All about psoriasis

What is happening to the skin?
In areas of skin affected by psoriasis new skin cells are produced at a much faster rate than dead cells are shed and the excess cells accumulate to form a thick scale. Underlying the surface scale is an area with increased numbers of small blood vessels.

Do I have psoriasis or could it be something else?
Other skin conditions can look similar to psoriasis, particularly if it is not the classic type. These include certain forms of eczema and ringworm, with other rarer skin diseases also being a possibility.

Types of psoriasis

1. Plaque psoriasis
This is the most common form of psoriasis and is a lifelong disorder that may develop at any age. Any part of the outer surface of the body can be affected but especially the outer borders of the limbs, the knees, elbows, lower back and scalp. Plaques can also arise in areas of previously damaged skin like scar tissue. The plaques can be itchy and sore, but the symptom that bothers people most is the continual shedding of the skin scales, particularly from the scalp, which is embarrassing and can cause severe psychological upset.

Sometimes the areas affected are the inner areas of the skin, so-called reverse psoriasis, when the armpits, groins and the skin between the buttocks or under the breasts is inflamed. There is no characteristic scale at these sites because it is rubbed off by friction, and so it can be harder to distinguish it from other skin disorders. Psoriasis in these areas can also become infected by bacteria or fungi and be very sore and uncomfortable.

The nails are also commonly involved, with small pits scattered across the nails, separation of the nail from the nail bed, and scale accumulating under the nail plate. Rarely, the nails only are affected, with no skin changes at all.

2. Guttate psoriasis
This form most commonly affects children and adolescents and frequently follows a throat infection or other viral illness. The attack lasts three to six months. Many plaques of psoriasis appear all over the body, mainly very small (less than one centimetre in diameter). About half of those affected can go on to develop one of the other forms of psoriasis later in life.

3. Pustular psoriasis
There are two types of this form of psoriasis. The more common is the type localised to the palms and soles, which consists of small blisters filled with pus, red tender inflamed surrounding areas of skin and some areas of thickened scaly cracked skin. Occasionally this type can affect the whole body and this is a serious and life-threatening condition needing hospital admission.

4. Joint disease
Around five per cent of people with psoriasis develop a typical form of arthritis. This may take the form of inflammation (pain, redness and swelling) of the small joints of the hands, feet, wrists and ankles. The other common type of arthritis associated with psoriasis is a more severe inflammation affecting and deforming various joints.

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