Plaque Psoriasis: Pictures and Symptoms of the Types You May See on Your Body

Plaque Psoriasis

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When plaque psoriasis first starts, it may look like red bumps on your skin. The bumps eventually get thicker, increase in size, and form scales (plaques) like you see here.

Psoriasis plaques are round to oval with clearly defined borders. They most often appear on extensor surfaces—areas of skin on the outer side of a joint (like the back of the elbow and the front of the knee)—as opposed to flexor surfaces on the inner side of a joint where the skin creases.

Plaque psoriasis can also develop on the scalp, neck, ears, and just above the buttocks adjacent to the lumbar spine. There may be only a few plaques or there may be a large number of them.

The plaques tend to be more than half a centimeter (0.2 inches) in diameter and have very thick scales.

On lighter skin tones, plaques appear pink. On darker skin, they may look brown or gray. After plaques heal, the affected skin may appear darker or lighter temporarily, but this typically fades.

Plaque psoriasis can sometimes be mistaken for eczema. However, eczema tends to be very itchy, while plaque psoriasis is only mildly so. 

Treatment

Treatment varies depending on where the psoriasis is located on the body and individual severity. Over-the-counter (OTC) and prescription topical creams can help clear plaques by tempering local inflammation and gently loosening the scales.

Light or laser therapy may be tried, as well as biologics and/or other medications.

Multiple Psoriatic Plaques

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In this photo, plaque psoriasis appears on the elbow and arm. There is little scaling, but the affected skin appears thick, red, and irritated. At first glance, it can be easy to mistake multiple lesions for any number of other skin conditions.

Because there are no blood tests or imaging studies that can definitively diagnose psoriasis, misdiagnosis can sometimes occur.

The diagnosis of psoriasis is based primarily on lesion appearance, a review of medical history (including a family history of psoriasis), and the exclusion of all other causes (referred to as the differential diagnosis).

Some of the diseases and conditions that look similar to psoriasis include:

• Tinea curis (jock itch)
• Tinea pedis (athlete's foot)
• Tinea capitis
• Seborrheic dermatitis
• Eczema
• Pityriasis rosea
• Ringworm
• Erythrasma
• Lichen planus
• Lupus
• Squamous cell carcinoma

Treatment

Treatment options include topical creams or ointments, light therapy, and medications. Treatments vary based on how severe the psoriasis is and previous treatment and self-care responses.

Plaque Psoriasis of the Elbow

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This photo illustrates how thick plaques can become if they are not treated.

Plaque psoriasis can also appear after any number of common and uncommon triggers, like stress, infections, skin trauma, medication use, extreme humidity, and cold/dry weather.

Many of these—drugs and stress, especially—can exacerbate flares, making symptoms worse and more difficult to control.

Treatment

Treatments include over-the-counter (OTC) or prescription creams (including topical steroids), light therapy, and medications.

In severe cases, immunosuppressant drugs may be recommended. These include disease-modifying antirheumatic drugs (DMARDs) like methotrexate and cyclosporine, or new biologic drugs like Humira (adalimumab) and Enbrel (etanercept).

Plaque Psoriasis of the Gluteal Cleft

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The gluteal cleft (the crease of skin between the buttocks) is a common site for plaque psoriasis. This photo illustrates the characteristic plaques with their clearly defined borders and patchy scales.

The scales are one of the clues that differentiate plaque psoriasis from inverse psoriasis, which can also develop in the gluteal crease. However, with inverse psoriasis, the lesions tend to be smooth with few visible scales.

The problem with gluteal involvement is that the very act of sitting can irritate inflamed skin and make the condition worse.

Treatment

Treatments include topical creams (including OTC products containing coal tar and calcipotriene, a form of vitamin D) and oral medications (e.g., cyclosporine, methotrexate, or biologics).

Scalp Psoriasis

Scalp psoriasis may appear as small, powdery scales or as thick, crusty scales that more closely resemble psoriasis on other parts of the body.

Scalp psoriasis may be mistaken for dandruff or seborrheic dermatitis, but it is typically a different color. Scalp psoriasis scales are silvery, while seborrheic dermatitis is yellowish. 

Scalp psoriasis can also be itchy, and it can cause your scalp to become dry and cracked. In addition to scaling and flaking, your scalp may also bleed, especially if you scratch it.

Treatment

Treatments include medicated creams applied to the scalp, medicated shampoos, scale softeners/exfoliants (creams that include salicylic acid, coal tar, and alpha-hydroxy acids), and light therapy. In severe cases, biologics and/or other medications may be recommended.

Nail Psoriasis

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Nail psoriasis can cause your nails to appear yellowish, brownish, or white. You may also notice a thickening of the nails and grooves or "pits" on their surfaces.

If you have nail psoriasis, your nails may become thicker and you might notice a white material accumulating under them. This can cause them to separate from the skin underneath. They might even feel sore or tender to the touch.

Nail psoriasis can affect your fingernails and/or your toenails. 

Treatment

Treatments include prescription creams containing steroids, calcipotriol, and tazarotene (derived from vitamin A). Laser treatment and steroid injections may be tried. In severe cases, biologics and/or other medications may be recommended.

Plaque Psoriasis of the Trunk

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It is not uncommon to have psoriatic plaques in areas where clothes are tight, causing friction to the skin. This picture is one such example in which pressure from a belt can give rise to a ring of psoriasis on the stomach area or trunk.

