Psoriasis is a chronic autoimmune skin condition that affects around 125 million people worldwide. Its main feature is rapid skin cell turnover. This leads to the formation of thick, scaly and inflamed patches on the skin that most people usually recognise as what Psoriasis looks like. Although it is not contagious, it can be physically uncomfortable and emotionally distressing. In this article we’ll explore the different types of skin psoriasis, its causes and the best treatment options.
What is Skin Psoriasis?
This is a lifelong autoimmune skin condition that speeds up the production and shedding of skin cells. Psoriasis leads to the accumulation of thick scaly patches on the skin. Although it can develop anywhere on the body, it most commonly affects the scalp, elbows, knees, lower back and nails. Psoriasis also varies in what it looks like and severity. As such, some people can experience occasional mild flare-ups whilst others struggle with persistent widespread symptoms. Depending on the symptoms, this condition can significantly impact a person’s quality of life.
To complicate matters further, there are several different types of psoriasis each with its own distinct features. However, there are some common signs of psoriasis that can help identify the condition:
- Red inflamed patches of skin covered with silvery-white scales: This is the most recognisable feature of psoriasis and the patches most commonly appear on the scalp, elbows, knees and lower back. These plaques can itch, burn, crack and bleed.
- Dry cracked skin that may itch, bleed or feel sore: Psoriasis disrupts the skin barrier, making it prone to dryness, irritation and increased sensitivity to the environmental.
- Thickened, discoloured or ridged nails: Nail psoriasis can cause pitting, yellow-brown discolouration, thickening or even separation from the nail bed. This makes the nails brittle and prone to crumbling.
- Small, red and teardrop-shaped lesions: These tiny red spots often appear on the torso, arms and legs which you see in guttate psoriasis. They commonly present after a bacterial infection like strep throat.
- Smooth shiny red patches in skin folds: Most common in inverse psoriasis, these patches appear in areas like the armpits, groin, under the breasts and around the genitals.
- White pustules on red swollen skin: These are a key feature of pustular psoriasis. Here fluid-filled blisters form on inflamed skin. They usually affect the hands and feet but in severe cases can spread across the body.
Types of Psoriasis on the Skin
As mentioned earlier, psoriasis presents in different forms each of which has its own triggers, severity and appearance. Recognising the specific type of psoriasis is key to finding the most effective treatment and preventing flare-ups. Below are the different types of psoriasis and how they look:
- Plaque: This the most common type and affects around 90% of people with psoriasis. It appears as thick, inflamed red patches covered with silvery-white scales. Plaque psoriasis typically presents on the elbows, knees, scalp and lower back. These plaques can be itchy, painful, and prone to cracking or bleeding especially during flare-ups. Common triggers include stress, infections, cold weather and certain medications.
- Guttate: More commonly seen in children and young adults, this type presents as small, red, drop-like spots. They usually appear across the torso, arms and legs. The trigger for gutatte psoriasis is usually bacterial infections (particularly strep throat). It may resolve on its own or develop into chronic plaque psoriasis.
- Inverse: This appears in skin folds such as the armpits, groin, under the breasts and genitals. Instead of scales, it presents as smooth, shiny red patches, which can become sore, irritated and worsened by sweat and friction. The most common triggers are obesity, fungal infections and hormonal changes.
- Pustular: Whilst rare, this severe form usually presents with white pustules (blisters of sterile pus) on red swollen skin. It can be just on the hands and feet (palmoplantar pustulosis) or widespread (generalised pustular psoriasis). The latter always requires immediate medical attention. Triggers include medications, infections, pregnancy and sudden withdrawal from corticosteroids.
- Erythrodermic: This is the rarest but most severe type of psoriasis. It affects large areas of the body and causes intense redness, peeling and burning skin. It can cause severe itching, pain and difficulties regulating body temperature. Erythrodermic psoriasis usually requires hospital treatment. Usual triggers are severe sunburn, infections or adverse reaction to medications.
- Nail: As per the name, this affects the fingernails and toenails. This form causes pitting, thickening, discolouration and separation from the nail bed. It can be linked to psoriatic arthritis, which causes joint pain, stiffness and swelling in addition to skin symptoms.
Causes & Triggers
Psoriasis is a complex skin condition with the look and severity of it influenced by a number of internal and external events. Although the exact cause remains unknown, researchers believe that a combination of factors can lead to flare-ups and worsening symptoms. Below are the main causes and triggers associated with psoriasis:
- Immune System Dysfunction: Psoriasis is an autoimmune skin condition which occurs because the immune system mistakenly attacks healthy skin cells. This disrupts normal skin cell renewal and leads to inflammation, scaling and plaque formation.
- Genetic Predisposition: Certain gene mutations are associated with an increased risk and having a close relative with psoriasis raises the likelihood of experiencing symptoms. However, not everyone with a genetic link to psoriasis will develop the condition.
- Environmental Triggers: Even if someone is genetically predisposed, psoriasis symptoms often remain dormant until triggered by external factors. Stress is one of the most significant external triggers and many people notice their symptoms worsen during periods of emotional or physical strain. Infections, such as strep throat, can lead to guttate psoriasis or exacerbate other types. Medications like beta-blockers, lithium and anti-malarials, have also been linked to worsening psoriasis or triggering new outbreaks. Weather (especially cold and dry conditions) can strip moisture from the skin, making symptoms more severe and persistent. Smoking and alcohol are also known to increase both the frequency and intensity of episodes especially in chronic plaque psoriasis.
Psoriasis Treatments
Unfortunately, there is no cure for psoriasis so treatment focuses on managing symptoms, reducing flare-ups and improving overall skin health. The best approach depends on the type and severity of psoriasis as well as what it looks like. The key treatment options for psoriasis at the moment include:
- Topical Treatments: These are the first-line treatments for mild to moderate psoriasis. They include corticosteroid creams, vitamin D analogues (calcipotriol), coal tar and salicylic acid. These treatments can help reduce inflammation, scaling and itching to improve skin texture and comfort.
- Phototherapy: Narrowband UVB light therapy is often used for moderate to severe psoriasis. Controlled exposure to ultraviolet (UV) light can slow skin cell growth, reduce inflammation and improve the overall look of skin lesions particularly in widespread or stubborn cases.
- Systemic Medications: For severe or treatment-resistant psoriasis, doctors may prescribe oral or injectable medications that target the immune system in the form of biologic or immunesuppressing drugs. Biologic drugs (e.g. adalimumab, etanercept, secukinumab) work by blocking specific immune pathways involved in psoriasis to reduce inflammation and flare-ups. Immunosuppressants (e.g. methotrexate, cyclosporine) help suppress overactive immune responses to prevent excessive skin cell turnover and inflammation.
- Lifestyle & Skincare: Identifying and avoiding triggers (such as stress, certain foods, or cold weather) can help reduce flare-ups. Additionally, using a supportive skincare routine which contains lots of moisturising and gentle exfoliation may also support long-term management.
Psoriasis is a chronic skin condition that affects may people around the world and can be managed with the right treatment plan and lifestyle adjustments. Finding the best treatment options start by understanding the different types of psoriasis and its triggers. However there is no one size fits all treatment and it may take trial and error to find the right combination of therapies for your skin. That’s why if you are struggling with psoriatic skin symptoms, its key to consult with a dermatologist who can help you find the best treatment for you.
