In its most common forms, psoriasis disrupts the immune system in a way that can lead to painful inflammation of the skin, joints, and nails. It can cause the skin to itch, hurt, become inflamed, flake, and sometimes crack and bleed.
Around 3% of the population suffers from some form of psoriasis. While it cannot be cured, psoriasis can be treated. Treatments aim to reduce the size and frequency of psoriasis outbreaks.
Psoriasis is easiest to treat when it is caught in its earliest stages, before it begins to spread and intensify. For this reason, it is important to understand the early signs and symptoms of psoriasis.
In this article, I’ll describe the most common early signs and symptoms of psoriasis, including those associated with common types of psoriasis, as well as psoriatic arthritis (PsA). I’ll discuss what we know about the causes and triggers of psoriasis. I’ll describe how psoriasis is diagnosed, and talk about the most common forms of treatment.
Finally, I’ll tell you when to see a doctor about a confirmed or possible case of psoriasis.
What is Psoriasis?
Psoriasis can appear anywhere on the body: It is commonly found in raised patches on people’s torso, back, and limbs, but it can also appear on the eyelids, ears, lips, hands, feet, scalp, and nails. Psoriasis patches can be small and contained to just one area, but they can also grow larger in size and number and can affect multiple regions of the body at once.
They can also vary widely in terms of appearance. Doctors, therefore, talk about psoriasis as having several different types. Some people only experience one type of psoriasis at a time, while others might experience two or more types together.
The different types of psoriasis include:
|TYPE OF PSORIASIS||DESCRIPTION|
|Plaque psoriasis||Appears as red or purple patches of thick, raised skin called plaques. Plaques are sometimes covered with silvery-whitish scales that exfoliate, or shed. This is the most common form of psoriasis, affecting around 90% of psoriasis patients. Plaque psoriasis most often occurs on the limbs, scalp, and back.|
|Guttate psoriasis||Appears as small, pinkish or purple “dew-drop”-shaped bumps, most often on the torso or limbs.|
|Inverse psoriasis||Thin, smooth, red or purple patches of skin that look “raw” or shiny, without much scaling. Occurs in places where skin touches skin, like in skin folds.|
|Pustular psoriasis (palmoplantar)||Pus-filled bumps that occur on top of red or purple inflamed skin. Occurs on the hands and feet.|
|Pustular psoriasis (generalized)||Pus-filled bumps that occur on top of inflamed skin, all over the body. A rare, but life-threatening form of psoriasis that can cause severe fever and dehydration, and requires immediate emergency treatment. Also known as GPP or Von Zumbusch psoriasis.|
|Erythrodermic psoriasis||Skin falls off in sheets rather than in smaller scales. Skin across the whole body looks like it’s been burned. This is a rare but life-threatening form of psoriasis that can cause severe fever and dehydration, and requires immediate emergency treatment.|
|Nail psoriasis||Inflammation and buildup of cells around the nails. This can lead to nails with a “crumbling” appearance, and to white, yellow or brown discoloration below the nails. Nails may also become lifted up or detached.|
If psoriasis is caught earlier, it is easier to treat and contain. In its early stages, psoriasis can often be managed by your primary healthcare provider, rather than a dermatologist or other specialist. Your primary healthcare provider will be trained to address any early symptoms of psoriasis that you may be experiencing.
Early signs of psoriasis may include:
|TYPE OF PSORIASIS||EARLY SYMPTOMS|
|Plaque psoriasis||Small red or purple bumps that begin to grow, connect, and develop whitish scales|
|Guttate psoriasis||Smallest, earliest “dew-drop” shaped lesions appear on the skin. Early symptoms often follow an incident of skin damage or infection (especially childhood and young adult strep throat infections).|
|Inverse psoriasis||Skin begins to feel raw or painful in the folds or recesses of your skin—commonly in the groin, buttocks, or breasts.|
|Pustular psoriasis (palmoplantar)||Skin on the hands or feet suddenly begins to turn dry, red and tender. Pus-filled bumps begin to appear within a few hours.|
|Pustular psoriasis (generalized)||Skin across the whole body suddenly begins to turn dry, red and tender. Pus-filled bumps begin to appear within a few hours.|
|Erythrodermic psoriasis||Most often occurs in patients who are already experiencing another type of psoriasis. This existing form of psoriasis will often worsen and spread in the period before the patient experiences a full-body episode of erythrodermic psoriasis.|
|Nail psoriasis||Tiny dents called “nail pits” begin to appear, sometimes alongside discoloration under one or more nails.|
|Psoriatic arthritis (PsA)||Most people with psoriatic arthritis already have another type of psoriasis. From there, patients may initially experience a swollen or tender joint. Sometimes, an entire finger or toe may become swollen, a symptom called a “sausage digit” or dactylitis.|
The exact causes of psoriasis are not yet known. Genetics are believed to have some effect on who experiences psoriasis, and how severely it occurs.
