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Types of Psoriasis
Which one do you have?
When you have psoriasis, it may seem that there's only one type: the red, scaly, uncomfortable kind. But dermatologists know that there are several types of psoriasis—each with different, identifiable symptoms and levels of severity. Because different types of psoriasis may call for different treatments, it is important to know which kind you have.
Psoriasis vulgaris
Most likely, this is the kind of psoriasis you have. Also known as "plaque psoriasis," it is the type that affects 80% to 90% of people with the disease. Psoriasis vulgaris can be recognized by the presence of raised, red, scaly patches (or "plaques"), usually on the elbows, knees, scalp, chest, nails, and lower back. These may vary in size—from smaller than a dime to larger than a Frisbee®. The scales may be thick and silvery.
Guttate psoriasis
This form is less common; only about 10% of patients have this type. Guttate psoriasis often appears after someone  suffers from strep throat (a throat infection caused by streptococcus bacteria). It commonly starts in childhood or adolescence with the sudden appearance of drop-sized patches (guttate means drop-like). These lesions may spread to cover large areas of the upper body, legs, arms, and scalp.
Pustular psoriasis
This is a rare form of psoriasis. It may be localized (usually appears on the palms of the hands and the soles of the feet), or generalized over the entire body.
Localized pustular psoriasis can be quite painful, making it difficult to use your hands or walk normally. Most commonly, skin becomes red and swollen, with small, pus-filled pimples that dry to form brown dots; some people may have scaly patches. Because of its location on the hands and feet, localized pustular psoriasis may require the use of gloves or plastic wrapping during conventional treatment with topical creams. Generalized pustular psoriasis is extremely rare, and more severe. Skin may be covered with blisters of pus. While these are not infectious, patients may feel ill and run a fever. The causes of generalized pustular psoriasis vary. They include infections, sunburn, and medications such as lithium and systemic cortisones (corticosteroids such as prednisone). It can even be caused by the abrupt discontinuation of medications.
Inverse psoriasis
This form is also called skin-fold, flexural, or genital psoriasis, because smooth, red, dry patches often occur in the folds of the skin (known as flexures). Inverse psoriasis may concentrate in the genital area, as well as under the breasts and in the armpits, and is more common in people who are overweight. It is characterized by increased sensitivity to friction and sweating. The affected skin can cause great discomfort, and this can make sexual relations difficult.
Erythrodermic psoriasis
Also known as exfoliative psoriasis, this is a form of psoriasis that covers almost the entire body. It is characterized by severe redness and scaling, which is often accompanied by itching and pain. Because symptoms are so widespread over the body, this form can be extremely serious. Erythrodermic psoriasis can cause the body temperature to fluctuate, especially in extremely hot or cold weather. It can also complicate heart disease and cause heart failure, because the heart rate may accelerate due to increased blood flow to the inflamed skin.
Psoriatic arthritis: a related condition
Psoriatic arthritis is an arthritic condition—a condition related to the joints. The most common symptoms are inflammatory arthritis, and dry, scaly, thick, and inflamed skin. However, the skin symptoms and the arthritis symptoms frequently appear at different times, often years apart, so their connection may not be obvious. Psoriatic arthritis usually involves the joints of the hands and feet, knees, and ankles, which can become painful, swollen, hot, red, and stiff. Pain and stiffness can also develop in the lower back, buttocks, neck, and upper back. Psoriasis skin symptoms may include pitting and ridges in the fingernails and toenails. Nearly one quarter of people with psoriasis have psoriatic arthritis.
Psoriasis: it can change over time
Sometimes, psoriasis starts as one type, and evolves into another. If you notice a significant change in your symptoms, or if you have any questions about which type of psoriasis you may have, talk with your dermatologist.
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