Psoriasis causes areas of dry, red, flaky skin called psoriatic plaques. They can be found on many parts of the body, including the face, hairline, and scalp. Plaques are itchy and can hurt. About 80% of people with psoriasis have plaque psoriasis.
How Severe Is My Psoriasis?
When psoriasis is severe, it can cover large areas of the body. Many doctors gauge how severe psoriasis is, in part, by how much of your body it covers.
Severe: more than 10% of the body
Moderate: from 3% to 10%
Mild: less than 3%
With psoriasis, skin cells multiply fast -- up to 10 times faster than normal. The buildup of dead skin cells forms dry, scaly, and itchy plaques. How red, thick, and scaly the psoriasis patches are also plays a part in judging severity.
When severe, psoriasis lesions can crack and bleed.
Itching and Pain
Sleeping, dressing, moving, and other everyday activities can be hard with psoriasis.
Intense itching can distract you and make it hard for you to get things done. Sometimes, plaques become painful and can keep you from working and doing the things you enjoy.
How much your psoriasis affects your day-to-day life also plays a role in determining severity.
Dandruff and Scalp Psoriasis
Psoriasis can cause crusting on the scalp and a silvery sheen. White, powdery flakes or thick, dry flakes are also common. About half of people with psoriasis have it on the scalp.
Over-the-counter medicated shampoo that contains ketoconazole, tar, pyrithione zinc, selenium sulfide, or salicylic acid may help. If not, see your doctor.
Plaque Psoriasis: Elbows and Knees
Doctors aren’t sure why, but elbows and knees are some of the most common places for plaques. The cause of psoriasis is unknown, but scientists think it's linked to genes and immune system problems. Coming into contact with things that bother your skin, like metals or fragrances, can trigger flares.
Plaque Psoriasis: Ears
Scales and flakiness build up on the outside of the ear and the outer ear canal. The buildup can even cause short-term hearing loss.
See a doctor to avoid eardrum damage. Prescription drops and ointment can help treat ear psoriasis.
Widespread, pus-filled blisters called pustules can form on psoriasis plaques. These can sometimes be triggered by corticosteroid medicine, infections, or pregnancy.
A form of pustular psoriasis called Von Zumbusch happens suddenly. If you also have a fever, chills, or dehydration, see a doctor right away.
Pustular Psoriasis: Palmar-Plantar
Pustules can form on fleshy parts of the hands or feet. They start out yellow, then turn brown, peel, crust, shrink, and fade. This type of psoriasis can happen alone or with other forms.
Hand or foot psoriasis is sometimes severe. It can be debilitating and painful.
Flaky, splitting nails are common, especially in severe psoriasis. Nails can turn yellowish and peel away from the nail bed. In some cases, skin can build up under the nail.
Nail psoriasis can cause tiny pits in nails, as well as yellow-red discoloration that looks like a drop of oil beneath the nail.
Inverse psoriasis is shiny and smooth, without silvery scales. It’s usually found in areas such as the armpits and under breasts, and in skin folds of the groin, private parts, and buttocks.
Inverse psoriasis can be hard on people who are overweight or who have deep skin folds. Sweat and friction tend to make it worse.
Children and young adults are more likely to get guttate psoriasis. Small red spots the size and shape of raindrops cover large areas of the body.
Sores come on suddenly on the trunk, arms, and scalp. Strep throat, tonsillitis, colds, and the flu may trigger outbreaks.
Fixing Moderate to Severe Psoriasis
There is no cure, but there are treatments.
And even people with severe psoriasis can get relief during flare-ups in about 85% to 90% of cases.
Ointments & Lotion
Thick, over-the-counter ointments and lotions with emollients may help soften and soothe dry skin.
Your doctor may also prescribe skin treatments made with tar, corticosteroids, vitamin D, or retinoids.
For more severe psoriasis, doctors may move to stronger treatments, but they can have greater side effects.
Light or Phototherapy
Skin is exposed to ultraviolet B or ultraviolet A light to slow the rapid growth of skin cells. The type of light depends on where you have psoriasis and its severity.
You get these treatments weekly until the psoriasis goes into remission, then occasionally after that. Like all exposure to UV rays, treatment may raise the risk of skin cancer.
This slide shows psoriasis before and after laser therapy. A doctor targets psoriasis with a targeted beam of light. This minimizes normal skin’s exposure to UV light. For most people, this therapy is painless.
Plaques thin after a series of treatments over 4 to 5 weeks and can go into remission.
These drugs curb immune system reactions and can help control skin cell growth and flares. They’re used when other treatments haven’t worked. Common medicines include methotrexate, retinoids, cyclosporine, and hydroxyurea. They can have serious side effects, so you'll need to be in touch with your doctor.
Biologic treatments target specific immune system cells and proteins that play a role in inflammation. You can get some biologic medicines by injection, others by IV. These drugs treat moderate to severe psoriasis.
In some cases, treatment can lead to remission. But they do carry a risk of side effects, including infection.
After a while, psoriasis may stop responding to a treatment. Also, the risk of side effects may grow with long-term use. Some doctors rotate treatments every 6 to 24 months to avoid those problems. But if your treatment is working well, your doctor may not rotate treatments.
Social Stigma and Depression
Getting treatment can be important for your quality of life. Besides pain and itching, psoriasis can cause unwelcome stares and questions. Some people withdraw socially. One study found nearly 24% of people with psoriasis suffer from depression.
Finding ways to manage your frustration, anger, and stress is an important part of treatment. Remember that stress can trigger flares.
1) Interactive Medical Media LLC
3) Interactive Medical Media LLC
4) Hill Street Studios/Blend Images
5) Interactive Medical Media LLC
6) Interactive Medical Media LLC
7) Interactive Medical Media LLC
8) John Bavosi/Photo Researchers, Inc.
9) Dr. P. Marazzi/Photo Researchers, Inc.
10) Interactive Medical Media LLC
11) Interactive Medical Media LLC
12) Interactive Medical Media LLC
14) Gianni Dilberto/Stock Image
15) Phaine/Photo Researchers, Inc.
16) "Color Atlas of Cosmetic Dermatology"; Marc R. Avram, Sandy Tsao, Zeina Tannous, Mathew M. Avram; Copyright 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
17) Scimat/Photo Researchers Inc.
18) Ian Hooton/SPL
19) Digital Vision
20) Lynn James/Photonica
Bhosle, M. Health and Quality of Life Outcomes, published online June 6, 2006.
California State University, Long Beach: "Skin Conditions."
Ginsburg, I. Journal of the American Academy of Dermatology, January 1989.
Johnson, B. American Family Physician, 2000.
National Psoriasis Foundation: "About Psoriasis Statistics," "Treating Psoriasis, Specific locations: Face," "Treating Psoriasis: Moderate to severe psoriasis: biologic drugs," "Learn: About psoriasis," "Treating psoriasis: Mild Psoriasis," "Press Release: Research shows patients with psoriasis at an increased risk for developing other serious medical conditions," "Living Well: Emotions: overcoming depression," "Scalp Psoriasis," "Psoriasis Treatments," "Inverse Psoriasis."
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.