Types of Psoriasis

Most people with psoriasis have plaque psoriasis, either alone or in combination with another type. It gets its name from the ‘plaques’ that are formed by the build-up of skin cells. These can be very red, itchy and sore, with white or silvery scales. Plaques are very well demarcated, meaning you can see where the plaque psoriasis starts and regular skin stops. Also, if you close your eyes and run your hand over the skin, you can clearly feel where each plaque begins and ends. The redness is caused by increased blood flow to the area, required for the speed in which the skin cells are being replicated.

A large variety of treatments can be used to treat plaque psoriasis, depending on how severe the condition is, the age of the individual, and how much success they have had with other treatments. The range includes topical treatments, UV Therapy, systemic and biologic medications.

Plaque psoriasis can occur more or less anywhere on the body, but psoriasis on the palms and soles, or in areas where skin touches skin (such as in the armpit or genitals) is usually a different type. Different types of psoriasis – or psoriasis on different areas of the body – may need different treatments. Use the other links below to read about the different types of psoriasis. 

It is very common for plaque psoriasis to occur on the scalp. It usually looks similar to plaque psoriasis on other areas of the body, but can be prone to quite a thick build-up of scaly skin, which may cause dandruff-like flakes to fall. Scalp psoriasis may also be visible around the hairline, on the forehead, neck and behind the ears. It can make the scalp feel itchy and tight. In severe cases, the thickness of the scale can cause thinning of the hair, but usually this is temporary and goes back to normal with effective treatment of the psoriasis.

Some shampoo treatments can be bought over the counter, however, if your scalp is covered with thick scale or doesn’t clear up, do consult your GP. There is a wide range of topical treatments that can be prescribed including coal tar, dithranol, salicylic acid, steroid creams and ointments, Vitamin D based treatments, as well as oils for moisturising the scalp, such as coconut or olive oil.

When applying treatments, it is important to make sure they are applied to the scalp itself, rather than just the hair. Scalp treatments often make hair greasy, so some people find it more convenient to apply at night and then wash their hair in the morning, if the instructions for use allow.

Have a look at our information leaflet on Scalp Psoriasis for more information on particular scalp psoriasis treatments, as well as advice on caring for the hair and scalp. 

Guttate psoriasis is also known as ‘tear drop’ or ‘rain drop’ psoriasis (the name was derived from the Latin, Guttae, which means drops), because of how it looks. Guttate spots are often a bright pink or red on fair skin types, whilst people with darker skin types may notice less redness and more darkening. There may also be some fine scaling on guttate spots. Some people say their guttate psoriasis is itchy or sore, whilst others do not notice this. Usually, guttate psoriasis is widespread across the torso, back and limbs, and clears up after several weeks or months.

Guttate psoriasis can occur at any age, but is common in children, adolescents and younger adults. It is often triggered by a streptococcal throat infection, and so people who are prone to this type of infection may experience repeat bouts of guttate psoriasis. Some people may find it evolves into one of the other types of psoriasis, but others will never have another bout of psoriasis.

Guttate psoriasis treatment is likely to begin with topical (applied to the skin) treatments, including steroid creams, vitamin D applications, and coal tar applications. If the psoriasis does not clear up, and topical treatments do not seem to help, a referral to a Dermatologist may be needed.

Have a look at our information sheet on Guttate Psoriasis for more information on particular guttate psoriasis treatments.

Pustular psoriasis is a kind of psoriasis where small white or yellow blisters (pustules) appear on top of very red or darkened skin. These pustules are filled with fluid which often gives them a yellow or cream colour, and they may dry up and turn brown or crusty after they have burst. The red or darkened skin around the pustules is often thick and flaky, and is often prone to cracking. The pus in the pustules is not a symptom of infection or bacteria, and, as with all types of psoriasis, they are not contagious.

There are two different types of pustular psoriasis: Pustular Psoriasis that affects only the palms of the hands and/or soles of the feet may also be referred to as Palmoplantar Pustulosis (PPP) or acropustulosis. Generalised Pustular Psoriasis (GPP), also known as von zumbusch psoriasis, looks similar, but is usually widespread across the body rather than confined to a particular area. This type of pustular psoriasis is quite rare, but is a serious condition that requires urgent medical attention.

Both types of pustular psoriasis can be quite painful and - particularly when the palms and soles are affected – can make walking and other everyday activities difficult. Pustular psoriasis can be unstable (meaning it is prone to flaring up), and so usually needs to be managed by a Dermatology Specialist.

Have a look at our information sheet on Pustular Psoriasis for more information on particular treatments.

The skin is more sensitive in certain areas of the body than others. Often, these are areas which are covered by clothes or other skin, such as the armpits, genitals and skin folds. You might hear these areas referred to as ‘flexural’ or ‘inverse’. The face is another sensitive area.

Psoriasis in flexural areas often does not have the typical ‘plaques’ or scaliness seen in other areas and usually appears as very bright red (or dark on darker skin tones) and shiny. It is well demarcated (easy to tell where the psoriasis ends and normal skin begins). Because psoriasis in these areas looks quite different to its typical dry and scaly appearance, it can often be mistaken for a fungal infection or other skin condition. Psoriasis in sensitive areas may be very uncomfortable and painful, and may make people feel embarrassed about or avoid intimate situations. Psoriasis in sensitive but non-flexural areas (such as the face) may look similar to psoriasis on other parts of the body.

It is always best to seek help from a GP or Dermatologist for psoriasis in sensitive areas. This is because psoriasis in these areas can be painful or particularly uncomfortable, can affect a person’s quality of life (such as their work, relationships and social life), and may be more prone to infection. Treatments that may have been prescribed for psoriasis on another area of the body are not always suitable for psoriasis in sensitive areas. Because of this, a separate treatment plan may be needed for these areas. Suitable treatment may only be available on prescription, and so a visit to a GP or Dermatologist is essential.

Have a look at our leaflet on Psoriasis in Sensitive Areas for more information on particular treatments and caring for sensitive areas.

Nail psoriasis affects up to half of all people with psoriasis and it is thought that around 80% of those with psoriatic arthritis have nail symptoms. Nail psoriasis can affect either fingernails or toenails, or both. It is possible for a person to just have psoriasis of the nails, with no other skin involvement.

The symptoms of nail psoriasis can range from mild to severe, and it is easy to misdiagnose as a fungal infection. Any of the following symptoms may indicate nail psoriasis:

• Discolouration of the nail

• ‘Pitting’ (small dents) across the surface of the nail

• Nails that split or crumble easily

• Thickening of the nail

• Nails that lift or detach themselves from the nail bed- known as onycholosis

Nail psoriasis is not just a cosmetic problem. As with other types of psoriasis, the visible nature of nail psoriasis means it can be upsetting to have. In moderate to severe cases, nail psoriasis can be painful and restrict movement and finger and toe function. Because nails grow slowly, it can take quite some time using a treatment before benefit is seen.

Have a look at our information sheet on Nail Psoriasis for more information on particular treatments and caring for the nails.