Psoriasis is a long-term disease that results from an immune system dysfunction causing it to overproduce inflamed skin cells that grow rapidly forming dry, scaly, itchy, red, and raised patches known as plaques. These symptoms generally differ from one patient to the other according to the type of psoriasis and its degree of severity.
Identifying the type and severity of your psoriasis is one of the main factors that will determine which treatment you’ll be prescribed. Other factors include your overall health, medical history, and treatment response.Read More
Moderate psoriasis. The affected areas range between 3-10% of the body.
Severe psoriasis. The affected areas manifest in more than 10% of the body.
Mild to Moderate Psoriasis
Mild to moderate psoriasis only appears in less than 5% of the body as areas of raised bumps that are covered with dead skin cells called scales. Fortunately, they can be easily managed with topical treatments and vitamin D analogues.
Moreover, these bumps and patches don’t affect sensitive areas like the genitals, face, hands, and feet.
Moderate to severe psoriasis appears when affected areas of the body exceed 10%. They affect any area of the body without limitations and can be more challenging to manage. Biologic treatments are most frequently used in this case.
The use of biologics as a monotherapy or combined with other treatments is a decision that will be made by your doctor depending on what’s best suitable for you.
What Does Psoriasis Look Like?
Aside from severity, the type of psoriasis also plays an important role in what your psoriasis looks like. There are seven types of psoriasis, each having its own unique characteristics and morphology that sets it aside from other types.
Below is a list of these different types and their distinguishing properties:
Plaque psoriasis. This is the most common of all psoriasis types that make up around 80-90% of all cases. It’s characterized by thick and raised patches of the skin (called plaques), symmetrically distributed with dry white or silvery scales covering them. The plaques may be asymptomatic, but pruritus is common.
The scalp, elbows, knees, and gluteal cleft are common sites for involvement. The extent of involvement can range from limited, localized disease to involvement of the majority of the body surface area.
Guttate psoriasis. They usually affect young adults and children who have also had other types of psoriasis and are characterized by spots and bumps on the skin that are red or purple and have a scaly texture. There is a strong association between recent infection, usually streptococcal pharyngitis, and guttate psoriasis. Guttate psoriasis spots generally appear on the torso, legs, and arms, but later when the disease progresses, they spread to other areas of the body like the face, scalp, and ears. These spots and bumps are very small in size (giving rise to the name “guttate,” which means “drop-like”), scaly, have a light pinkish color, and can suddenly appear and go away on their own without any treatment.
Inverse psoriasis. also known as intertriginous psoriasis or flexural psoriasis. This type differs from other types of psoriasis by the smoothness, flatness, and raw-looking rashes they form. They usually appear in areas where the skin folds continuously rub against each other, these include areas like armpits, under the breasts, and the genitals.
They’re the only type of psoriasis with little to no scales. Additionally, they have a rash-like appearance which triggers pain and discomfort in the affected areas after sweating.
Pustular psoriasis. One of the rarest types of psoriasis that can be very serious and fatal. They appear in various areas of the body and when they dry out, they cause brown scaly spots. The characteristic mark of pustular psoriasis is pus-filled bumps and red, dry sores or bumps in various areas of the body.
People who have pustular psoriasis suffer significantly and may need medical help, aside from symptoms affecting their skin they can also have other symptoms which include the following:
- Weakness in the muscles
It’s worth noting that in its early stages, pustular psoriasis can be mistaken for pustular acne lesions which can make for a challenging diagnosis.
Erythrodermic psoriasis. Like pustular psoriasis, erythrodermic psoriasis is rare, extremely life-threatening and needs immediate medical intervention. It’s characterized by skin shedding and debilitating pain. Early symptoms of erythrodermic psoriasis include burn-like symptoms in over 90% of the body, intense pain, itching, and red and dry skin which is extremely sensitive to touch.
You need immediate medical attention for this type of psoriasis. In addition, if you notice your psoriasis symptoms getting worse you should seek your doctor right away so that they can prevent any complications before they ensue.
Complications of erythrodermic psoriasis include the following:
- Increased heart rate
- Muscle weakness
- Hypothermia (Dangerous low blood temperature)
Nail psoriasis. This type is very common and occurs in more than 50% of people with other types of psoriasis. Symptoms of the disease include discoloration of nails (they may turn yellow or brown), nails crumbling and becoming rougher or dainty, and in some cases, the nails may fall off their nail beds.
Psoriatic arthritis (PsA). Psoriatic arthritis is when your joints are affected causing the following symptoms:
- Pain in the heel
- Swollen fingers
- Painful and tender joints
- Joint stiffness (especially in the morning)
“Half of the patients with psoriatic arthritis are not being treated with a systemic medicine,” Dr. George Han, a dermatologist at Northwell Health/Lenox Hill Hospital, said in a previous interview with SurvivorNet. “That is just not okay in this day and age when we have so many treatments that can really stop the joint damage in its drugs.
“So I think we are in a place where we’ve got great treatments, but we need to make sure we connect that to the right people.”
You can also get an idea of what these patches look like in different types of psoriasis from pictures on the American Academy of Dermatology Association website.
How to Measure Psoriasis Severity?
To assess the severity of your psoriasis, your doctor can use the following tools:
Body surface area. This refers to how much of your body is affected by psoriasis.
Severity. This refers to measuring the condition of your scales (their thickness, roughness, or redness), this is calculated by a complex tool known as Psoriasis Area and Severity Index (PASI). However, it’s not approved for measuring for children and young adults.
Quality of life. This refers to the impact psoriasis has on your life and your day-to-day activities. These typically include questions involving your social interactions and how you feel.
Other scales and assessment tools are available for psoriasis, these include the following:
- Physician’s Global Assessment (PGA)
- Self-administered PASI (SAPASI)
- Dermatology Life Quality Index (DLQI) and Children’s Dermatology Life Quality Index (CDLQI)
- Psoriasis Assessment Severity Score (PASS)
- The Simplified PASITrusted Source (SPASI)
However, your doctor will choose the most suitable one that’s suitable for you.
Whether you’ve been diagnosed with mild, moderate, or severe psoriasis, there’s no doubt your life has been impacted significantly by this disease. Therefore, we recommend that you seek out help through finding a support group, therapy, or from family and loved ones.
These can help you manage your stress, depression, and anxiety as well as improve your mental health, especially with the stigma surrounding psoriasis.
Questions to Ask Your Doctor
- How severe is my psoriasis?
- Which type of psoriasis do I have?
- What treatment do you recommend for me?
- What are the risks and benefits associated with your recommended treatment?
- Can my mild psoriasis become severe?
- Is there anything I should avoid doing to avoid flare-ups?
- Can my diet affect my remission chances?
- What rules should I follow to stay in remission as long as possible?
- How can I improve my quality of life with this disease?
The Bottom Line
Understanding the severity of your psoriasis is very important to help your doctor determine the best treatment option for you as well as know your body’s response to that treatment and whether you’re getting better or worse.