What we do know is that psoriasis is an immune-mediated disease. That means the rashes and raised lesions experienced during psoriasis are a consequence of the immune system malfunctioning in certain ways. People develop psoriasis when their immune systems accelerate the process of skin cell growth and shedding.
Where psoriasis is present, it takes as few as four days for skin cells to complete their growth cycles; the normal cycle is one month. This acceleration can cause skin cells to “pile up” on the surface of the skin, with varying, but often painful, results.
We still don’t know exactly why some people develop psoriasis and some don’t. But it’s clear that for many people, certain events or conditions can trigger psoriasis to appear and spread.
Many of these triggers are the same regardless of the type of psoriasis that develops.
The most common triggers for psoriasis include:
- Starting or stopping medication
- Cold or dry weather
- Tobacco use
- Alcohol use
- Other skin injuries
- Infections (especially strep, staph, and respiratory infections)
Psoriatic arthritis often, but not always, appears after a person develops another form of psoriasis. Psoriatic arthritis should be caught early as possible to limit the damage to the joint and prevent mobility problems later on.
Primary care health providers are trained to tell psoriasis apart from other types of rashes and inflammation. They rely on psoriasis’s distinctive visual features and spreading patterns.
For example, plaque psoriasis often shows up symmetrically across the left and right sides of the body, and looks much more “raised” than other types of disordered skin. Patients’ family histories are another important tool for making a diagnosis.
Doctors will only occasionally need to perform biopsies or other lab tests to diagnose psoriasis. In initial consultations, doctors will also measure how much of the body’s surface area has become covered with psoriasis.
And they will ask questions to determine how quickly it has spread. In some more severe or hard-to-distinguish cases, you may be referred to a dermatologist or other specialist.
Most often, your primary provider will be able to begin treating you immediately, especially if your psoriasis is diagnosed in its earlier stages.
There is currently no cure for psoriasis. But many treatments have been proven to safely reduce the size and frequency of psoriasis outbreaks, often to an area of less than 1% of skin surface. Treatment can also stop or slow psoriatic arthritis before it severely interferes with your mobility.
The most common form of treatment for psoriasis, especially in its early stages, are topical creams and ointments. These include over-the-counter and prescription corticosteroids, which reduce inflammation by slowing the body’s immune response.
Other key ingredients in topical treatments include synthetic vitamin D3 and vitamin A (retinoids), which are sometimes used in combination with corticosteroids. For moderate and severe psoriasis, dermatologists often turn to a wider range of prescription-strength treatment options.
- Intralesional steroids: Corticosteroids are injected directly into psoriasis plaques or lesions.
- Phototherapy: The skin is exposed to ultraviolet light spectrums (usually UVB) using special medical equipment that works to interrupt the patterns of skin cell growth.
- Systemic oral medications: Taken orally, certain types of retinoids, steroids, immunosuppressants, and anti-rheumatic drugs can reduce inflammation by working on the immune system as a whole.
There are now also more specialized drugs, called biologics, that work to target only specific cells and parts of the immune system—in this case, those that are most closely tied to psoriasis and PsA.
Drugs in this category include etanercept (Enbrel), adalimumab (Humira), and infliximab (Remicade). These biologics are most often taken by injection or by IV infusion.
Your doctor might also recommend complementary lifestyle changes, such as improving your diet, becoming more physically active, learning how to reduce your stress, and getting acupuncture. While these may help alleviate your symptoms, they are not replacements for prescription medication.
Avoiding foods that cause inflammation can be suggested as well, however, the full efficacy of this recommendation is still pending full evaluation.
When to See a Doctor
See a doctor if you have a rash of any kind that lasts longer than a week. Raised skin that is itching, painful, or bleeding is an especially clear sign that you should see a doctor.
Psoriasis is easiest to treat when it’s spotted early. If you think you’re experiencing any early signs of psoriasis, including joint pain or nail pits, see your doctor and start tracking your symptoms.
Let your doctor know if you have any family history of psoriasis. Erythrodermic and generalized (entire body) pustular psoriasis are life-threatening conditions that can severely affect your body’s temperature and fluid control systems.
If you are experiencing a severe psoriasis outbreak covering most of your body, seek emergency care immediately.
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Frequently Asked Questions
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Psoriasis Prevalence in Adults in the United States. (2021).
“About Psoriasis.” (2021).
“Psoriasis: Signs and Symptoms.” (2022).
“Diagnosis and management of psoriasis.” (2017).
Erythrodermic Psoriasis. (2020).
Guttate psoriasis. (2021).
Plaque psoriasis. (2022).