What Is Psoriasis: Causes, Symptoms, and Treatment

• Psoriasis is a chronic skin condition caused by an overactive immune system. It often manifests as bumps on the skin with white or grey scales on top.
• There are various types of Psoriasis, and it can look similar to other conditions, including eczema and Psoriatic arthritis.
• There is no cure for Psoriasis. The condition is lifelong, but symptoms can be managed through a combination of lifestyle changes and medications. A healthcare provider can help someone create a treatment plan tailored to their symptoms. 

If you experience a persistent red rash that is extremely itchy, psoriasis may be to blame. About 2–3% of people worldwide suffer from psoriasis, an autoimmune condition that affects the skin. Diagnosing this condition can be difficult since it looks similar to other skin conditions, and treatment often consists of managing symptoms. To better understand this condition, let’s look at the most common symptoms of psoriasis, what causes the condition, and treatment options. 

Psoriasis is a long-lasting, chronic condition due to an overactive immune system, causing skin cells to multiply quicker than they should. While psoriasis is a chronic condition, symptoms aren’t always present. Instead, people with psoriasis experience periods where symptoms flare and other periods of remission, where symptoms aren’t present.

Common Symptoms of Psoriasis 

Psoriasis symptoms vary, depending on the type of psoriasis someone has and the color of their skin. During psoriasis flares, common symptoms across psoriasis and skin types include:

• Raised patches of skin referred to as psoriasis plaques or psoriasis lesions 
• Pus-filled bumps
• Dry, cracked skin
• Scaly patches
• Itchiness or burning in affected body parts
• Inflamed skin
• Patches of thick skin

In people with lighter skin, patches and scales are often red. In those with darker skin, patches may be brown or purple, and scaly skin tissue may look grey.

While we often think of psoriasis as an autoimmune skin condition, it can impact other parts of the body. Those with psoriasis often report mental health issues such as trouble sleeping, low self-esteem, or anxiety related to the condition. If psoriasis impacts the scalp, it can lead to dandruff, and psoriatic nails often cause small pits in the nails or discoloration. Severe cases may also result in joint pain.

Developing psoriasis also increases someone’s risk of developing additional health complications, since it’s a chronic condition involving the immune system. Complications include secondary infections (bacterial or fungal infections in skin lesions) and a higher risk for:

• Psoriatic arthritis
• Lymphoma
• Heart disease
• Liver disease
• Musculoskeletal and skin diseases 

Where Psoriasis Occurs on the Body

Psoriasis rash or lesions can show up anywhere on the body. That said, the condition most often affects these body parts:

• Elbows
• Knees
• Nails
• Scalp
• Skin folds in the groin, butt, or breasts
• Lower back
• Palms
• Feet

Psoriasis Classifications (Mild, Moderate, or Severe)

Psoriatic disease can also be classified into mild, moderate, and severe psoriasis. According to the National Psoriasis Foundation, severity is determined based on the body surface area affected and the condition’s impact on an individual’s quality of life and daily tasks. That means mild psoriasis impacts fewer body parts or has a smaller impact on a patient’s overall well-being, while severe psoriasis impacts more of the body and has a larger impact on someone’s day-to-day life.

Psoriasis Common Causes

No one knows exactly why psoriasis develops. Since it’s an immune-mediated disease, someone must first have an overactive immune system to experience psoriasis. Scientists don’t understand what triggers the immune system to become overactive in the first place or why overactivity sometimes targets skin cells. It does, however, appear to stem from a combination of genetic and environmental factors. Common causes linked to psoriasis include:

• Family History: Those who have a family history of psoriasis are more likely to develop the condition themselves.
• Medications: Certain medicines, including ones for malaria, heart disease, and some mental health conditions, can trigger psoriasis.
• Smoking: Smoking is associated with a higher risk of developing psoriasis and more severe symptoms. 
• Weight: Being overweight can induce psoriasis.
• Medical Conditions: HIV and streptococcal (strep throat) can trigger psoriasis.
• Age: Young adults and individuals in their 50s or 60s are the most likely to develop this condition. Psoriasis is particularly prevalent as we age, with up to 19% of those over 65 experiencing psoriasis. As we age, psoriasis is more likely to progress into a more severe form. Older individuals may also have other conditions that exacerbate symptoms or experience more side effects from some psoriasis treatments. 

Common Psoriasis Triggers

Psoriasis symptom flares are often triggered by something internally or in your environment. Common triggers include:

• Stress
• Dry air
• Bacterial or viral infections, like strep throat
• Skin injury
• Insect bites
• Some skin products
• Dry skin 

There are various types of psoriasis. Types differ based on what symptoms are present and where flares appear on the body. It is possible to develop multiple types at once, and treatment options often overlap.

Plaque Psoriasis 

Plaque psoriasis is the most common type, affecting 80–95% of those with psoriasis. It appears as raised patches or bumps on the skin, covered in silvery-white scales. Plaque psoriasis usually occurs on the scalp and limbs, especially knees and elbows.

