Despite a common assumption that psoriasis is simply an external issue with the skin, the cause of psoriasis goes much deeper. The reaction is seen on the surface of the skin, but it is a chronic disease believed to be caused by an overactive immune system. Inflammation is triggered internally which causes the visual symptoms you see on the skin.

Experts have yet to agree on a definitive cause of this reaction, but they do have a good understanding of the process once the overzealous immune response is triggered. Normal skin cells are mistaken as unhealthy, and the immune system initiates the rapid production of new cells. These cells develop up to seven times faster than the normal process, resulting in the abundance of dead skin cells and inflammation that appears on the skin.

What are the Symptoms of Psoriasis?

The overproduction of skin cells results in thick, raised patches of skin. The patches are usually very dry and scaly. The scales are typically a silvery white color and the area is itchy. The presentation will differ depending on the type of psoriasis and the location on your body. Psoriasis can be localized to one area, or you may find it in many areas.

Types of Psoriasis

• Plaque Psoriasis

This is the most common type of psoriasis. It occurs in 80-90% of psoriasis cases, and it results in thick, raised patches of skin called plaques. Plaques are covered in scales, and they form in different sizes. They appear red on Caucasian skin, and a darker purple or brown on skin with color.

The most common areas to find plaques are the scalp, elbows, knees, and torso. However, these itchy patches can be found in any location on the body. They are usually symmetrical. That means they appear in the same areas on both the right and left sides of the body.

Triggers include medications, infections, injury, stress, and tobacco use. Treatments used are topicals, phototherapy, and oral medications.

• Guttate Psoriasis

Guttate psoriasis is identified by the sudden appearance of small red bumps (called papules) on the torso, limbs, face, ears, and scalp. These bumps are small and scaly, but unlike the plaques, they do not result in thick patches. You are likely to see these bumps spaced apart, and they are usually a dark pink color.

This type of psoriasis is temporary and often only appears once. The cause is unknown, but it has been linked to childhood infections and most often appears on children and young adults. Strep throat has been linked to this type of psoriasis. Other triggers include tonsillitis, injury, medication, infection, and stress.

Like other types of psoriasis, guttate is unpredictable and my last a lifetime and trigger other types to appear. Treatment is usually phototherapy or oral medication.

• Inverse Psoriasis

This type of psoriasis is found in folds of skin or any areas where two skin surfaces touch. This includes the armpits, buttocks, under breasts, and the groin. Inverse psoriasis is smooth and lacks the slivery white coating seen on other types, because it is found in areas with moisture. The patches are red on Caucasian skin, and purple or brown on skin of color. These lesions look raw land cause much soreness and pain.

Sweating or skin rubbing can exacerbate inverse psoriasis, and it is more common on people who are overweight. Triggers include medication, infection, injury, stress, tobacco use, alcohol use, and friction. Treatments used are topicals, systemic medications, and powders to keep the skin dry. Dryer skin reduces the risk of fungal infection which is associated with inverse psoriasis.

• Pustular Psoriasis

Pustular Psoriasis is extremely rare, but it can be life-threatening. Skin on most of the body is affected with the generalized type, and it becomes dry, red, and sore. Pus-filled bumps appear and burst in the first 24 hours, then dry up within 48 hours. The dried skin peels away to expose a shiny new surface that will soon repeat the cycle. This type of psoriasis is accompanied by headache, fever, and weakness. Medical attention is paramount to ensuring survival.

Two other types of pustular psoriasis are localized and Acro pustulosis. Localized pustular psoriasis only affects the palms of hands, soles of the feet, base of the thumbs, and sides of the heels. Acro pustulosis affects the tips of the fingers and toes.

Triggers include medication, exposure to an excess of ultraviolet light, infection, stress, and pregnancy. Treatment options are topicals, phototherapy, oral medications, and biologics.

• Erythrodermic Psoriasis

This is another rare but life-threatening type of psoriasis. Skin on most of the body appears burnt, and other symptoms include fever, chills, weakness, rapid pulse, extreme itchiness, edema, erratic body temperature and hypothermia. Erythrodermic psoriasis is often secondary to another form of psoriasis that will not resolve.

Triggers include medication, infection, severe sunburn, stress, and alcohol use. This type of psoriasis impacts your temperature and fluid balance and requires immediate medical attention.

• Nail Psoriasis

Psoriasis is not exclusive to the skin. It can also affect the fingernails or toenails. It is estimated that up to 50% of people who suffer from plaque psoriasis will have problems with their nails. Symptoms of nails psoriasis include indentations, thickening, discoloration (yellow, white, or brown), a crumbling or rough surface, and feeling that the nail is detaching,

Treatments include topicals, intralesional steroids, phototherapy, oral treatments, and biologics. It is best to keep nails trimmed and wear gloves to protect loose nails when you need to work with your hands. Any kind of injury to the nail can worsen nail psoriasis, so it is best to be gentle with nail care and to leave cuticles intact.

• Psoriatic Arthritis

Psoriatic arthritis is a type of arthritis that affects chronic psoriasis sufferers. Arthritis is an inflammation of the joints. Symptoms include joints that are sore or swollen, heel pain, swelling above the heel, and morning stiffness. The joints most affected are those of the fingers and toes.

Symptoms of Psoriasis that Affect More than Skin

Though psoriasis is primarily a condition that is associated with the skin, it also increases the risk of developing other medical issues. The following symptoms may also be linked to psoriasis:

• Eyes: crusty eyelashes, redness, tearing, yellow discharge, dryness, sensitivity, blurry vision, seeing dark spots
• Digestive system: diarrhea, abdominal pain, Crohn's disease
• Weight: psoriasis may cause weight gain, and overweight people are more likely to develop psoriasis
• Mood: anxiety, depression
• Teeth: bleeding gums, receding gums, periodontal disease
• Joints: pain, stiffness upon rising
• Kidneys: fluid retention, less frequent urination, swollen ankles or legs

Why is Psoriasis Commonly Misdiagnosed?

Research studies indicate 600,000 to 3.6 million cases of psoriasis are undiagnosed. This is primarily because psoriasis shares the same symptoms and appearance of other skin conditions. Psoriasis is commonly misdiagnosed as seborrheic dermatitis, atopic dermatitis, lichen planus, ring worm, pityriasis rosea, secondary syphilis, tinea corporis, and even as a drug reaction.

If you suspect you have psoriasis, you should schedule a visit with a dermatologist. Dermatologists can correctly identify the type of psoriasis you are struggling with and work with you to develop the most appropriate treatment plan.

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