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Plaque Psoriasis

  • Plaque psoriasis (also known as psoriasis vulgaris) is the most common form of psoriasis, affecting approximately 90% of patients.
  • Plaque psoriasis has the appearance of plaques of inflamed skin covered by a flaky white buildup called scale.
    • Red plaques with white scale are typically seen in lighter skin types
    • Darker skin types tend to have more purple to grey plaques and tend to be thicker. There also tends to be more dyspigmentation (change in skin pigment).
  • The top scales flake off easily and often, but those beneath the surface of the skin clump together. Removing these scales exposes tender skin, which bleeds and causes the plaques (inflamed patches of skin) to grow.
  • Plaque psoriasis can develop on any part of the body, but most often occurs on the elbows, knees, scalp, and trunk.
  • Some treatments that may be effective in treating plaque psoriasis include topical steroid, topical vitamin D or a combination of both, phototherapy, systemic drugs and biologic therapies. Visit Treatments for Psoriasis and Psoriatic Arthritis for more information about treatments for plaque psoriasis.
plaque psoriasis elbow
plaque psoriasis stomach closeup
plaque psoriasis ear
plaque psoriasis closeup
plaque psoriasis stomach

Guttate Psoriasis

  • Named for the Latin word gutta, which means a “drop”.
  • Guttate psoriasis is characterized by small, red, drop-like dots that enlarge rapidly and may be somewhat scaly.
  • It is often found on the arms, legs, and trunk and sometimes in the scalp.
  • Guttate psoriasis is estimated to affect less than a third of people diagnosed with psoriasis and typically affects children and young adults under 30 years of age.
  • Guttate psoriasis can clear up without treatment or disappear and resurface in the form of plaque psoriasis.
  • Guttate psoriasis can sometimes appear scaly, and often develops suddenly after an infection (such as strep throat).
  • Other possible triggers may include stress, sunburn and other injuries to the skin, excessive alcohol use and other bacterial or viral infections such as tonsillitis as well as oral steroid withdrawal.

Some treatments that may be beneficial in the treatment of guttate psoriasis include:

guttate psoriasis back
guttate psoriasis close

Pustular Psoriasis

  • Pustular psoriasis usually occurs in adults.
  • It is characterized by blister-like lesions filled with non-infectious pus and surrounded by reddened skin.
  • Widespread, acutely painful plaques of inflamed skin develop suddenly.
  • Pustules appear within a few hours, then dry and peel within two days.
  • Pustular psoriasis may be limited to one part of the body (localized) or can be widespread (generalized).
    • Generalized pustular psoriasis is more severe, affecting larger areas of the body and can develop suddenly and progress quickly. Generalized pustular psoriasis can put life-threatening demands on the kidney and liver. The symptoms may include fever, chills, change in heart rate, muscle weakness and fatigue. It’s important to contact your health care provider immediately if you are experiencing any symptoms.
  • Pustular psoriasis most commonly affects the hands and the feet.
  • Pustular psoriasis may be the first symptom of psoriasis, or it may develop in a patient already affected by chronic plaque psoriasis.
  • Some factors that may trigger pustular psoriasis include starting or stopping certain forms of medicines, over exposure to ultraviolet (UV) light, infections, stress, and pregnancy.

Some treatments that may be beneficial in the treatment of pustular psoriasis include:

Systemics
  • Acitretin
  • Cyclosporine
  • Methotrexate
  • Phototherapy
Biologics
  • Infliximab
  • Adalimumab
  • Etancercept
  • Ustekinumab
  • Secukinumab
  • Brodalumab
Topicals
  • Topical corticosteroids
  • Topical Vitamin D Analogues
  • Combination Therapy
pustular psoriasis feet
pustular psoriasis closeup

Supplied by Waikato District Health Board

pustular psoriasis face

Inverse Psoriasis

  • Inverse psoriasis (also known as intertriginous or flexural psoriasis) is estimated to occur in 21-30% of people with psoriasis.
  • Inverse psoriasis occurs in the armpits and groin, under the breasts, and in other areas where the skin flexes or folds.
  • This disease is characterized by smooth, inflamed lesions that can be moist to the touch and can be debilitating. Inverse psoriasis lacks the scales associated with plaque psoriasis due to the moist environment.
  • Inverse psoriasis in more common in individuals who are overweight.
  • The symptoms of inverse psoriasis include irritation and itching and may worsen with friction or sweating. Wearing loose and comfortable clothing is recommended as it can help avoid rubbing against sore skin and prevent moisture from getting trapped in skin folds.
  • Apart from friction on deep skin folds, common triggers for inverse psoriasis include starting and stopping medicines, infections, injury to the skin, stress and tobacco or alcohol use.

