Different Types of Psoriasis
Learn about different types of psoriasis, including plaque, guttate, inverse, pustular, erythrodermic psoriasis, and psoriatic arthritis. Discover symptoms, treatments, and emerging therapies for better management.
Written by Dr. Sonia Bhatt
Last updated on 3rd Jul, 2025
What is Psoriasis?
Psoriasis is a chronic condition caused by an overactive immune system, leading to the rapid production of skin cells in days instead of weeks. This results in the build-up of skin cells on the surface, forming plaques or rough, scaly patches that can burn, itch, or sting. These plaques commonly develop on the elbows, knees, back, face, scalp, palms, and feet but can appear anywhere on the body.
Types of Psoriasis
There are different types of psoriasis, each with distinct symptoms and affecting different areas of the body. While some types share similarities, they often require tailored treatments. Understanding the specific type you have is essential for working with your doctor to create a personalised treatment plan, allowing for better symptom management and improved quality of life.
1. Plaque Psoriasis
Plaque psoriasis is the most common type, affecting around 8 in 10 people with psoriasis. Doctors may also refer to it as "psoriasis vulgaris."
The symptoms include raised, inflamed patches of red skin covered with silvery-white scales. On darker skin, these patches may appear purplish with grey scales. They can cause itching, burning, or discomfort. While plaque psoriasis can develop anywhere on the body, it often occurs on the elbows, knees, scalp, and lower back.
To ease discomfort, doctors may recommend applying moisturisers to prevent the skin from becoming too dry or irritated. This may include over-the-counter (OTC) cortisone creams or ointment-based moisturisers. Identifying individual psoriasis triggers is also an important part of managing the condition.
Treatment options can include:
Vitamin D creams, such as calcipotriene and calcitriol, to slow skin cell growth, often combined with topical steroids to reduce inflammation and itching.
Topical retinoids, like tazarotene, to reduce inflammation.
Immunosuppressants, such as methotrexate or cyclosporine.
Coal tar applications, available as creams, oils, or shampoos.
Biologics, a class of anti-inflammatory drugs.
Light therapy, which exposes the skin to UVA and UVB rays, may also be recommended. In some cases, treatments combine prescription oral medications, light therapy, and topical ointments to manage inflammation. For moderate to severe psoriasis, systemic treatments may involve oral, injectable, or intravenous (IV) medications.
2. Guttate Psoriasis
Guttate psoriasis is characterised by small, red spots on lighter skin tones, which may appear violet or brown on darker skin tones. It is the second most common type of psoriasis, affecting approximately 8% of people with the condition. It often develops in childhood or early adulthood, making it a common type among younger individuals.
The spots are typically small, distinct, and drop-shaped, and while they are often less thick than the plaques found in plaque psoriasis, they can spread and eventually evolve into plaque psoriasis if not managed effectively. These spots are most commonly found on the torso and limbs but can also appear on areas like the face, scalp, and ears.
Guttate psoriasis is usually triggered by a range of factors. Common triggers include:
Strep throat (often linked to the initial flare-up)
Stress
Skin injuries (such as cuts, scrapes, or sunburns)
Infections (e.g., respiratory infections or colds)
Certain medications (including beta-blockers, lithium, and antimalarial drugs)
To treat guttate psoriasis, a doctor may prescribe steroid creams, light therapy, and oral medications to reduce inflammation and manage symptoms. Identifying and addressing the underlying cause of an infection is also important in clearing guttate psoriasis. If a bacterial infection, such as strep throat, is identified as the trigger, antibiotics may be prescribed to help resolve the infection and potentially reduce the severity and frequency of outbreaks.
3. Inverse Psoriasis
Flexural or inverse psoriasis is a form of psoriasis that affects the skinfold areas of the body, such as the armpits, groin, under the breasts, and around the genitals or buttocks. Unlike typical psoriasis, squamous lesions do not form in these areas due to the constant friction and moisture that occur in skin folds. Instead, the lesions appear as bright red, smooth, shiny patches that are symmetric and infiltrative, often with sharp, distinct contours. These plaques can be fissured, which means they may crack or split, adding to the discomfort.
