What Are The Different Types of Psoriasis? – HealthCentral.com

On this page:BasicsPlaque PsoriasisScalp PsoriasisNail PsoriasisGuttate PsoriasisInverse PsoriasisPustular PsoriasisErythrodermic PsoriasisPsoriatic Arthritis

With 125 million people in the world who have psoriasis, chances are you know someone who has the condition. But what you may not know is that there are several types of the chronic skin disease. They tend to get lumped in with the most common one: plaque psoriasis, which accounts for a whopping 80% of all cases. But there are six others that look, act, and may even be treated differently than the rest. Knowing which one you have can help you get better, faster.

For the most up-to-date info on the types of psoriasis, we reached out to top skin doctors across the country.

Red, scaly, painful patches or bumps on your skin are the telltale signs of this inflammatory skin condition. It happens when your skin cells turn over at a way-too-fast rate (10 times faster than normal), causing a pile up of cells on the skins surface that form those angry, red patches, or plaques. Why this happens isnt so clear, but researchers believe psoriasis is caused by a mix of genetics, an overactive immune system, and triggers such as bacterial infection, skin trauma, smoking, medications, and obesity, just to name a few.

As we mentioned above, there are seven different types of psoriasis:

Theres also psoriatic arthritis, a combo of psoriasis and arthritis. Heres what you need to know about the causes and treatments for each one.

This is the type youre probably thinking of when someone mentions psoriasis. Its characterized by clearly demarcated, raised, red, scaly patches called plaques that appear most commonly on your elbows, knees, scalp, and back (but they can pop up anywhere on the body).

Because it accounts for 80% of all cases, plaque psoriasis tends to get the most press. Its the type addressed in most psoriasis drug commercials, and celebs including reality star Kim Kardashian and singer Cyndi Lauper have both been vocal about being plagued with plaques.

The cause for all cases of psoriasis stems from a combo of genetics, immune dysfunction, and triggers. People who have psoriasis are also more likely to have other inflammatory diseases such as Crohns disease, heart disease, or diabetes, suggesting some link between the underlying inflammation.

A study in Archives of Dermatology that looked at over 100,000 patients with psoriasis found those with severe psoriasis had a 46% greater chance of having diabetes than those without the skin disease.

There are several treatments that target plaques. Your physician will decide which one is right for you based on your general health, any underlying conditions, and the severity of your plaque psoriasis. Your options include:

Research suggests that biologics for psoriasis might help with those other inflammatory diseases linked to the skin condition, too. A study in Cardiovascular Research found that treating psoriasis with biologics helps reduce the plaque buildup in the arteries, which leads to heart attacks and strokes.

However, once your skin plaques disappear, youre not necessarily in the clear. Exposure to your triggers can bring on a new bout of plaque psoriasis. Only 10% of people are lucky enough to have whats called spontaneous remission, when your skin clears up forever and you never have a flare up again.

If youre scratching your head over an itchy scalp condition that wont clear up with a traditional dandruff shampoo, you may have scalp psoriasis. This type can go hand-in-hand with plaque psoriasis (see above), or even appear in those who dont have any history of the skin disorder at all.

Its often confused with dandruff, because, well, it itches and causes flakes, only these flakes are typically silvery-white and scaly. You might also have painful red scales or silver plaques on your head. In severe cases, scalp psoriasis appears as thickened, crusty patches of skin not only on the hairline, but also on the forehead, back of the neck and near the ears.

Unlike dandruff, scalp psoriasis doesnt come and go with the weather, hormonal fluctuations, or changes in hair products. The cause is the same as other types of psoriasis: an overactive immune system, genetics, and triggers such as stress and certain medications. But in this case, the plaques that show up may only show up on your scalp.

Mild cases can be nipped in the bud or improved with salicylic-, coal-tar-, or clobestasol propionate-containing (a topical steroid) shampoos. More severe cases may require systemic or biologic drugs, oral treatments, light therapy, or a combination of treatments. Unfortunately, you may lose some hair with some of these treatments, which is usually temporary.

If youve nailed it with psoriasis, then you know all too well that this type brings pitted, discolored, thickened, and even deformed fingernails and/or toenails. In severe cases, the nail plate can lift from the nail bed and you may see some gunk or even blood in between.

Of all the people who have some type of psoriasis, up to 50% will also have nail psoriasis. Like scalp psoriasis, it often comes along with plaque psoriasis, but it can also accompany other types or appear all on its own, too. Those with psoriatic arthritis will have an 80% chance of having nail psoriasis, too.

The same underlying causes as plaque psoriasis are at play here, too, revving up your skin cell production. Nails are considered part of the skin (theyre literally made up of skin cells), which is why they are also affected by the disease.

Typically, mild cases are treated with topical ointments rubbed into the nails such as:

More severe cases might require:

This type doesnt bring large plaques, but instead little red bumps smaller than a fingertip. You can wind up with hundreds of them scattered on your arms, legs, and torso.

About 10% of all psoriasis cases are the guttate type. You can have a mild case with just a few spots in one area, a moderate case that covers up to 10% of your body, or a severe breakout that leaves most, or even all, of your body covered in bumps.

This type often stems from a bacterial infection such as strep throat, an upper respiratory infection, or tonsillitis. There is also a genetic component. If a family member has had guttate psoriasis, youre more likely to get it, too.

