Skin can itch, burn, bleed, and crack. In severe cases, the discomfort can make it difficult to sleep and focus on everyday activities.

Guttate Psoriasis

How to recognize guttate psoriasis:

• Drop-sized, red dots form — usually on the trunk, arms, and legs. Lesions occasionally form on the scalp, face, and ears.

• Lesions widespread.

• Appears quickly, usually a few days after a strep throat or other trigger, such as a cold, tonsillitis, chicken pox, skin injury, or taking certain medications.

• Can first appear as another form of psoriasis, such as plaque psoriasis, and turn into guttate psoriasis.

Pustular Psoriasis
This type of psoriasis occurs in less than 5% of people who develop psoriasis and primarily occurs in adults. It may be the first sign of psoriasis or develop from plaque psoriasis. Pustular psoriasis can be triggered by infections, sunburn, or medications such as lithium and systemic cortisones. There are two forms of pustular psoriasis: localized and generalized.

How to recognize localized pustular psoriasis:

• Psoriasis confined to certain areas (localized), usually the palms and soles. This is known as “palmoplantar psoriasis.”

• Skin red, swollen, and dotted with pus-filled lesions.

• Pus-filled lesions dry, leaving behind brown dots and/or scale.

• Affected areas tender and sore. Using hands or walking often painful.

Generalized pustular psoriasis is a rare and severe form of psoriasis that can be life-threatening, especially for older adults. Hospitalization may be required. Generalized pustular psoriasis may be triggered by an infection such as strep throat, suddenly stopping steroids, pregnancy, and taking certain medications such as lithium or systemic cortisone.

This patient suffers from generalized pustular psoriasis. (Photo used with permission of Mark Lebwohl, MD. Photo originally published in his book, The Skin & Systemic Disease: A Color Atlas and Text by Mark Lebwohl, MD. Published by Churchill Livingston, 2004. )

How to recognize generalized pustular psoriasis:

• Widespread areas of fiery-red swollen skin covered with small, white, pus-filled blisters

• Person feels exhausted and ill

• Fever

• Chills

• Severe itching

• Rapid pulse rate

• Loss of appetite

• Muscle weakness

• Anemia

Inverse Psoriasis
Not common, inverse psoriasis also is called “skin-fold,” “flexural,” or “genital” psoriasis. This type of psoriasis can be severe and incapacitating.

How to recognize inverse psoriasis:

• Red and inflamed plaques that only occur in skin folds — armpits, in the genital area, between the buttocks, and under the breasts.

• Scale usually does not form, and the lesions are shiny and smooth.

• Skin very tender.

• Lesion easily irritated, especially by rubbing and perspiration.

• More prevalent in people who are overweight.

• Many people have another type of psoriasis elsewhere on the body.

Erythrodermic Psoriasis
Also known as “exfoliative” psoriasis, this is the least common type. It occurs in about 1% or 2% of people who develop psoriasis. Erythrodermic psoriasis can be life-threatening because the skin loses its protective functions. The skin may not be able to safeguard against heat and fluid loss nor prevent harmful bacteria and other substances from entering the body. Patients are usually hospitalized and given intravenous fluids. Body temperature regulation may be required.

Erythrodermic psoriasis may occur suddenly in a person who has never had psoriasis or evolve from plaque psoriasis. Triggers include infection, emotional stress, alcoholism, and certain medications such as lithium, anti-malarial drugs, and a strong coal tar preparation. It also may be triggered by excessive use of potent corticosteroids, which is why it is important to use corticosteroids as instructed. Suddenly stopping a psoriasis medication, such as cyclosporine or methotrexate, also can trigger erythrodermic psoriasis.

How to recognize erythrodermic psoriasis:

• Severe redness and shedding of the skin that covers a large portion of the body.

• Skin looks as if it has been burned.

• Fluctuating body temperature, especially on very hot or cold days.

• Accelerated heart rate due to increased blood flow to the skin — can complicate heart disease and cause heart failure.

• Severe itching and pain.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.