7 Common Psoriasis Symptoms and How to Relieve Them
Psoriasis symptoms can vary from person to person, and also depend on the type of psoriasis a person has. But knowing what to expect from this condition can help you find the best ways to care for your symptoms, as well as what to discuss with your doctor.
Most people with psoriasis have plaque psoriasis—the American Academy of Dermatology (AAD) estimates that this type affects about 80 percent of people with the condition. It’s characterized by inflamed skin lesions called plaques. On lighter skin, the plaques are red; on darker skin tones, they may be dark-brown, red, or purple. Usually, there are also white or silver scales on top of these plaques.
Plaques can appear almost anywhere on the body, but the scalp, elbows, and knees are the most common places, says Mary Stevenson, M.D., an assistant professor of dermatology at NYU Langone Health in New York City.
“A variety of emollient creams can help to repair the epidermal barrier when it is broken by psoriatic plaques or the accompanying scratching,” says Evan Rieder, M.D., a board-certified dermatologist also at NYU Langone. For a soothing at-home remedy, Rieder suggests using an aloe-based cream that you keep cool in the refrigerator. The coolness may also help relieve itch symptoms.
If you have scalp psoriasis, you may have plaques anywhere on your head including along the scalp, hairline, back of your neck, or behind the ears.
Sandy Skotnicki, M.D., a board-certified dermatologist at Bay Dermatology Centre in Toronto, Canada, and author of Beyond Soap, recommends washing your scalp with a medicated shampoo containing coal tar or salicylic acid. It may also be helpful to use a prescription steroid, such as a clobetasol shampoo, a few times a week. For maximum effectiveness, apply the shampoo to the skin of the scalp and wait a few minutes before rinsing. “It’s also important to avoid heavily fragrant shampoos, whether they’re natural, organic, or synthetic scents, as these can aggravate an already inflamed scalp,” she says.
Another type of psoriasis is pustular psoriasis, which is characterized by pus-filled blisters usually appearing on a background of red, inflamed skin. Although pustules can be widespread, they are typically confined to smaller parts of the body, like the hands or feet.
Various factors are usually taken into account before a treatment is prescribed for pustular psoriasis, including the area of the body involved, whether it’s affecting quality of life, symptoms such as pain and/or itch, the person’s other medical conditions or medications, and severity, according to the AAD. “Pustular psoriasis often needs systemic medications to get it under control,” Skotnicki says. This may mean oral medication, injectables, or an infusion. If you have pustular psoriasis, it’s best to discuss specifics with a dermatologist so that they can pick the correct treatment based on your medical history.
The itch of psoriasis—which some people describe as burning or soreness—may have a bigger impact on quality of life than the visible effect of the disease, according to the National Psoriasis Foundation.
Along with following the psoriasis treatment plan set by your dermatologist—which should help relieve the itch as well as your other symptoms—the AAD recommends using salicylic acid to soften scales (less scaling often means less itchiness), and doing everything you can to seal moisture into your skin. For starters, limit your showers to five minutes or less and baths to 15 minutes or less, use lukewarm water instead of hot water, and apply a moisturizing cream or ointment after every hand washing, bath, and shower.
Placing something cool— like ice, a gel pack, cool compresses, or cool water—on the itchy skin can also help. This is because the nerves that send itch signals to the brain are weakest when they’re cold.
About half of people with psoriasis also have nail psoriasis, which may present as thickening, lifting, or ridging of the fingernails and/or toenails. It can be difficult to treat without prescription medication, say the experts, but meticulous nail care is a must.
“Nails should be kept short, gently filed, and hydrated,” Rieder says. “I like using a thick ointment like petrolatum at night to retain nail hydration. It’s critical to minimize nail trauma, including from manicures, which can damage the nail plate.”
Stevenson adds that taking all necessary steps to avoid trauma to the nails should include wearing protective gloves when gardening, doing DIY projects, and other tasks with your hands.
Pitting is another symptom that can happen. Rieder says sometimes emollients and barrier ointments can help to mask the pitting. But he stresses that pitting won’t improve unless medicine is delivered to the nail matrix, which is the area under the skin at the base of the nail where the nail is created.
Some doctors prescribe topical medications for patients to apply daily to the skin around the nail. Others may inject Kenalog (triamcinolone) directly into the nail matrix each month. Systemic agents like oral medications or biologics are also very helpful in improving nail psoriasis for people whose condition is negatively impacting their quality of life.
It’s important to notify your doctor if you have nail symptoms, because there is strong evidence that nail psoriasis is a predictor of joint disease.
If you experience stiff, aching joints alongside psoriasis, you may have psoriatic arthritis. This inflammatory form of arthritis affects about 30 percent of people with psoriasis and causes stiffness, pain, throbbing, swelling, redness, and tenderness in one or more joints. It can also cause fatigue. This condition is usually managed by a rheumatologist.
If you get the green light from your doctor, you could take an over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB) and naproxen (Aleve), to relieve pain and inflammation.
Psoriatic arthritis may be progressive in some patients, meaning it can get worse over time. So, treatments aimed at reducing inflammation and swelling—including systemic medications, such as oral or injectable biologics, which target specific parts of the immune system—can help prevent further joint damage.
Cracks and Fissures
In severe cases of psoriasis, plaques can crack and bleed, creating fissures and open sores. These can be extremely painful, causing people to become susceptible to infection. Stevenson says some patients may find Krazy Glue useful. “It’s often used by surgeons for their dry hands,” she adds. The Krazy Glue can be applied directly to cuts, which prevents them from getting larger and also provides a waterproof seal. However, she advises getting advice from your dermatologist before trying it, since some patients may have a skin allergy to the active ingredients in the glue.
Remember that fissures are merely a symptom of the underlying psoriasis, and unless the psoriasis is treated appropriately, fissures will continue to appear, leading to a vicious cycle.
When to See a Doctor
If you haven’t been diagnosed, it’s important to see a dermatologist to find out whether your symptoms are due to psoriasis or due to a condition with similar symptoms. If you do have psoriasis, it’s important to see your doctor regularly, or anytime you feel you have new or worsening symptoms.
Most types of psoriasis go through cycles, meaning symptoms flare for a few weeks or months, then lessen for a time—or, very rarely, may go into remission.
How often you see your dermatologist really depends on the severity of your symptoms at any given time. “When it’s not controlled, every few weeks is sometimes necessary,” Rieder says. “But when it’s under control, twice a year will usually suffice.”
And through it all, make sure you’re happy with the advice and care you receive. “Find a dermatologist with expertise in psoriasis if you have seen other providers who have not helped or have not been a good fit,” says Stevenson. “Part of the treatment process is having a good relationship with your provider. It’s an ongoing, evolving process to treat a chronic condition that can change with time.”
You May Also Like:
Want to Read More?
Access all of Twill Care’s content, community, and experts for free!
Already a member? Login