Although psoriasis may be almost unnoticeable in its early stages, patients often report an itching and/or burning sensation as the disease progresses.

This photo on the left shows itching (skin after itching) and bleeding spots thereafter, on psoriasis lesions. In this photo, the patient has scratched it profoundly to an extent that there are bleeding spots. (Click photo to enlarge.)

There are many variants and types of psoriasis. But usually the course follows like this: It starts with red small bumps on the skin that progress to bigger scaly patches. The condition is associated with lot of itching. As the scales accumulate, pink to deep red plaques with a white crust of silvery scales appear on the skin surface.

Although psoriasis may affect any area of the body, it is most commonly found on the scalp, elbows, knees, hands, feet, and genitals.

Types of psoriasis: Psoriasis has many variants. The common ones are as follows:

• Plaque Psoriasis: Plaque psoriasis is the most common type of the disease and is characterized by raised, thickened patches of red skin covered with silvery-white scales. Its scientific name is psoriasis vulgaris.

• Pustular psoriasis is characterized by pus-like blisters. Attacks of pustular psoriasis may be triggered by medications, infections, emotional stress, or exposure to certain chemicals. Pustular psoriasis may affect either small or large areas of the body.

• Erythrodermic psoriasis characterized by intense redness and swelling of a large part of the skin surface, is often accompanied by itching or pain. Erythrodermic psoriasis may be precipitated by severe sunburn, use of oral steroids (such as cortisone), or a drug-related rash.

• Guttate psoriasis is characterized by small, drop-like lesions on the trunk, limbs, and scalp. Guttate psoriasis is most often triggered by bacterial infections (for example, Streptococcus).

• Inverse psoriasis is characterized by smooth red lesions in the folds of the skin like in the folds of the skin near the genitals, under the breasts, or in the armpits. Inverse psoriasis is related to increased sensitivity to friction and sweating and may be painful or itchy.

The Psoriatic Nail
About 50 percent of persons with active psoriasis have psoriatic changes in fingernails and/or toenails. In some instances psoriasis may occur only in the nails and nowhere else on the body. Nail changes in psoriasis fall into general categories that may occur singly or all together:

• The nail plate is deeply pitted or depressed
• The nail has a yellow to yellow-pink discoloration
• White areas appear under the nail plate. There may be reddened skin around the nail.
• The nail plate crumbles in yellowish patches (onychodystrophy)
• The nail may be entirely lost

Nail psoriasis is frequently associated with psoriatic arthritis
For the most part people with psoriasis can function normally. Sometimes people experience low self-esteem because psoriasis appears unsightly. Psoriasis is often misunderstood by the public, and this can make social interactions awkward. This may lead to emotional problems such as anxiety, anger, embarrassment, and depression.

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