Psoriasis: Types, Symptoms & Triggers

Psoriasis is a chronic skin disease causing red, itchy patches with white, silvery scales depending on the severity. This autoimmune condition, usually hereditary, puts a certain type of white blood cells known as leucocytes on high function mode making it over develop skin cells up to ten times. These skin cells surface to the top level much faster than the normal skin development cycle works and hence, expose the lesions causing itching and irritation.

There are different types of psoriasis: plaque, guttate, pustular, erythrodermic, inverse, scalp, nails and psoriatic arthritis that may affect different parts of the body. In order to have a proper treatment, it is very important to know the type of psoriasis one is suffering from.

Psoriasis is often triggered by physical and psychological exhaustion, leading to stress situations for the body and mind. An erratic lifestyle, high-pressure work situations, personal life issues could act as a trigger if the individual continues to be stressed over a prolonged period.

During winter, when the skin is most likely to dry up faster, in general, psoriatic patients have a harder time dealing with the condition due to constantly drying skin. Living in or visiting places with low or no humidity can cause flare-ups as the skin does not receive any moisture from the air and in turn dries much faster.

Types of Psoriasis

Types of Psoriasis are as follows:

Plaque Psoriasis

This is the most common form of psoriasis characterized by excessive plaque production on the skin. Usually, this form develops on knees, elbows, face, ears, and back. It starts like a general rash, and most likely won’t go away with regular rash ointments. The rash will be very peculiar – red, scaly, raised skin patches with defined edges. These exposed lesions are red, itchy and sometimes could bleed due to excessive drying of the skin or scratching. If these patches grow, two could merge into a larger one. If the scalp is affected, dandruff-like white scales will be visible. Psoriatic nails are a possibility where the nail starts chipping and in certain cases is uprooted from the nail bed.

Triggers include:

Stress, infections that directly affect the immune system

Skin injuries leading to the Koebner effect, due to vaccinations, scratches or sunburns

Anti-malarial medicines, beta blockers, lithium or strong topical steroids

Other Factors –Diet, dry climate, and allergies may also trigger plaque psoriasis

Guttate Psoriasis

Small, red spots on trunks and limbs are another form that is common amongst people under 30. It can also appear on the ears, face, and scalp. Usually, in hundreds, these red spots are small and distinct. They do not cover large areas. These lesions are not as thick as the ones in plaque. A person who is a strep carrier and has inherited psoriasis can see outbreaks during a cold or strep outbreak.

Triggers include:

Stress, respiratory problems and Streptococcal infections

Tonsillitis, injury to skin

Anti-malarial and beta blocker medications

Pustular Psoriasis

Primarily affecting adults, it is characterised by white blisters or pustules with non-infectious pus and red skin around the pustules. The pus is white blood cells and hence is not infectious or contagious, unlike popular belief. The skin becomes red and creates pustules or blisters over the affected area. This eventually leads to scaling of the skin. It causes itching and pains in the affected areas.

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Triggers include:

Infections, Systematic steroids

Withdrawal from systematic medicines or topical steroids

Emotional and mental stress

Overexposure to UV light

Pregnancy

Internal medications and irritating topical lotions

Erythrodermic Psoriasis

Considered as one of the most dangerous forms of psoriasis, this form covers large skin surfaces with red patches generally co-existing with pustular psoriasis. It is also common in individuals suffering from unstable plaque form where the lesions are undefined.

Triggers include:

Emotional stress

Sudden withdrawal of systematic steroids

Infection and allergies

Alcoholism

Sore sunburn and skin injuries that induce the Koebner phenomenon

Inverse Psoriasis

This form usually appears in the folds of the skin like underarms, groin, and under the breasts. This is can be particularly uncomfortable as these are primary areas of sweating and tend to have tender skin. It appears as large red lesion-like patches but without the scales. It is smooth looking and covers large areas in the folds of the skin.

Triggers include: Common in overweight people, due to more folds on the skin, this form of psoriasis could be triggered by any of the causes of other types.

Nail Psoriasis

When the nails start chipping, develop an uneven surface or are uprooted from the nail bed during flare ups, it is characterized as nail psoriasis. This is commonly paired with one of the other types like plaque or scalp. Symptoms include uneven texture of nails, chipping of nails and uprooting from nail bed.

Triggers include: While there are no separate symptoms for nail psoriasis, it coexists with another type like plaque or guttate when the outbreak is high.

Scalp Psoriasis

Presence of dandruff-looking flakes on the scalp could be psoriasis. The scalp is also skin and just like any other area it could be affected. Almost 50% of the people suffering from any type of psoriasis have presence of it on the scalp.

It begins with light, thin scales or dense and thick scales. From isolated areas on the scalp it could extend to the entire scalp, forehead, neck and ears.

Triggers include: Similar to nail psoriasis, the scalp also does not have individual triggers, however, it is commonly paired with plaque or guttate psoriasis and can continue to spread.

Psoriatic Arthritis

People suffering from psoriasis, are likely to develop psoriatic arthritis between the ages of 30 to 50 which causes inflammation, swelling and pain in and around joints. The statistics say about 30% of the people affected with psoriasis have psoriatic arthritis.

It is important to diagnose and start treatment for it at the earliest as a delay of even six months could permanently damage the joints. The severity of the psoriasis is not directly related to the severity of psoriatic arthritis.

Triggers include:

Along with immunity, psoriasis outbreaks also affect the joints. Obesity, no form of exercise, and ignorance of psoriasis can lead to the joints experiencing symptoms of psoriatic arthritis.

Symptoms of Psoriasis

Swelling, inflammation and pain in and around joints

Stiffness or locking of joints

Fatigue and limited movement

Swelling of fingers and toes

Reddening of eyes, similar to conjunctivitis

Stiffness and exhaustion in the morning

Tenderness of tendons

Psoriasis and Depression

Psoriasis patients are also likely to show symptoms of depression. The unappealing appearance of the lesions tends to draw unwanted attention and could negatively affect the patient’s self-esteem and confidence. At such times, it is vital for the family and friends to provide understanding and support to the person.

It is important to note that every person affected cannot be treated with the same medication. Since each person has a different working of the immune system, the type of treatment that may work will vary.

Sometimes, a trial and error method is used for treating psoriasis. It is advised to consult a dermatologist immediately in case you encounter any of the symptoms.

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