Early Signs of Psoriasis: What to Know and When to Seek Help
Catching psoriasis early is vital for managing the disease effectively and minimizing its impact on your quality of life. Timely intervention can help slow disease progression, alleviate symptoms, and reduce the risk of complications.
This chronic condition is caused by an overactive immune system, leading to scaly, inflamed patches of skin anywhere on the body. Psoriasis can also impact overall health, contributing to complications like psoriatic arthritis, cardiovascular issues such as heart attacks and stroke, and mental health challenges.
It can even increase your risk for a range of other conditions such as:
The early signs and symptoms of psoriasis, and which parts of the body it affects, depend on the type. It is possible to have more than one type of psoriasis occurring at the same time.
Plaque Psoriasis
The most common type of psoriasis, plaque psoriasis accounts for 85 to 90 percent of cases.
Plaque psoriasis usually begins as small bumps on your skin. These bumps grow in groups and can form anywhere on your body, but most often affect the scalp, face, elbows, back, and knees.
As the condition progresses, the bumps form plaques, which are patches of thick skin covered in a silvery-white coating called scales. The color of the patches depends on the color of your skin; they’re typically red or pink on white skin and shades of purple with gray scale on darker skin.
The plaques are often initially round or oval and can connect to form larger plaques. They also are itchy, burning, or even painful, and the scales flake off easily. Scratching the plaque can cause it to flare up with inflammation and to bleed, potentially leading to dangerous infections.
The plaques also flare up in response to specific environmental triggers, ranging from stress to dry air to certain infections — this is another sign you may have plaque psoriasis instead of a simple rash or other skin condition.
Guttate Psoriasis
If instead of scaly patches you suddenly develop small, scaly red dots or lesions on your torso, back, or limbs, you may have guttate psoriasis. Be on the lookout for these symptoms if you have strep throat, which is guttate psoriasis’s most common trigger.
Typically appearing in children to young adults, guttate psoriasis often disappears completely after a few weeks, but some people with it go on to develop plaque psoriasis.
Inverse Psoriasis
You may have this type of psoriasis if you develop smooth, red patches of inflamed skin in the moist folds or creases of your skin, such as in your armpits or groin, under your breasts, or between your buttocks. The patches can be painful and contain cracks or fissures that are itchy or smell bad (or both).
Another sign you have inverse psoriasis is if these patches get worse from friction or sweat.
Nail Psoriasis
Psoriasis can affect your fingernails and toenails, too. You may have nail psoriasis if one or more of your nails starts becoming:
Pitted with little dents
Discolored
Rough and crumbly
Separated from the nail bed
Spotted with blood underneath
Nail psoriasis is common in people with plaque psoriasis, but it can also develop on its own.
Psoriatic Arthritis
If you have psoriasis, especially if it’s severe, make sure to pay attention to how your joints feel, as you have an increased risk of developing psoriatic arthritis. In fact, the majority of people who develop psoriatic arthritis already have psoriasis.
Look for these signs:
A painful, sausage-like swelling of a finger or toe, called dactylitis
Heel pain
Swelling in the area just above the heel
Joint stiffness in the morning
Pustular Psoriasis
In rare cases, psoriasis may present as non-infectious, pus-filled bumps called pustules, which are surrounded by red skin. The pustules are often localized to the hands and feet, but they may also spread to cover your whole body. The pustules usually break open and leak pus within a day, and after another day or two your skin will dry out and peel, revealing a smooth surface. The cycle may repeat itself after a few days or weeks.
Pustular psoriasis can be serious and life-threatening. If you have it, you will feel very sick and may develop:
Fever
Headache
Muscle weakness
Joint pain
Anyone with symptoms of pustular psoriasis should seek immediate medical attention.
Erythrodermic Psoriasis
If your psoriasis appears to be worsening or is unresponsive to treatment, it could be an early sign that you are developing erythrodermic psoriasis. This rare and life-threatening condition is marked by whole-body skin inflammation that’s severely itchy, red, and painful (it may look like the skin is burnt). Other symptoms such as chills, fever, and muscle weakness are also possible.
Anyone with symptoms of erythrodermic psoriasis should seek immediate medical attention.
Psoriasis can resemble other skin conditions, making early diagnosis challenging. But there are some telltale differences between psoriasis and these conditions.
Psoriasis vs. Eczema
Both plaque psoriasis and eczema can cause a rash-like skin discoloration, as well as itching and burning sensations. But while psoriasis produces distinct patches of thick, very inflamed, scaly skin, eczema produces a more generalized rash made of thinner patches of bumpy skin that are less differentiated from unaffected skin. Eczema patches may also ooze or weep clear fluids.
Similar to inverse psoriasis, eczema tends to appear in the body’s skin folds. But while inverse psoriasis’s smooth patches usually appear in moist areas like the armpits and groin, eczema’s bumpy patches tend to appear in dryer areas like the creases of the elbows and knees.
Psoriasis vs. Dermatitis
Psoriasis has some features that are similar to certain types of dermatitis (skin inflammation). Like psoriasis, seborrheic dermatitis initially produces inflamed skin patches with scales, but the white scales caused by seborrheic dermatitis are fine, like dandruff. It also forms in areas where the skin produces the most sebum or oil, such as the scalp, around the eyebrows, and behind and just inside the ears.
