There are a few types of psoriasis. While some are similar, they can also have different symptoms and treatments. Each type affects a different area of your body.
Knowing which kind of psoriasis you have helps you and your doctor make a treatment plan. Most people have only one type at a time. Sometimes, after your symptoms go away, a new form of psoriasis may crop up.
What Triggers Different Types of Psoriasis?
In general, most types of psoriasis result from the same triggers:
- Skin injury
Other things that may trigger psoriasis include:
Here's how you can spot the seven types of psoriasis and what you can do to treat them.
This is the most common type. About eight in 10 people with psoriasis have this kind. You may hear your doctor call it "psoriasis vulgaris."
The symptoms of plaque psoriasis include raised, inflamed, red skin covered with silvery, white scales. On darker skin, the patches may be purplish with gray scales. These patches may itch and burn. It can appear anywhere on your body, but it often pops up in these areas:
- Lower back
Plaque psoriasis treatments include:
Topical treatments. These go on your skin and are usually the first thing doctors try. Some have steroids; others don’t. Prescription products slow skin cell growth and ease inflammation.
Phototherapy . This treatment uses ultraviolet light. You’ll get it at your doctor's office or at home with a phototherapy unit.
Systemic medications. These prescription drugs work throughout your body. You’ll get them if you have moderate to severe psoriasis that doesn’t respond to other treatments. You could take them by mouth or get them as a shot or IV. This category includes drugs called biologics, which target specific parts of your immune system that play a role in the inflammatory process. Learn more about systemic treatments for psoriasis.
This type often starts in children or young adults. It makes up about 8% of psoriasis cases.
Guttate psoriasis causes small, pink-red spots on your skin. On darker skin, the spots may be purplish. They often appear on your:
- Upper arms
This type of psoriasis may go away within a few weeks, even without treatment. Some cases, though, are more stubborn and require treatment.
To treat mild guttate psoriasis, you can use:
- Creams. These can treat itching and inflammation, especially if they have cortisone or other corticosteroids in them. Other creams that can help are ones that include coal tar.
- Medications with vitamins. You can apply medication that has vitamin D on your skin to help. Or you can take medications with vitamin A by mouth.
- Dandruff shampoo. You can get this over-the-counter in a prescription-strength version to treat guttate psoriasis on your scalp.
For severe cases, treatments include:
- Biologic medications. These will target parts of your immune system and stop them, which will lessen your symptoms.
- Phototherapy. You can treat your guttate psoriasis with ultraviolet (UV) light. You can use this on its own, or along with other medications.
- Immunosuppressant medications. These drugs lower your body's immune response, which will help ease the symptoms of guttate psoriasis.
This type is usually found in these locations:
- Under the breasts
- Skin folds around the genitals and buttocks
- Patches of skin that are bright red, smooth, and shiny, but don't have scales
- Getting worse with sweating and rubbing
Common triggers are:
- Fungal infections
Treatments for inverse psoriasis include:
Ointments. There are a few ointments that can help with this form of psoriasis:
- Calcipotriene (Calcitrene, Dovonex, Sorilux), a form of vitamin D that helps lessen discoloration
- Corticosteroid creams or ointments, to ease inflammation
- Anti-inflammatory creams such as roflumilast (Zoryve) or tapinarof (Vtama)
Injectable medications. You may use drugs like adalimumab (Humira Pen, Humira Pen Crohn's-UC-HS Start, Humira Pen Psoriasis-Uveitis), etanercept (Enbrel), or infliximab (Avsola, Inflectra, Ixifi, Remicade, Renflexis). You can inject these under your skin, or your doctor will inject it into your vein.
Oral medications. You can take medications by mouth to treat severe forms of inverse psoriasis. They come in pill or capsule form. Some options include acitretin (Soriatane) capsules, apremilast (Otezla) oral tablets, deucravacitinib (Sotyktu) oral TYK 2 inhibitor, or methotrexate (Otrexup (PF), Trexall Tablets, Xatmep).
Phototherapy. Just like with guttate psoriasis, this treatment can help ease the symptoms of inverse psoriasis.
This kind of psoriasis is uncommon and mostly appears in adults. It causes pus-filled bumps (pustules) surrounded by red or purplish skin. These may look infectious but are not.
This type may show up on one area of your body, such as the hands and feet. Sometimes, it covers most of your body, which is called "generalized" pustular psoriasis. When this happens, it can be very serious, so get medical help right away.
- Topical medicine (ointments you put on your skin) or systemic medicine (drugs that treat your whole body), especially steroids
- Suddenly stopping systemic drugs or strong topical steroids that you used over a large area of your body
- Getting too much ultraviolet light
- Exposure to certain chemicals
Treatments for pustular psoriasis include:
- Topical medications, creams, or ointments
- Oral medications
- Biological treatments
The goal of treatment is to get rid of pustules, prevent side effects (like infections), and stop itchiness or pain.
This type is the least common, but it's very serious. It affects most of your body and causes widespread, fiery skin that appears to be burned.