Inverse Psoriasis 

21–30% of those with psoriasis develop inverse psoriasis, which is when the condition manifests as smooth, red rashes in skin folds. It can appear at any age, and it’s most common in those who are overweight or obese or have deep skin folds.

Guttate Psoriasis 

When psoriasis manifests as small, red dots on the torso or limbs, it may be classified as guttate psoriasis. 8% of individuals with psoriasis develop this type, and it usually starts in childhood or early adulthood.

Erythrodermic Psoriasis

This rare type of psoriasis often leads to a more severe disease where red, scaly patches are found on most of the body. About 2% of those with psoriasis develop this type.

Nail Psoriasis

Nails are considered a high-impact site for psoriasis, with many people experiencing discoloration, pitting (holes in nails), deformation of shape, or increased thickness in fingernails and/​or toenails. While over 90% of those with psoriasis experience some symptoms in their nails, 50% have nail psoriasis, which is when nail symptoms last longer and are more severe.

Sebopsoriasis

When there are red plaques with greasy scales, sebopsoriasis may be to blame. It commonly affects areas that produce sebum (an oily substance that protects the skin) such as the scalp, forehead, sternum, and skin folds.

Pustular Psoriasis

About 3% of people with psoriasis experience pustular psoriasis, which is when there are white or yellow pus-filled bumps on the skin. Usually, these bumps are painful and are more common in people of color. 

Psoriasis, psoriatic arthritis, and eczema are three conditions that affect the skin and are caused by disruptions in the immune system. While similar, they are three distinct conditions:

• Eczema (dermatitis): Refers to a group of inflammatory skin conditions that often present as red skin patches with undefined borders that may ooze. It’s the most common of the three.
• Psoriasis: By contrast, psoriasis often appears as red plaques with scales and often has defined borders around plaques and lesions.
• Psoriatic arthritis: This type of arthritis leads to psoriasis symptoms alongside arthritis symptoms like joint pain, swelling, or stiffness. About 30% of those with psoriasis will develop psoriatic arthritis. It is the least common of the three. 

Since psoriasis is so similar to other skin diseases, a healthcare provider, usually a dermatologist, must diagnose the condition. Usually, they will conduct a physical exam and ask about symptoms. To confirm results, they may order a skin biopsy, which is when they collect a small sample of skin and send it to a lab that analyzes the cells under a microscope.

There is no known cure for psoriasis, which is why treatment focuses on how to manage symptoms. To treat psoriasis, a healthcare provider may recommend:

• Topical treatments: Over-the-counter or prescription strength ointments, lotions, and shampoos.
• Autoimmune medication: Pills or injections that strengthen the immune system.
• Phototherapy: The use of ultraviolet light to treat flares.

The right treatments for psoriasis vary depending on the individual’s severity level and how well they tolerate the side effects of phototherapy, medications, or topical therapy. To develop the right treatment plan, work with a healthcare provider, ideally a dermatologist.

Like other autoimmune diseases, psoriasis treatments work better alongside lifestyle modifications to avoid or soothe triggers:

• Bathe or shower daily, though don’t scrub affected areas too hard as this can cause skin damage
• Take oatmeal baths to soothe the skin
• Keep skin clean and hydrated
• Moisturize more frequently in winter and whenever the weather is dry and cold
• Get sun as vitamin D can help with psoriasis, but remember to wear sunscreen to avoid sunburn
• Practice stress management, since there is a relationship between psoriasis flares and stress levels
• Take any and all medications and treatments as prescribed

Diet & Exercise

While diet and exercise may not seem related to psoriasis, both can help reduce flares. Thanks to exercise’s ability to boost mood and reduce stress, it can help reduce mental health triggers for psoriasis flares. It also helps people maintain a healthy weight. Being overweight or obese is associated with more severe psoriasis flares, and some medications don’t work as well as they would for those in a healthy weight range. 

Diets that reduce inflammation in the body (and help maintain a healthy weight) are also a good choice. While there’s no ​“psoriasis diet,” eat a balanced diet with plenty of vegetables, fruit, lean protein, whole grains, and legumes. Those with psoriasis also have a higher rate of celiac disease than the general population, meaning a gluten-free diet may also help soothe symptoms. 

Psoriasis Questions for Your Provider

Healthcare providers can help with psoriasis management. Most will schedule regular follow-ups to discuss the condition, since conducting regular examinations of the skin helps people stay on top of this condition. Patients can also book appointments with a provider if they notice any changes in their skin. 

At regular check-ups, consider asking a healthcare provider:

• Are there any changes we can make to my treatment plan that may help?
• Those with psoriasis tend to develop other conditions, like heart disease and liver disease, at a higher rate. Is there anything I can do to prevent these conditions?
• Besides medications, what else should I be doing to help manage my symptoms?
• What are other options if my current treatment doesn’t work?
• What should I do if my psoriasis won’t go away?