• There are five main types of skin psoriasis: plaque, guttate, inverse, pustular, and erythrodermic.
• The symptoms a person develops and where on the body they appear depends on which type (or types) of psoriasis they have.
• A type of psoriatic disease called psoriatic arthritis (PsA) can affect a person’s joints, and it’s possible to develop PsA if you don’t have any form of skin psoriasis.

Psoriasis is an inflammatory skin condition caused by an overactive immune system. There are five main types of skin psoriasis — plus psoriatic arthritis, which affects the joints. Health care providers identify psoriasis types by their symptoms. It is possible to have multiple types of skin psoriasis at one time, or one type of psoriasis may change into another type. Psoriatic arthritis can also develop alone or with skin psoriasis.

Locations of Psoriasis on the Body

Different types of psoriasis can form on any area of the body. The location of psoriasis determines the kinds of treatments your dermatologist will prescribe.

Facial Psoriasis

Facial psoriasis is common, affecting around 50 percent of people with the condition. Facial psoriasis can be found on the upper forehead, around the eyes and eyebrows, and on the skin between the nose and upper lip.

Psoriasis can also occur in and around the ear. In some cases, scaling can build up in the ear canal and lead to hearing loss. If this occurs, do not use objects to remove the scaling, and consult your doctor.

Scalp Psoriasis

Scalp psoriasis affects 45 percent to 56 percent of people living with psoriasis. It commonly forms along the hairline and on the scalp, forehead, skin around the ears, and back of the neck. Scalp psoriasis can look like dandruff or appear as thick plaques that cover the scalp.

Scalp psoriasis may also be mistaken for another skin condition called seborrheic dermatitis — however, plaques from seborrheic dermatitis are greasy and yellowish, whereas scalp psoriasis plaques are white and more flaky.

Hand, Feet, and Nail Psoriasis

Psoriasis can also form on the skin covering the hands and feet — known as palmoplantar psoriasis (PPP). About 12 percent to 16 percent of people living with psoriasis will develop psoriasis on their hands or feet. PPP can have a great impact on quality of life, as expected for a disease affecting hands and feet.

Nail psoriasis is also a common condition, affecting around 50 percent of those with psoriasis. It typically affects the fingernails more than the toenails, and it can even be an indicator of psoriatic arthritis.

Genital psoriasis typically develops in people who have psoriasis on other parts of their body. Almost two-thirds of people with psoriasis will have genital psoriasis at some point in their lives. The skin in this area is extremely sensitive, so it is important to find a safe, effective treatment with the help of your dermatologist.

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Genital psoriasis can affect several areas around the genitals, including:

• Inner and upper thighs
• The crease between the thigh and genital area
• The skin above the genital area
• The vulva, scrotum, or penis
• The crease between the buttocks

Types of Psoriasis

There are five main types of psoriasis:

• Plaque psoriasis
• Guttate psoriasis
• Inverse psoriasis
• Pustular psoriasis
• Erythrodermic psoriasis

Each type can be found in various locations on the body and is treated differently.

Plaque Psoriasis

The most common type of psoriasis — plaque psoriasis — makes up 80 percent of psoriasis cases. Also called psoriasis vulgaris, plaque psoriasis typically affects the elbows, knees, back, torso, and scalp, but it may appear elsewhere. The condition is characterized by plaques (thick patches) of skin that can crack or bleed where the skin bends at joints.

On lighter skin, plaques are often covered with silver or white scales caused by the buildup of dead skin cells. On darker skin, plaques may be thicker, with gray, purple, or brown coloring. Plaques can become inflamed, causing intense itching, burning, and soreness.

Topical therapies like creams, ointments, and moisturizers are commonly used to treat plaque psoriasis, which contain anti-inflammatory active ingredients such as:

• Vitamin D
• Corticosteroids
• Coal tar
• Salicylic acid

Topicals are usually the starting point of treatment. In more severe cases that are spread over large areas of the body, oral or injected drugs that affect the immune system — either disease-modifying drugs or biologics, a more intense form of therapy — may be necessary to control plaque psoriasis.

Read more about plaque psoriasis.

Guttate Psoriasis

In guttate psoriasis, patches of rash are small and scaly and have a round, oval, or teardrop shape. Lesions may look red or pink on people with lighter skin and darkened on people with darker skin. Guttate psoriasis can affect any part of the body except the palms of the hands and soles of the feet, but it is commonly confined to the arms, legs, chest, and scalp. In some people, guttate psoriasis causes itching.

Guttate psoriasis is most common in childhood, adolescence, and early adulthood. Some people experience recurrent bouts of guttate psoriasis, but others only have one episode that never repeats. Bouts are often triggered by bacterial or viral infections, such as strep throat caused by a streptococcal infection.