Other symptoms include:
- Severe itching, burning, or peeling
- A faster heart rate
- Changes in body temperature
If you have these symptoms, see your doctor right away. You may need to get treated in a hospital. This type of psoriasis can cause severe illness from protein and fluid loss. You may also get an infection, pneumonia, or congestive heart failure.
- Suddenly stopping your systemic psoriasis treatment
- An allergic drug reaction
- Severe sunburn
- Medications such as lithium, antimalarial drugs, cortisone, or strong coal tar products
Erythrodermic psoriasis may also happen if your psoriasis is hard to control.
Treatment for this type of psoriasis won't cure it. But it can lessen and prevent symptoms. In severe cases, you'll need medical care, sometimes at a hospital.
You might use treatments like:
- Nonsteroidal anti-inflammatory drugs (NSAIDs)
- Oral retinoids
- Biologic therapies
- Hypoallergenic moisturizers and cool compresses
- Topical ointments like corticosteroids or retinoids
- Immunosuppressants like cyclosporine or methotrexate
- Disease-modifying antirheumatic drugs (DMARDs)
With erythrodermic psoriasis, stay away from:
- Phototherapy that uses UV light
- Oral corticosteroids
- Coal tar products
Up to half of those with psoriasis have nail changes. Nail psoriasis is even more common in people who have psoriatic arthritis, which affects your joints.
- Pitting of nails
- Tender, painful nails
- Separation of the nail from the bed
- Color changes (yellow-brown)
- Chalklike material under your nails
- Thickened nails
You're also more likely to also have a fungal infection.
Treatment for nail psoriasis can be tricky. You might have to try multiple options before you find one that works. Treatment types include:
Injectable medications. For severe nail psoriasis, your doctor will inject medicine into the skin around your nails. You might receive adalimumab (Humira Pen, Humira Pen Crohn's-UC-HS Start, Humira Pen Psoriasis-Uveitis), etanercept (Enbrel), ixekizumab (Taltz), or ustekinumab (Stelara).
Oral medications. These are also for serious cases. They come in liquid, pill, or tablet form. You might take apremilast (Otezla), cyclosporine (Gengraf, Neoral, Sandimmune), deucravacitinib (Sotyktu), or methotrexate (Otrexup (PF), Trexall, Xatmep).
Corticosteroids. These are prescription drugs and come in a cream, ointment, or nail polish form.
Phototherapy. This can also help with nail psoriasis as it does with psoriasis that affects your skin.
Laser therapy. Your doctor might use a pulsed dye laser (PDL) that will reach the blood vessels under your nails. This might help make your condition less intense.
Psoriatic arthritis is a condition where you have both psoriasis and arthritis (joint inflammation). In more than 80% of cases, people had psoriasis for an average of 12 years before getting psoriatic arthritis. About 90% of people with it also have nail changes.
The symptoms of this type include:
- Painful, stiff joints that are worse in the morning and after rest
- Sausage-like swelling of the fingers and toes
- Warm joints that may be discolored
There's no cure for psoriatic arthritis, but you can use some treatments to help control inflammation, pain, and disability. Some options include:
Medications. Some drugs can treat this condition:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can lessen pain and inflammation if you have a mild version.
- Conventional DMARDs are another type of drug that can slow down the condition's progression and can save your joints and tissues from damage.
- Biologic agents are another class of DMARDs that affect different parts of your immune system.
- Targeted synthetic DMARDs can help if biologic agents and conventional DMARDs weren't helpful.
- Newer oral drugs, like apremilast (Otezla) and deucravacitinib (Sotyktu), lower inflammation. They're for people with a mild to moderate version who can't use DMARDs or biologic agents
Therapy. Occupational, physical, and massage therapy can help ease pain so that you can move better.
Procedures and surgery. You may need joint replacement therapy if your joints have been damaged. Steroid shots can also help with this condition. They'll lower inflammation.
Psoriasis vs. Parapsoriasis
Parapsoriasis is the term for a group of rare skin problems that look like psoriasis but behave differently. Your doctor may need to take a sample of your skin (biopsy) to be sure of what you have.
Like psoriasis, parapsoriasis shows up as a patchy rash. Spots are usually pink or red but also can appear brown or yellowish. They can be raised and bumpy with a scaly or wrinkly appearance.
You typically get them on your chest, stomach, and back, but they also may appear on your arms and legs. They're generally round or oval but can be different sizes.
You may have itching, but you probably won't have any other symptoms.
There are two kinds of parapsoriasis:
Small-plaque. Rash spots are less than 5 centimeters (about 2 inches) across. It's usually considered harmless.
Large-plaque. Rashes are bigger and sometimes irregularly shaped. Some people with this form get a kind of lymphoma called mycosis fungoides. It's a cancer of the white blood cells that starts in the skin. Some doctors consider large-plaque parapsoriasis a separate disease. Others think it's just an early stage of mycosis fungoides.
Most people with small-plaque parapsoriasis don't need treatment. But if you have symptoms or want to get rid of the appearance of the condition, topical corticosteroids can help. If this doesn't work, phototherapy may be a better option.
Treatment for large-plaque parapsoriasis includes topical corticosteroids (for mild versions). For more severe cases, phototherapy can treat the condition.