Some treatments that may be beneficial in the treatment of inverse psoriasis include topicals such as:

  • Topical corticosteroids
  • Topical Vitamin D3 Analogues
  • Topical Calcineurin Inhibitors (pimecrolimus, tacrolimus)
  • Topical Antimicrobials
  • Emollients
  • Tar-based products

Phototherapy and biologics may also be used as treatments.

inverse psoriasis

Supplied by Prof. Raimo Suhonen

Erythrodermic Psoriasis

  • Erythrodermic psoriasis is the rarest form of psoriasis but also the most severe.
  • It is estimated to effect 1-2% of individuals with psoriasis and is described as a peeling rash across the entire surface of the body.
  • It can cause itching or intense burning and usually spreads quickly.
  • Erythrodermic psoriasis interrupts the body’s normal temperature and fluid balance which can lead to shivering episodes and swelling from fluid retention.
  • Symptoms of erythrodermic psoriasis include severe redness of skin over a large part of the body, intense pain, fluctuations in body temperature, dehydration and fatigue.
  • While erythrodermic psoriasis is rare, it’s important to consult your physician immediately if you experience symptoms as it can be life threatening.
  • Common triggers of erythrodermic psoriasis include suddenly stopping psoriasis treatment, steroid withdrawal, infections or severe illness, sunburns, stress and alcohol use.
  • Treatment options for erythrodermic psoriasis vary depending on severity and can sometimes be difficult to treat if complications arise. In addition to the treatments listed below, antibiotics are common and emergency treatments such as IV fluid to treat dehydration or other oral medications may also be needed.

 

Some treatments that may be beneficial in the treatment of erythrodermic psoriasis include:

Systemics
  • Acitretin
  • Cyclosporine
  • Methotrexate
Biologics
  • Infliximab
  • Etancercept
Combination therapy
erythrodermic psoriasis hand

Scalp Psoriasis

Research finds that 45-56% of people living with psoriasis have it on their scalp. Scalp psoriasis is also found on the hairline, forehead, back of the neck and around the ears. In mild cases, it may look like dandruff. In more severe cases, it may be thick, crusted plaques covering the entire scalp.

Treatments range from over-the-counter shampoos to topicals, systemics and biologics. In particular, the following list may be beneficial in treating scalp psoriasis:

 

Systemics
  • Acitretin
  • Cyclosporine
  • Methotrexate
  • Phototherapy
  • Intralesional corticosteroid injections
Biologics
  • Infliximab
  • Adalimumab
  • Etancercept
Topicals
  • Calcipotriene
  • Topical Vitamin D Analogues
  • Combination topical therapy
  • Salicylic acid
  • Anthralin
  • Coal tar shampoo
  • Tazarotene
scalp psoriasis forehead
scalp psoriasis ear

Hands and Feet

An estimated 12-16% of people with psoriasis have it on their hands and feet. This is called palmoplantar psoriasis and occurs as red or discoloured, dry and thickened skin. It can also cause deep cracks on the soles of feet. This type of psoriasis can significantly impact quality of life as it can limit mobility and impair the use of the hands and feet.

Topicals and phototherapy are common treatments however oral and biologic treatments may also be an option if you have severe psoriasis and are not responding well to other forms of treatment.

Nail Psoriasis

  • Nail psoriasis is a form of psoriasis that occurs when psoriasis arises in the nail bed.
  • Approximately 50% of people living with psoriasis will experience nail psoriasis.
  • It can appear as discolouration of the nail, tiny dents in the nail, fragile nails, blood under the nails, or the nail separating from the finger or toe.
  • Nail psoriasis typically develops in patients who already have plaque psoriasis.
  • Nail psoriasis may also be an indicator of psoriatic arthritis (PsA) so if you suspect you might have nail psoriasis, visit a dermatologist, and see a rheumatologist to screen for PsA.

Some treatments that may be beneficial in the treatment of nail psoriasis include:

Oral and biologic medications are only recommended for nail psoriasis if psoriasis is present in substantial amounts elsewhere on the body and/or if the above treatments have failed.

nail psoriasis hand
nail psoriasis 5 fingers
nail psoriasis 3 nails

Facial

It is estimated that 50% of people living with psoriasis will experience psoriasis on their face. It can occur on the eyebrows, between the nose and upper lip, upper forehead and hairline. Facial psoriasis may also appear around, behind, and in the ears. Symptoms include red or discoloured skin, itching and scaling.

Facial psoriasis must be treated carefully as the skin in this area is sensitive. Topical treatments are most common for facial psoriasis as well as using gentle cleansers and moisturizers. Phototherapy or biologics may also be prescribed if topicals prove to be ineffective.

Genitals

Research states that up to two-thirds of people with psoriasis will experience genital psoriasis at some point in their lives. It is rare for psoriasis to only affect the genitals and will usually be found in other areas of the body. Genital psoriasis can occur on the inner and upper thighs, the crease between the thigh and genital area, the vulva, penis, scrotum, and skin above the genitals.

Inverse psoriasis and plaque psoriasis are the two most common types that affect the genital area. Treatment options include topicals, oral treatments and biologics. Although it is rarely spoken of, genital psoriasis is common and manageable. As embarrassing as it may feel, it’s important to speak with a dermatologist if you have psoriasis in this area to determine the right treatment for you.