Psoriasis: Symptoms, Types, Treatment and Everyday Support

• Plaques — raised patches of skin, often with clearly defined edges.
• Scaling — silvery, white or greyish flakes on the surface of a plaque.
• Itching — some people itch a great deal, others hardly at all.
• Soreness, burning or stinging, particularly where skin rubs or bends.
• Cracking and bleeding where plaques are dry or over a joint such as a knuckle.
• Tightness, especially after washing or in cold weather.

Plaques may leave temporary darker or lighter marks after they settle. These usually fade over weeks or months and are not scars.

Descriptions of psoriasis often say the patches are "red". That reflects how it looks on white skin. On brown and black skin, plaques more often look purple, violet, grey or dark brown, and the scale can appear greyer. The redness that clinicians look for may be difficult to see at all.^{[9]British Association of Dermatologists}

Because of this, psoriasis on darker skin is sometimes recognised later or mistaken for another condition. Darker or lighter marks left behind after a flare-up (post-inflammatory pigment change) also tend to be more noticeable and can last longer on brown and black skin.

If you feel your skin has not been properly examined, it is reasonable to say so and to ask for a further opinion or a dermatology referral.

Psoriasis often appears on the elbows, knees, scalp and lower back — but it can develop anywhere, including places that are easy to miss.^[1]NHS

• Elbows, knees, shins and forearms
• Scalp, hairline, behind the ears and the ear canal
• Lower back and buttocks
• Hands, feet, palms and soles
• Skin folds — under the breasts, armpits, groin and between the buttocks
• Face, eyelids, navel and genital skin
• Fingernails and toenails

By far the most common type. Raised patches covered in scale, typically on the elbows, knees, scalp and lower back. Plaques vary from small coin-sized patches to large areas.^[1]NHS

Thickened, scaly patches on the scalp, often along the hairline, behind the ears or at the back of the head. It can range from light flaking that resembles dandruff to thick, crusted plaques. Hair may thin over badly affected areas during a flare-up, but hair usually regrows once the skin settles.^{[10]British Association of Dermatologists}

Small, drop-shaped scaly spots, often spread over the trunk, arms and legs. It frequently appears a week or two after a throat infection, particularly in children and younger adults. It often clears within a few months, though some people go on to develop plaque psoriasis.^[1]NHS

Affects skin folds such as the armpits, groin, under the breasts and between the buttocks. Because the skin there is moist, the patches tend to be smooth and shiny rather than scaly, and they can become sore or cracked. It is easily mistaken for a fungal infection, so it is worth having it properly assessed rather than treating it yourself.

Small pus-filled spots (pustules) on inflamed skin. The pus is not an infection. Localised forms affect the palms and soles (palmoplantar pustulosis). A rare, widespread form called generalised pustular psoriasis can develop quickly and make a person feel very unwell — that needs urgent medical assessment.^[1]NHS

A rare and serious form in which almost the whole skin surface becomes inflamed, hot and shedding. It can affect body temperature and fluid balance and is treated as a medical emergency. See the urgent-help panel further down this page.^[1]NHS

Around half of people with psoriasis have nail changes. Look out for:

• Pitting — small dents in the nail surface.
• Colour changes — yellow-brown or oily-looking patches under the nail.
• Thickening and crumbling of the nail.
• Onycholysis — the nail lifting and separating from the nail bed.
• Ridges and lines across the nail.

Nail psoriasis can be uncomfortable and is closely linked with psoriatic arthritis, so it is worth mentioning to your GP. Nail treatment often takes many months to show a difference because nails grow slowly.^{[8]NICE CKS}

Psoriasis is normally diagnosed by examining the skin. There is no routine blood test for it. A GP will usually look at the pattern, site and appearance of the patches, check your scalp and nails, ask about family history, and ask how the condition affects your day-to-day life.^{[8]NICE CKS}

They should also ask about joint symptoms, because psoriatic arthritis is common and is better treated early. Ask for your skin to be examined in good light and for all affected areas — including the scalp, nails and skin folds — to be looked at.

NICE suggests referral to a dermatologist when, for example:

• the diagnosis is uncertain;
• psoriasis is extensive, or covers a large part of the body;
• it affects sensitive or high-impact sites such as the face, hands, feet or genitals;
• treatments prescribed in general practice have not worked well enough;
• the condition is having a major effect on wellbeing, work or sleep; or
• an urgent form such as generalised pustular or erythrodermic psoriasis is suspected — this needs same-day assessment.

Emollients soften scale, reduce cracking and itching, and make other treatments work better. They come as lotions, creams, ointments and soap substitutes, and heavier products generally suit drier skin. Many are available on prescription as well as over the counter.^[5]NHS

Emollients containing paraffin can make fabric and dressings highly flammable. Keep away from naked flames, cigarettes and heat sources, and wash clothing and bedding often.

• Vitamin D preparations (such as calcipotriol) slow the rate at which skin cells build up and reduce scale.
• Topical corticosteroids reduce inflammation and itching. They are prescribed at a strength suited to the site and used for defined periods with review, because long-term unsupervised use can thin the skin.^[6]NHS
• Combined vitamin D and steroid products are often used for plaque psoriasis.
• Coal tar preparations for plaques and the scalp.
• Dithranol, used for short contact periods, usually under specialist guidance.
• Calcineurin inhibitors for delicate sites such as the face and skin folds, on specialist advice.