Unlike infections, guttate psoriasis is not contagious and will not spread to others. Topical steroids and other treatments are usually effective for controlling guttate psoriasis, but it may also respond to phototherapy (therapy that uses sunlight or artificial light) or systemic medications.

Read more about guttate psoriasis.

Inverse Psoriasis

Also called flexural or intertriginous psoriasis, inverse psoriasis causes smooth patches of brown, pink, purple, or red skin — depending on skin tone — that feel painful. The characteristic silvery, scaly patches of psoriasis are often not seen in this form.

Inverse psoriasis is more common in people of higher weights and usually appears in skin folds where sweat and friction occur — such as the armpits, genitals, and under the breasts. Other causes include infections, taking certain medications, and stress.

Treating inverse psoriasis can be challenging because the affected areas tend to be extremely sensitive. Medication also absorbs more effectively there, increasing the likelihood of side effects. Some treatments that work for other types of psoriasis tend to irritate inverse psoriasis. It is often misdiagnosed as a fungal infection because it can look like jock itch. Your health care provider may also recommend powders to help keep the moist areas dry.

Read more about inverse psoriasis.

Pustular Psoriasis

Pustular psoriasis, an uncommon form of the disease, causes intensely red or darkened skin with sterile pustules (pus-filled blisters). The skin around the blisters may be prone to cracking and peeling. After the blisters form, they merge and burst, leaving crusty skin.

There are six different subtypes of pustular psoriasis, based on the location and characteristics of the pustules. Four generalized subtypes, which cause pustules all over the body, include:

• Von Zumbusch — Causes widespread pustules and systemic symptoms like joint stiffness and fever
• Annular — Causes ringlike lesions with pustules on the edges
• Impetigo herpetiformis — Pustular psoriasis that occurs during pregnancy
• Exanthematic — Causes widespread pustules on the body but with no systemic symptoms like fever

Localized subtypes, which only affect specific areas of the body, include:

• Palmoplantar psoriasis — Also called acropustulosis; causes pustules on the palms of the hands and soles of the feet
• Acrodermatitis continua of Hallopeau — Causes pustules on the fingers, toes, and nails

Pustular psoriasis is very painful and can be debilitating. In particular, generalized subtypes of pustular psoriasis can be life-threatening, require urgent medical treatment, and may require hospitalization.

Pustular psoriasis can occur at any age. Flare-ups can come on rapidly and be accompanied by fever and malaise. Pustular psoriasis can be difficult to treat and prone to flares. If topical treatment fails, systemic treatment such as methotrexate or cyclosporine may be required. Psoralen plus UVA (PUVA) treatment — which uses ultraviolet light — can also be helpful.

Read more about pustular psoriasis.

Erythrodermic Psoriasis

Erythrodermic psoriasis, also called exfoliative psoriasis, is the rarest type of psoriasis. This highly inflammatory form can affect the whole body, causing a bright red rash that itches, burns, and peels off in sheets. Skin affected by erythrodermic psoriasis can look similar to a sunburn. Approximately 2 percent of people with psoriasis experience a bout of erythrodermic psoriasis at least once during their lives. Erythrodermic psoriasis may accompany a flare of generalized pustular psoriasis.

Other symptoms include:

• Increased heart rate
• Difficulty controlling body temperature, especially on hot or cold days
• Shivering
• Edema (swelling), particularly in the feet and ankles

Erythrodermic psoriasis can be life-threatening. It requires immediate medical treatment and hospitalization to help your body regulate fluid balance and temperature. Treatment usually involves a combination of systemic immunomodulators, topicals, and oral treatments.

Psoriatic Arthritis

Psoriatic arthritis can cause inflammatory pain, swelling, and progressive damage in any joint in the body. Researchers estimate that about 30 percent of people with skin psoriasis will develop PsA within 10 years, according to the National Psoriasis Foundation. It is possible to have psoriatic arthritis without skin psoriasis. Typically, PsA develops in people between the ages of 30 and 50, but it can occur earlier, even in children.

Symptoms of psoriatic arthritis can include:

• Dactylitis, a painful swelling in the fingers or toes sometimes referred to as “sausage digits”
• Enthesitis, a condition characterized by pain or tenderness where ligaments and tendons — most frequently the Achilles tendon — attach to bone
• White spots, flaking, pitting (shallow or deep dents) of the nails, or lifting of the nail bed
• Stiffness, pain, and swelling of joints
• Uveitis, inflammation of part of the eye that can cause pain and redness

Treatment of psoriatic arthritis includes pain management as well as medications that halt the progression of joint damage.

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