It is possible to have both psoriasis and seborrheic dermatitis, resulting in a condition called sebopsoriasis, which produces yellowish, greasy scales in common seborrheic dermatitis areas.
Similar to pustular psoriasis, contact dermatitis can cause an itchy or burning, bumpy rash, often on the hands. Pustular psoriasis, however, often develops without a known cause and produces yellowish pustules that leak pus, while contact dermatitis produces leaky blisters in response to the skin coming into contact with an irritant such as cleaning chemicals or poison ivy.
Psoriasis vs. Fungal Infections
Psoriasis is sometimes misidentified as ringworm — a common fungal infection of the hair, nails, and skin, including the groin, hands, and feet — but the two have some notable differences.
Ringworm of the skin causes a red rash, but, unlike plaque psoriasis, it usually forms a ring-shaped, scaly red rash, with the inside of the ring a mix of clearer skin and small discolored bumps.
A ringworm nail infection, called onychomycosis, can cause nails to become discolored, thick, and break easily, but it doesn’t usually cause the pitting or nail separating found in nail psoriasis.
Jock itch (fungal infection of the groin) is commonly mistaken for inverse psoriasis, but jock itch sometimes has the circular, ringworm form and is more likely to cause scaly or flaky skin.
There are many potential triggers for psoriasis flare-ups, including:
Stress
Skin injuries such as scratches, sunburns, tattoos, piercings, and bug bites
Smoking
Alcohol consumption
Obesity
Calcium deficiency
Cold, dry weather
Illnesses such as ear infections, respiratory infections, and tonsillitis
Certain medications such as lithium, strong steroids, and some drugs used to treat high blood pressure, heart issues, and arthritis
Hormonal changes such as occur during puberty and menopause
Your diet can also trigger psoriasis, especially if your diet includes a lot of inflammatory foods, including:
Refined carbohydrates, such as white rice, white bread, and pasta
Food high in saturated and trans fats, such as red meet, fried food, and margarine
You are more likely to develop psoriasis if you have a family history of the condition.
If you’ve yet to be diagnosed with psoriasis, it’s important to see your healthcare provider if you spot any potential signs of the disease, such as:
Bumps on your skin that grow in numbers or size
A rash with itchy, scaly patches on your face, scalp, back, knees, or elbows
A rash of small, scaly bumps that appear after having strep throat
Smooth, red patches of inflamed skin in the folds of your skin
Pitting in your nails or nails separating from the nail bed
Catching psoriasis early — and getting a formal diagnosis by a medical professional — allows for prompt treatment, possibly slowing the progression of the disease and its impact on your life.
To diagnose psoriasis, your provider will review your symptoms and closely examine any rash or skin lesions you have, as well as body areas commonly affected by psoriasis. They will also ask you about your family’s medical history, any joint tenderness, and any recent illnesses or severe stress you’ve experienced. They may conduct a biopsy (take a small skin sample for analysis) to confirm a diagnosis or rule out other potential causes of your symptoms.
If you have psoriasis, you and your provider will discuss your treatment plan. Seek immediate help if you experience:
Worsening symptoms or skin irritation despite treatment
Fever accompanying your skin issues
A rash that covers most of your body
Joint pain or stiffness
Symptoms that significantly affect your quality of life
Psoriasis treatments aim to reduce inflammation and slow skin cell turnover. There are several broad categories of treatments.
Topical Treatments Various types of prescription and over-the-counter skin lotions, ointments, creams, and shampoos can reduce symptoms when put directly on the affected skin or scalp. Some options include corticosteroids, coal tar, dandruff shampoo, and medicines containing vitamin D or vitamin A (retinoids).
Phototherapy Also known as light therapy, this treatment involves exposing your skin to controlled ultraviolet A or ultraviolet B light. Phototherapy typically occurs in a clinical setting, but your provider may also prescribe a UV light unit for at-home treatments.
Systemic Medications If you have a severe case of psoriasis, you may need treatment with systemic drugs (those that affect the whole body), such as methotrexate and other immunosuppressants, biologics, and TYK2 inhibitors. These drugs work in different ways to reduce inflammation, suppress your immune system or certain immune cells, slow down cell growth and division, or interrupt the specific immune process involved in psoriasis.
While medical treatments are essential, certain lifestyle changes may help alleviate symptoms.
Avoid smoking.
Limit alcohol.
Identify and avoid your triggers.
Follow a healthy anti-inflammatory diet such as the Mediterranean diet.
Bathe in lukewarm water and wash with mild soap that has added oils.
Use gentle skin-care products and avoid harsh soaps and fragrances that may irritate the skin.
Moisturize regularly, especially in dry climates and cold weather and after taking a shower (while your skin is still damp).
Lose weight or maintain a healthy weight, including by exercising.
Manage your stress, for example with relaxation techniques like meditation and yoga.
Expose your affected skin to small amounts of sunlight.
For effective disease management, it's essential to recognize the early signs of psoriasis, in any of its forms, and seek timely medical attention.
With proper care, treatment, and lifestyle adjustments, you can lead a fulfilling life with psoriasis and minimize the impact of this chronic condition.
If you suspect you have psoriasis, don’t hesitate to consult a healthcare provider — early diagnosis and intervention makes all the difference.
