The early signs and symptoms of psoriasis, and which parts of the body it affects, depend on the type. It is possible to have more than one type of psoriasis occurring at the same time.
Plaque Psoriasis
The most common type of psoriasis, plaque psoriasis accounts for 85 to 90 percent of cases.
Plaque psoriasis usually begins as small bumps on your skin. These bumps grow in groups and can form anywhere on your body, but most often affect the scalp, face, elbows, back, and knees.
As the condition progresses, the bumps form plaques, which are patches of thick skin covered in a silvery-white coating called scales. The color of the patches depends on the color of your skin; they’re typically red or pink on white skin and shades of purple with gray scale on darker skin.
The plaques are often initially round or oval and can connect to form larger plaques. They also are itchy, burning, or even painful, and the scales flake off easily. Scratching the plaque can cause it to flare up with inflammation and to bleed, potentially leading to dangerous infections.
The plaques also flare up in response to specific environmental triggers, ranging from stress to dry air to certain infections — this is another sign you may have plaque psoriasis instead of a simple rash or other skin condition.
Guttate Psoriasis
If instead of scaly patches you suddenly develop small, scaly red dots or lesions on your torso, back, or limbs, you may have guttate psoriasis. Be on the lookout for these symptoms if you have strep throat, which is guttate psoriasis’s most common trigger.
Typically appearing in children to young adults, guttate psoriasis often disappears completely after a few weeks, but some people with it go on to develop plaque psoriasis.
Inverse Psoriasis
You may have this type of psoriasis if you develop smooth, red patches of inflamed skin in the moist folds or creases of your skin, such as in your armpits or groin, under your breasts, or between your buttocks. The patches can be painful and contain cracks or fissures that are itchy or smell bad (or both).
Another sign you have inverse psoriasis is if these patches get worse from friction or sweat.
Nail Psoriasis
Psoriasis can affect your fingernails and toenails, too. You may have nail psoriasis if one or more of your nails starts becoming:
- Pitted with little dents
- Discolored
- Rough and crumbly
- Separated from the nail bed
- Spotted with blood underneath
Nail psoriasis is common in people with plaque psoriasis, but it can also develop on its own.
Psoriatic Arthritis
If you have psoriasis, especially if it’s severe, make sure to pay attention to how your joints feel, as you have an increased risk of developing psoriatic arthritis. In fact, the majority of people who develop psoriatic arthritis already have psoriasis.
Look for these signs:
- A painful, sausage-like swelling of a finger or toe, called dactylitis
- Heel pain
- Swelling in the area just above the heel
- Joint stiffness in the morning
Pustular Psoriasis
In rare cases, psoriasis may present as non-infectious, pus-filled bumps called pustules, which are surrounded by red skin. The pustules are often localized to the hands and feet, but they may also spread to cover your whole body. The pustules usually break open and leak pus within a day, and after another day or two your skin will dry out and peel, revealing a smooth surface. The cycle may repeat itself after a few days or weeks.
Pustular psoriasis can be serious and life-threatening. If you have it, you will feel very sick and may develop:
- Fever
- Headache
- Muscle weakness
- Joint pain
Anyone with symptoms of pustular psoriasis should seek immediate medical attention.
Erythrodermic Psoriasis
If your psoriasis appears to be worsening or is unresponsive to treatment, it could be an early sign that you are developing erythrodermic psoriasis. This rare and life-threatening condition is marked by whole-body skin inflammation that’s severely itchy, red, and painful (it may look like the skin is burnt). Other symptoms such as chills, fever, and muscle weakness are also possible.
Anyone with symptoms of erythrodermic psoriasis should seek immediate medical attention.
