First symptoms of psoriasis

The disease may begin at any age. However, psoriasis often first appears between ages 15 and 25. This condition may as well occur in young children and elderly patients.
In the beginning, psoriasis is manifested by characteristic bumps on the skin, all of which merge together to form psoriatic plaques, fluctuating in extent and severity. Skin manifestations of psoriasis most commonly affect the: scalp, elbows, knees, lumbar or sacral region of the spine, hands, and feet. Psoriatic plaques can also be present on fingernails. This condition rarely affects the face. In some people psoriatic lesions also develop in the oral cavity.

Types of psoriasis

Psoriasis varies in form and degree of intensity. It can also vary in severity in the same person at different times and range from mild to very severe. The type of psoriasis is an important criterion for selecting the most appropriate and effective treatment. Psoriasis types are typically identified by their hallmark appearances, sites of involvement, and the degree of severity. In order to determine the type of psoriasis, the affected skin areas must be examined by a dermatologist. Most common types of psoriasis are: plaque psoriasis, guttate psoriasis, pustular psoriasis, inverse psoriasis, erythrodermic psoriasis, and psoriatic arthritis.
Plaque psoriasis

Plaque psoriasis is the most common form of psoriasis, affecting about 80 percent of patients. Plaque psoriasis typically appears as skin bumps that merge into reddened flat areas of oval patches (plaques). Plagues of various sizes, mostly red, are easily palpable. They are covered by flaky silvery scales. These skin manifestations are usually (but not always) accompanied by persistent and annoying itching, which  leads patients to scratch the itch, causing the plaques to bleed. Psoriasis vulgaris  typically develops on various parts of the skin and most commonly affects the knees, elbows, shoulders, back, legs, or scalp. Various types of psoriasis vulgaris can also be present in other areas of the body, including palms and soles, fingernails, or the lower back.


 Erythrodermic psoriasis

Erythrodermic psoriasis is the most serious form of the disease. In erythrodermic psoriasis, extensive erythematous and desquamative flaky lesions on the skin cover most of the body surface. Patients may experience fever and joint pain which exacerbate the itching and scaling of the skin. Peripheral lymph nodes may be enlarged. Erythrodermic psoriasis can develop from psoriasis vulgaris and a concomitant infection. If neglected or treated inadequately, erythrodermic psoriasis can cause severe illness or even death.


Pustular psoriasis

Pustular psoriasis is distinct from other types of psoriasis and can be classified as a separate medical condition. Pustular psoriasis is primarily seen in adults. It is manifested by pustules. The areas surrounding the involved sites of skin are inflamed. Skin manifestations in pustular psoriasis are either limited to specific body areas, such as palms or soles, or spread all over the body. Localised pustular psoriasis affecting hands and feet is most common in women over 50. Pustules appearing regularly on the skin are painful and are vulnerable to mechanical damage. Diffuse pustular psoriasis occurs rarely and has a more severe clinical course. Other symptoms, apart from skin lesions, include high temperature, listlessness, and fatigue. Smoking has been observed to be one of the key triggers in the development of this form of psoriasis.


Inverse psoriasis 

Inverse (or flexural) psoriasis tends not to have a silvery scale. It shows up as very red lesions in body folds: on elbow joints, behind the knees, under the arms or in the groin, and under the breasts. Disease-affected skin areas are hypersensitive and can be irritated by sweat or clothes. Inverse psoriasis is more common in overweight people and in the elderly population. This type of psoriasis can be induced by fungal infections.


Guttate psoriasis 

Guttate psoriasis most commonly occurs in children and young people and looks like small red drops (up to 1 cm in diameter) on the skin of various severity. The trigger of this psoriasis type is usually a streptococcal infection. Guttate psoriasis often involves a Köbner phenomenon, in which disease-specific lesions can occur in areas of minor epidermal trauma.


Psoriatic arthritis

Psoriatic arthritis is a chronic inflammatory arthritis accompanying psoriasis, affecting both children and adults. The symptoms of psoriatic arthritis are most commonly located on the arms, feet, and lower back. Fingers become deformed; psoriatic lesions appear on the skin and fingernails. The disease is also manifested by joint pain and swelling. Psoriatic arthritis  requires rapid diagnosis and the initiation of effective therapy. Psoriatic arthritis has to be managed by both a dermatologist and a rheumatologist.

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