The phenomenon, known as the Koebner response, is associated with psoriasis and other diseases in which a rash or lesions will develop along the line of trauma.

With psoriasis, a flare may occur as a result of a cut, abrasion, sunburn, rash, or even vigorous scratching. It is even possible for psoriasis to develop on old scar tissues, including tattoos and surgical scars.

Treatment

OTC and prescription topical creams, light or laser therapy, and biologics and/or other medications may be tried, depending on severity.

Guttate Psoriasis

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Guttate psoriasis is a type of psoriasis that appears as many small, teardrop-shaped lesions called papules. The spots most often develop on the trunk but they can also appear on the legs, arms, and scalp.

Guttate psoriasis is often triggered by a bacterial or viral infection. This is especially true with streptococcal infections like strep throat and viral infections like chickenpox and measles.

Because the diseases that trigger guttate psoriasis are more common in childhood, children tend to be affected by this type of psoriasis more often than adults. Adults under 30 are also vulnerable.

Treatment

If a recent bacterial infection is involved, antibiotics may be given.

OTC or prescription creams containing steroids, calcipotriol, and tazarotene may be recommended.

More severe cases are managed with biologics and/or other medications. Light or laser therapy may be suggested.

Mild Guttate Psoriasis

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This photo illustrates a mild form of guttate psoriasis. The onset of symptoms is often rapid with multiple lesions erupting on the trunk and extremities. Itchiness is common.

In addition to infections, certain drugs can trigger a flare. Beta-blockers, antimalarial drugs (like Plaquenil), and nonsteroidal anti-inflammatory drugs (NSAIDs), especially naproxen, are some of the usual suspects.

Treatment

If a recent bacterial infection is involved, antibiotics may be given.

OTC or prescription creams containing steroids, calcipotriol, and tazarotene may be recommended. Mild cases can be treated at home.

Severe Guttate Psoriasis

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This image depicts a severe case of guttate psoriasis.

Fortunately, an outbreak is usually self-limiting and will resolve on its own without treatment after several weeks or months. Some people may never experience another episode; others may develop chronic plaque psoriasis.

Because there is no definitive way to diagnose guttate psoriasis, severe cases will typically require a battery of tests to exclude other causes (such as cutaneous T-cell lymphoma or syphilis) and check for likely triggers (most commonly strep throat or chronic tonsillitis).

Treatment

If a recent bacterial infection is involved, antibiotics may be given.

A severe guttate psoriasis outbreak usually resolves without treatment, however, options to lessen symptoms include OTC or prescription creams containing steroids, calcipotriol, and tazarotene.

In severe cases, biologics and/or other medications and light or laser therapy may be suggested.

Inverse Psoriasis

Inverse psoriasis appears in skin folds or on body parts where the skin rubs together, such as the armpits or groin. It is called "inverse" because it affects body parts opposite to the bends in joints where plaque psoriasis usually appears. 

Inverse psoriasis usually looks red and shiny. The lesions aren't typically raised and they can be very sore and irritated. You probably won't see scales in skin creases and folds because the scales tend to flake away with skin-to-skin friction. 

Treatment

In addition to standard psoriasis treatment options, additional therapies may be recommended due to the risk of yeast and fungal infections. Powders may be added to keep skin dry as it heals.

Erythrodermic Psoriasis

Erythrodermic psoriasis is a rare and severe type that causes a bright red, burn-like rash on most of the body. Like a burn, this uncommon type of psoriasis can cause serious complications and requires immediate medical care.

When you have this type of psoriasis, your skin may peel off in large sheets and you may also develop fluid-filled blisters. Other symptoms include:

• Fever and chills
• Joint pain
• Rapid heartbeat
• Swelling in the legs and ankles
• Irregular body temperature
  

Treatment

An erythrodermic psoriasis flare is a medical emergency. Seek immediate medical care if you suspect this condition.

Treating erythrodermic psoriasis first involves getting body temperature and fluid balance back to normal. Depending on the severity of symptoms, hospitalization for treatment may be necessary.

IV antibiotics, biologics, immunosuppressive agents, and topical steroids may be recommended to treat this condition.

Pustular Psoriasis

Pustular psoriasis is an uncommon type of psoriasis that causes pus-filled blisters (pustules) to form on the body. In serious cases, these blisters may cover most of the body. When this happens, it is important to seek medical attention right away. 

Pustular psoriasis may affect only small parts of the body, such as the palms or soles of the feet. This type is known as palmoplantar pustulosis.

The second type, called acrodermatitis continua of Hallopeau, causes tiny, painful pustules on the fingertips and toes, which may spread to the hands or soles of the feet.

Von Zumbusch psoriasis is the most serious type of pustular psoriasis. People with this type will experience pustules over a large part of the body. Additional symptoms may include:

• Fever and chills
• Headache
• Nausea
• Muscle weakness
• Joint pain
• Fatigue

People with Von Zumbusch psoriasis need to seek medical care immediately to avoid more serious complications like dehydration and an increased risk of infection.

Treatment

People exhibiting the symptoms of Von Zumbusch psoriasis need immediate medical care.

Treatment for milder types of pustular psoriasis can include prescription topical creams, light or laser therapy, and biologics and/or other medications depending on severity.

Psoriasis Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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