Types of psoriasis

Types of psoriasis

There are several types of psoriasis. The most common psoriasis classification is based on clinical signs of the disease. 

According to those, there are five basic psoriasis types:

  • Plaque psoriasis, which is also known as psoriasis vulgaris
  • Erythrodermic psoriasis (also called psoriatic erythroderma)
  • Inverse psoriasis
  • Pustular psoriasis
  • Guttate psoriasis

Plaque psoriasis

Plaque psoriasis is the most common type of psoriasis. It appears as red skin patches covered with silvery white scales on top. White scales are made of accumulated dead skin cells. Commonly affected areas include scalp, forearms, knees, lower back, shins and navel area. Psoriasis in ear will also probably manifest as plaque psoriasis. Patches and scales tend to crack and bleed when damaged. They are also painful and able to cause itch. Plaque psoriasis accounts for approximately 80- 90% of all psoriasis cases.

Erythrodermic psoriasis

Erythrodermic psoriasis is a very severe and rare form of the disease. It affects the entire body. Lesions spread all over the body, plaques coalesce and skin acquires red hue. Sometimes, the skin peels off greatly. This condition causes intense itch and is very painful, therefore, it must be treated immediately. Erythrodermic psoriasis usually affects people with plaque psoriasis. It accounts for 3% of all psoriasis cases. This type of psoriasis requires immediate medical attention because it is a life- threatening condition. Immunosuppressive medication is used to manage this disease.

Inverse psoriasis

Inverse psoriasis affects body folds, flexural surfaces and other intertriginous areas. It appears as smooth and shiny red skin lesions, which usually do not have scales. The lesions most commonly are located in popliteal areas, armpits, groin, and skin folds of breasts. Inverse psoriasis is triggered by moist environment, sweat and friction. Obese people are more likely to suffer from this condition because they have deeper skin folds. Inverse psoriasis must be differentiated from Candida infection, which possess similar clinical signs and affects moist intertriginous areas as well. In some cases, skin biopsy is needed to clarify the diagnosis.

Pustular psoriasis

Pustular psoriasis manifests as tiny skin vesicles filled with pus. Pus is sterile; there are no bacteria in it, but it contains white blood cells. Vesicles are surrounded by red skin. Pustular psoriasis affects adults more frequently than children. Lesions often appear on hands and feet, but can affect any part of the body.

Guttate psoriasis

Gutatte psoriasis manifests as teardrop-shaped red skin lesions. It usually affects trunk and upper limbs. It is the second most common type of the disease, accounting for 10% of all psoriasis cases. Streptococcal infection is thought to be the main trigger of guttate psoriasis, since rash usually appears after the infection is gone. People younger than 30 years tend to be affected more often.

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There is also another classification of psoriasis, which distinguishes these psoriasis types:

  • Psoriasis vulgaris. It includes guttate, plaque, inverse and palmoplantar psoriasis.
  • Pustular psoriasis. It includes pustular psoriasis of Zumbusch, palmoplantar pustulosis and Acrodermatitis continua.
  • Psoriatic erythroderma.

According to Henseler and Christophers, there are 2 main types of psoriasis:

  • Type I affects people younger than 40 years;
  • Type II affects elder people.

Early stages of psoriasis can be undetected and therefore left untreated. Early psoriasis signs slightly differ from typical clinical manifestation. For instance, plaque psoriasis at first erupts as red patches. Only later, they become covered with the white scale. Pustular psoriasis initially looks like red sore skin. Vesicles with pus appear only after several hours.