Because guttate psoriasis is commonly triggered by infections, once you treat the infection, the psoriasis usually goes away, too. If the skin condition lingers, or you have a severe case, your physician may want to treat your symptoms with topical steroids and/or phototherapy, artificial UVB light that halts the inflammatory process.

This type affects fewer than 10% of people with psoriasis. Its called inverse psoriasis because it appears in unusual places such as the groin, armpits, bellybutton, genitals, under the breasts and behind the knees. Often, its accompanied by one of the other types of psoriasis listed here.

The same underlying culprits can lead to this type, only its brought on by sweat and friction. Thats why its commonly found in areas where there is skin-to-skin rubbing and moisture. Weight seems to be a factor, too. If youre overweight, youre more likely to have skin folds, prime spots for inverse psoriasis.

The gold standard is typically topical steroids and ointments in those vulnerable spots where moisture and friction are likely. If those dont work, phototherapy, and systemic treatments are an option.

As the name implies, this type causes pus-filled bumps. These white spots can appear anywhere on your body, but most commonly the hands and feet. The bumps come on suddenly and look infected, but theyre not.

The real danger here is damage to the skins barrier, the outermost protective layer of your skin. That means your skin cant retain water or nutrients, while also allowing bacteria and other irritants to get a fast pass into your body. As a result, in some cases, pustular psoriasis can be deadly, so make an appointment with your doctor asap, if you develop it.

There are a few sub-types of pustular psoriasis:

At the risk of sounding like a broken record, genes are to blame. But researchers have dug deeper and discovered a specific gene mutation that may be responsible for pustular psoriasis.

A study in the American Journal of Human Genetics IDd the gene AP1S3. If you have this particular genetic predisposition, the triggers for pustular psoriasis are often infection, stress, hormonal changes such as pregnancy, and exposure to chemicals. Also, certain drugs such as OTC pain relievers and anti-inflammatory drugs, penicillin, and some antidepressants such as lithium can trigger a flare. Stopping a course of steroids too fast can bring on a flare of pustular psoriasis, too.

Your doctor may prescribe a topical retinol or an immune-suppressing biologic such as Remicade (infliximab) to calm inflammation and stop the bumps. In severe cases, you may get a combo of a biologic and an oral immune-calming med such as Trexall (methotrexate) to get it under control.

The rarest of all psoriasis types, erythrodermic psoriasis affects only 2% of those with psoriasis. This type causes redness from head to toe, as if your skin has been burned. Even worse, its possible that your skin could peel off in sheets.

As with the pustular type, erythrodermic psoriasis severely compromises the skins protective barrier, so swift medical attention is a must. You can also develop fever, chills, swollen, painful joints, and rapid heart rate.

This type can be triggered by a bad sunburn, an infection, drug reaction, stopping a medication too abruptly, steroid use, stress, and alcoholism.

Your doctor will likely start with an immune suppressant. To soothe your sore skin, you may be prescribed topical steroids, itch-suppressing medications, or prescription pain treatments.

An estimated 30% of people with psoriasis also have or will develop psoriatic arthritis, or PsA, a chronic autoimmune condition that affects 2-3% of the population. While psoriasis affects the skin, psoriatic arthritis affects the joints and some parts of the body where ligaments and tendons are attached to the bone, particularly in the fingers, toes, wrists, knees and spine. The result is stiffness, swelling, pain and, if not caught early, irreversible damage, which is why early diagnosis and treatment are important.

PsA is an autoimmune disease. That means your immune system gets its messages mixed up and attacks healthy tissue, in this case, of your skin and joints. Youre also more likely to develop PsA if you have a family history of it (40% of people who have it also have a family member who has it, too), you already have psoriasis, and youre between the ages of 30 and 50.

If you have this condition, youll want to see a rheumatologist, a doctor who specializes in arthritis. Treatments can range OTC non-steroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) to disease-modifying antirheumatic drugs (DMARDs), including methotrexate, that work by slowing your immune system and your bodys inflammatory response. If those dont work, biologics may be considered.

Both can be itchy and cause shedding onto your hair, clothes and furniture. But the similarities stop there. Scalp psoriasis, like plaque psoriasis, is an autoimmune disease that is usually chronic and incurable. On the other hand, dandruff can go away on its own or be treated with a mild dandruff shampoo (if its caused by dry weather, for instance) and doesnt require medical attention.

Yes. In fact, keeping nails clean and trimmed and not biting them can help, and the cosmetic benefit can make you feel better about your nails. Be sure to tell your manicurist you have psoriasis because its easily mistaken with a fungal infection, which is contagious. One tip: Avoid long soaks. It robs your nails of moisture and that can make your nail psoriasis worse.

Around 85% of people develop skin psoriasis first or at the same time as psoriatic arthritis. Only about 15% get arthritis symptoms before the skin disease. Psoriasis is most likely to develop between 15 and 35 years old, while psoriatic arthritis shows up between ages 30 and 50.

For some people, guttate psoriasis, characterized by spotty, scaly lesions on arms, legs and torso, may come once and never return. It is commonly triggered by infections, like a common cold or strep throat. Once you treat it, it may be gone for good.

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What Are The Different Types of Psoriasis? - HealthCentral.com