Controlled ultraviolet light treatment given in a hospital or clinic, usually two or three times a week for a course of several weeks. It is used when topical treatments have not been enough. It is not the same as using a sunbed — sunbeds are not a treatment for psoriasis and carry skin-cancer risk.^[2]NHS

For more severe or resistant psoriasis, a dermatology team may prescribe tablets or injections that act on the whole body — for example methotrexate, ciclosporin or acitretin. These require monitoring, often with regular blood tests, and some are unsuitable in pregnancy.

Biologic treatments are targeted injected medicines used when other systemic treatments have not worked, are unsuitable, or cannot be tolerated. They are prescribed and monitored by specialist services under NICE criteria.^{[7]NICE CG153}

Scalp psoriasis is usually treated with medicated shampoos, scalp applications, oils to loosen thick scale, and prescribed topical treatments designed for hair-bearing skin.^{[10]British Association of Dermatologists}

• Loosen thick scale with an oil or ointment before washing rather than picking it off.
• Leave medicated shampoos on for the time stated on the label — rinsing straight away does little.
• Use a gentle conditioner; combing gently reduces pulling at plaques.
• Avoid harsh chemical treatments during a flare-up and tell your hairdresser it is not contagious.
• Any hair thinning over plaques is usually temporary and improves as the scalp settles.

• Use lukewarm rather than hot water, and a soap substitute instead of soap or foaming shower gel.
• Pat skin dry rather than rubbing, and apply emollient while the skin is still slightly damp.
• Apply emollient generously and often — several times a day during a flare-up.
• Smooth creams on in the direction the hair grows to reduce irritation of hair follicles.
• Loose cotton or other soft fabrics are usually more comfortable than wool or tight synthetics.
• Ointments can mark clothing and bedding; older sheets or dark towels save frustration.

• Keeping emollient in the fridge can make it more soothing on itchy skin.
• Keep nails short, and press or pat rather than scratch — scratching can trigger new patches.
• A cooler bedroom and lighter bedding often help night-time itching.
• Tell your GP if itching is regularly disturbing your sleep; it is a treatable problem, not something to put up with.

Psoriasis is a visible condition and it is entirely normal to feel self-conscious, frustrated or low because of it. Many people describe worrying about other people staring, avoiding swimming, short sleeves or the gym, or feeling anxious about relationships and intimacy.

The effect on wellbeing is a legitimate reason to seek treatment or a referral, and clinicians are expected to ask about it. Support routes include:

• Speaking to your GP about how psoriasis is affecting your mood, confidence or sleep.
• NHS Talking Therapies in England, which you can refer yourself to; equivalent services exist in Scotland, Wales and Northern Ireland through your GP.
• Peer support through the Psoriasis Association and PAPAA.
• Our Mental Health and Depression pages.

Psoriasis can start in childhood. Guttate psoriasis after a throat infection is relatively common in children and teenagers. Treatments are broadly similar but are chosen carefully for children's skin, and stronger treatments are usually managed by a paediatric dermatology service.

Practical points for families: tell the school it is not contagious, ask about PE and swimming rather than letting a child opt out quietly, and take teasing or bullying seriously — see our School Bullying and Cyberbullying page.

Applying creams to the back, legs or feet can be genuinely difficult if you have limited movement, painful joints, tremor or reduced vision. That is a practical problem with practical answers.

• Ask your GP or pharmacist about pump dispensers, long-handled applicators and easier-to-open containers.
• Ask about a district nurse or carer support with applying treatment where you cannot manage it yourself.
• Ask your council adult social care service for an assessment if washing or dressing has become difficult.
• Ask for appointments at accessible clinics, longer appointments, home visits where appropriate, or telephone and video review.
• Thin, fragile skin and other long-term conditions can affect which treatments are suitable, so make sure the whole medicines list is reviewed.

Our Mobility Aids and Home Adaptations and Care After Hospital pages cover related help.

Psoriasis behaves differently in different pregnancies — some people improve, some flare, and flares after birth are common. Several psoriasis treatments, including some tablets, are not suitable in pregnancy, and some require reliable contraception for a period before conceiving.

If you are pregnant, breastfeeding or planning a pregnancy, ask your GP, dermatology team, midwife or pharmacist to review your treatment. Do not simply stop a prescribed medicine — stopping some treatments suddenly can cause a serious flare. Care is also needed with where creams are applied when breastfeeding.

Severe psoriasis can amount to a disability under the Equality Act 2010 in England, Scotland and Wales (and the Disability Discrimination Act 1995 in Northern Ireland), which can mean an employer or school should consider reasonable adjustments.^[15]Acas

• Time off for phototherapy courses or hospital appointments.
• Uniform flexibility where fabric or fit irritates the skin.
• Gloves, barrier creams or reduced exposure to irritants in hands-on roles.
• Somewhere private to apply treatment during the day.
• Adjusted PE, swimming or uniform arrangements at school.