Symptoms

The signs and symptoms of the different types of psoriasis are:

Plaque psoriasis

¬  Raised, inflamed, red lesions (plaques) covered in a silvery white scale

¬  Typically found on the elbows, scalp, knees and lower back. They can, however, appear anywhere on the surface of the body.

¬  Plaques are typically itchy, sore (or both).

¬  Skin around the joints may crack and bleed in severe cases.

Nail psoriasis

v  Yellow-red nail discoloring. It likes like a drop of oil (or blood) under the nail plate. Health care professionals sometimes refer to this as an oil drop or salmon patch.

v  Pits in the nails, also known as pitting of the nail matrix. Pitting is the result of the loss of cells from the surface of the nail.

v  Lines across the nails – often referred to as Beau line by health care professionals. The lines go side-to-side, rather than from top-to-bottom. The lines are caused by inflammation of the cells.

v  Leukonychia (midmatrix disease) – areas of white on the nail plate.

v  Subungual hyperkeratosis – the skin under the nail thickens.

v  The nail loosens – health care professionals may use the terms onycholysis of the nail bed and nail hyponychium. Where the nail separates from the skin under it, a white area may develop, starting at the nail’s tip and extending downwards. The skin under the nail (nail bed) may become infected.

v  Nail crumbling – health care professionals may refer to nail plate crumbling at the nail bed or nail matrix. As the structures that support the nail are not working properly, the nail weakens.

v  Splinter hemorrhage – also known as dilated tortuous capillaries in the dermal papillae. These are small black lines that go from the tip of the nail to the cuticle. Tiny capillaries (very small blood vessels) between the nail and the skin under it bleed, causing the lines to appear.

v  Spotted lunula – the lunula is the crescent-shaped whitish area of the bed of a fingernail or toe. It is the visible part of the nail matrix (root of the nail). The lunula becomes red when the capillaries under the nail are congested.

v  Nail changes with arthritis of the fingers – at least half of all patients with psoriatic arthritis experiences nail changes.

v  Onychomycosis – this is a fungal infection of the nails. Sometimes linked to nail psoriasis.

v  Paronychia – inflammation of the folds of tissue around the nail, caused by an infection. It may be a bacteria (staph or strep) or fungal infection. Sometimes linked to nail psoriasis.

Guttate psoriasis  

Sometimes known as teardrop psoriasis or raindrop psoriasis.

Ø  Plaques are usually small, no more than 1cm in diameter.

Ø  Plaques are fairly widespread. They may develop anywhere in the body, except the soles of the feet and palms of the hands. Most commonly affects the chest, arms, legs and scalp.

Ø  Some signs and symptoms of nail psoriasis may also be present.

Ø  Usually occurs after a strep infection (throat infection) and is more common among teenagers and children.

Ø  There is a good likelihood that the guttate psoriasis eventually disappears completely. However, some young patients eventually develop plaque psoriasis.

Scalp psoriasis

ü  Usually affects the back of the head. However, it can occur on the whole scalp, or other parts of the scalp.

ü  Red patches of skin

ü  The red patches are covered in thick silvery-white scales.

ü  Can be extremely itchy (sometimes it isn’t itchy).

ü  Can cause hair loss in severe cases.

Inverse psoriasis (Flexural psoriasis)  

More common among overweight/obese individuals

¬  As opposed to plaque psoriasis, inverse psoriasis is not characterized by scaling.

¬  Inverse psoriasis is characterized by inflamed, bright red, smooth patches of skin.

¬  Can be very itchy

¬  Can be very painful

¬  If the skin rubs together in the folds, symptoms will be aggravated.

¬  Sweating in the skin folds may also aggravate affected areas.

¬  Most commonly affected areas include the armpits, groin, skin between the buttocks, and skin under the breasts.

¬  In obese/overweight patients, there may be symptoms under the belly (where it folds over).

Pustular psoriasis  

A much rarer type of psoriasis. There are three main types, and they affect different areas of the body:

Von Zumbusch psoriasis

Ø  Pustules appear across a wide area of skin

Ø  Pustules develop rapidly

Ø  The pus is made up of white blood cells

Ø  The pus is not infected

Ø  Within a couple of days the pustules dry and peel off, after which the skin is shiny and smooth

Ø  Pustules may appear in cycles of weeks, or even a few days

Ø  At the start of a cycle the patient may experience fever, chills, fatigue and weight loss

Palma planter pustular psoriasis

v  Pustules may appear on the soles of feet or the palms of the hands

v  Pustules develop into round, brown, scaly sports

v  Pustules eventually dry and peel off

v  There may be cycles of recurrence, every few weeks or even days

v  Acropustulosis

v  Pustules appear on fingers and/or toes

v  Pustules burst

v  Burst pustules leave bright red areas that may become scaly, or

v  Burst pustules leave bright red areas that ooze

v  Sometimes symptoms of nail psoriasis appear

Erythrodermic psoriasis  

It is the most uncommon form of psoriasis.

¬  Whole body can be covered with a fiery red rash

¬  There is usually intense itching

¬  There is typically an intense burning sensation

¬  There is widespread inflammation

¬  There is widespread exfoliation (shedding of skin), during which time itching, burning and swelling is more severe.

¬  Body more susceptible to losing proteins and fluid, leading to dehydration and malnutrition (as well as heart failure).

¬  Hypothermia is possible – the patient’s body temperature becomes too low; 35C (95 F) or below.

Psoriatic arthritis

The majorities of patients develops psoriasis first, and are diagnosed with psoriatic arthritis at a later date. However, arthritis may sometimes develop before the skin lesions appear.

ü  Joint pain

ü  Stiffness, especially first thing in the morning, or after resting

ü  Redness, swelling around the affected joints and tendons

ü  Finger(s) swells around the affected joints and tendons

ü  Reduced range of movement at the affected joint

ü  Symptoms of nail psoriasis

ü  Flaking silver patches of skin. Inflammation under the skin, usually red

ü  Iritis – inflammation of the iris. The eye becomes reddened. There may be sensitivity to light.

ü  Uveitis - inflammation involving the uvea - the iris, choroid, and ciliary body (parts of the eye). Symptoms may include redness of the eye, blurred vision, unusual sensitivity to light, and eye pain.

ü  Inflammation of the skin and the symptoms of psoriasis

ü  Spondylitis - inflammation of one or more of the vertebrae of the spine. Inflammation can also occur where ligaments and tendons attach to your spine. Symptoms may include pain and stiffness in the lower back, upper buttock area, neck, and the rest of the spine. Symptoms are usually worse on waking up, or after long periods of inactivity.

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