How to Tell If It's Psoriasis

The classic symptoms of psoriasis are raised, red patches of skin topped with loose, silvery scales, usually on the knees or elbows.

There are several types of psoriasis. Symptoms for each type may vary in severity and appear in a wide array of combinations. In general, the major symptoms of psoriasis include:

• Bright red areas of raised patches (plaques) on the skin, often covered with loose, silvery scales. Plaques can occur anywhere, but commonly they occur on the knees, elbows, scalp, hands, feet, or lower back. Nearly 90% of people with psoriasis have plaque-type psoriasis.¹
• Tiny areas of bleeding when skin scales are picked or scraped off (Auspitz's sign).
• Mild scaling to thick, crusted plaques on the scalp.
• Itching, especially during sudden flare-ups or when the psoriasis patches are in body folds, such as under the breasts or buttocks.
• Nail disorders. Nail disorders are common, especially in severe psoriasis. Nail symptoms include:
  • Tiny pits in the nails (not found with fungal nail infections).
  • Yellowish discoloration of the toenails and sometimes the fingernails.
  • Separation of the end of the nail from the nail bed.
  • Less often, a buildup of skin debris under the nails.

Other symptoms of psoriasis may include:

• Similar plaques in the same area on both sides of the body (for example, both knees or both elbows).
• Flare-ups of many raindrop-shaped patches. Called guttate psoriasis, this condition often follows a strep infection and is the second most common type of psoriasis. It affects less than 10% of those with psoriasis.¹
• Joint swelling, tenderness, and pain (psoriatic arthritis).

Koebner's phenomenon can occur when a person with psoriasis has an injury (such as a cut, burn, or excess sun exposure) to an area of the skin that is not affected by psoriasis. Psoriasis patches then appear on the injured skin or any other part of the skin from several days to about 2 weeks after the injury. Because this response is common, it is important for people who have psoriasis to avoid irritating or injuring their skin.

Several other skin conditions have symptoms similar to psoriasis. Some medicine reactions can cause symptoms (such as reddened skin) similar to psoriasis. Talk to your doctor about the medicines you are taking.

Psoriasis is usually long-lasting, returns often (chronic), and can be unpredictable. Symptoms may come on suddenly (flare) and then improve and go away (remission). This cycle continues over and over. In some cases, psoriasis may go away without treatment. But in moderate to severe cases, it is best to treat psoriasis so that it does not get worse.

Several factors can make the condition worse, depending on the type of psoriasis. These factors include cold, dry climates; stress; infection; skin injury; and certain medicines.

The severity of psoriasis is indicated by the amount of redness and scaling, the thickness of the large areas of raised skin patches (plaques), and the percentage of your skin that is affected.

Mild psoriasis causes plaques that cover a small portion of the body, such as the elbows or knees.

Moderate psoriasis causes:

• Several large areas of plaque. For example, most of the scalp may be affected.
• Plaques that may cover up to 20% of the skin (about equal to having both arms completely covered).
• Mild joint pain that is not disabling.
• Concern about plaques being visible to other people.

Severe psoriasis includes:

• Plaques that may cover large areas (20% to 30%) of the body. When determining the percent of coverage, consider that the palm of your hand equals about 1% of your body surface, and the total surface of both arms equals about 20%.
• Psoriasis on the face.
• Pustular psoriasis with large, fluid-filled plaque and severe scaling, or erythrodermic psoriasis with severe inflammation and shedding (sloughing) of the skin.
• Psoriatic arthritis, which includes ongoing joint swelling, tenderness, limitation of range of motion, or joint warmth or redness. Severe cases can result in joint destruction.

Psoriasis may persist for long periods of time without getting better or worse.

Psoriasis can cause a lot of stress and lowered self-esteem. In one study, people with psoriasis reported problems doing everyday activities similar to problems reported by people with cancer, arthritis, heart disease, depression, and other serious conditions.² You can get specialized treatment and emotional support from psoriasis day care centers. For more information on available resources, see the Other Places to Get Help section of this topic.