Psoriasis

  • Medical Author:
    Gary W. Cole, MD, FAAD

    Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuidePsoriasis Types, Images, Treatments

Psoriasis Types, Images, Treatments

Can psoriasis affect my joints?

Yes, psoriasis is associated with inflamed joints in about one-third of those affected. In fact, sometimes joint pains may be the only sign of the disorder, with completely clear skin. The joint disease associated with psoriasis is referred to as psoriatic arthritis. Patients may have inflammation of any joints (arthritis), although the joints of the hands, knees, and ankles tend to be most commonly affected. Psoriatic arthritis is an inflammatory, destructive form of arthritis and is treated with medications in order to stop the disease progression.

The average age for onset of psoriatic arthritis is 30-40 years of age. Usually, the skin symptoms and signs precede the onset of the arthritis.

Can psoriasis affect only my nails?

Yes, psoriasis may involve solely the nails in a limited number of patients. Usually, the nail signs accompany the skin and arthritis symptoms and signs. Nail psoriasis is typically very difficult to treat. Treatment options are somewhat limited and include potent topical steroids applied at the nail-base cuticle, injection of steroids at the nail-base cuticle, and oral or systemic medications as described below for the treatment of psoriasis.

What are psoriasis symptoms and signs? What does psoriasis look like?

Plaque psoriasis signs and symptoms appear as red or pink small scaly bumps that merge into plaques of raised skin. Plaque psoriasis classically affects skin over the elbows, knees, and scalp and is often itchy. Although any area may be involved, plaque psoriasis tends to be more common at sites of friction, scratching, or abrasion. Sometimes pulling off one of these small dry white flakes of skin causes a tiny blood spot on the skin. This is a special diagnostic sign in psoriasis called the Auspitz sign.

Fingernails and toenails often exhibit small pits (pinpoint depressions) and/or larger yellowish-brown separations of the nail from the nail bed at the fingertip called distal onycholysis. Nail psoriasis may be confused with and incorrectly diagnosed as a fungal nail infection.

Symptoms and signs of guttate psoriasis include bumps or small plaques (½ inch or less) of red itchy, scaling skin that may appear explosively, affecting large parts of the skin surface simultaneously, after a sore throat.

In inverse psoriasis, genital lesions, especially in the groin and on the head of the penis, are common. Psoriasis in moist areas like the navel or the area between the buttocks (intergluteal folds) may look like flat red plaques without much scaling. This may be confused with other skin conditions like fungal infections, yeast infections, allergic rashes, or bacterial infections.

Symptoms and signs of pustular psoriasis include at rapid onset of groups of small bumps filled with pus on the torso. Patients are often systemically ill and may have a fever.

Erythrodermic psoriasis appears as extensive areas of red skin often involving the entire skin surface. Patients may often feel chilled.

Scalp psoriasis may look like severe dandruff with dry flakes and red areas of skin. It can be difficult to differentiate between scalp psoriasis and seborrheic dermatitis when only the scalp is involved. However, the treatment is often very similar for both conditions.

Medically Reviewed by a Doctor on 3/23/2017

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