This type of psoriasis is more commonly seen in individuals with obesity, as increased skin folds and sweating contribute to the development of these lesions. Additionally, seborrheic lesions, which are associated with dandruff or scalp psoriasis, can also appear in conjunction with flexural psoriasis. It is known to be more resistant to traditional treatments, such as topical steroids, due to the unique nature of the affected skin areas, requiring more specialised approaches for management and care.
4. Pustular Psoriasis
Pustular psoriasis is a rare form of psoriasis that mainly affects adults. It causes pustules, or pus-filled bumps, surrounded by red or purplish skin. Although the blisters may appear infectious, they are not. While the pustules may clear up within days, the condition is chronic, meaning flare-ups are likely to recur.
This type of psoriasis may affect specific areas of the body, such as the hands and feet. In more severe cases, it can cover large areas, known as "generalised" pustular psoriasis, which can be very serious.
Symptoms of generalised pustular psoriasis include:
Fever
Chills
Nausea
Rapid heart rate
Muscle weakness
Due to its severity, prompt treatment and medical care are essential for managing this condition effectively.
Types of pustular psoriasis include:
Von Zumbusch psoriasis, also known as generalized pustular psoriasis, is a severe form that can rapidly cover large areas of the body. It often comes on suddenly and is associated with symptoms such as fever, chills, intense itching, changes in heart rate, fatigue, and muscle weakness. This form of psoriasis requires immediate medical attention due to its potential seriousness.
Palmoplantar pustulosis is a more localized type of pustular psoriasis that specifically affects the palms of the hands and/or soles of the feet. It tends to appear at the base of the thumb and along the sides of the heels, causing discomfort in these areas.
Acropustulosis, also known as acrodermatitis continua of Hallopeau (ACH), is an extremely rare form of pustular psoriasis. It often develops after an injury or infection and is limited to the tips of the fingers or toes, particularly around the nails.
Treatments for pustular psoriasis may include:
Topical medications, such as creams or ointments, to help manage symptoms and reduce inflammation.
Oral medications, which can help control the condition and reduce flare-ups.
Phototherapy, which is most effective after the blisters have cleared and the skin is less irritated. This treatment uses controlled exposure to ultraviolet (UV) light to help reduce symptoms.
Biological treatments, which are advanced medications that target specific parts of the immune system to reduce inflammation and prevent flare-ups.
5. Erythrodermic Psoriasis
Erythrodermic psoriasis, also known as exfoliative psoriasis, is a rare and severe form of psoriasis. It presents as bright red patches on lighter skin tones or dark purplish areas on darker skin tones, and is characterised by widespread skin shedding. This condition is considered a medical emergency, and hospitalisation may be required, as the body may struggle to regulate temperature effectively.
The skin typically becomes covered with red or purple areas and silvery scales, with exfoliation occurring in larger pieces compared to the small scales typical of other forms of psoriasis.
Erythrodermic psoriasis can develop as a complication of several factors, including:
Pustular psoriasis
Widespread, poorly controlled plaque psoriasis
Severe sunburn
Infection
Alcohol use disorder
Significant stress
Abrupt discontinuation of systemic psoriasis treatments
Use of oral steroids, cyclosporine, or methotrexate
Almost all cases of erythrodermic psoriasis require hospital treatment. In a hospital setting, a combination of therapies may be administered, which can include:
Medicated wet dressings, to calm and protect the skin
Topical steroids, to reduce inflammation and manage flare-ups
Biologics, advanced medications that target specific immune system components
Prescription oral medications, to control symptoms and prevent recurrences
6. Psoriatic Arthritis
Psoriasis can cause the body to attack both the skin and joints. It often affects multiple joints and can be particularly severe in the hands, leading to damage of the nails. Typically, skin symptoms appear before joint symptoms.
Psoriatic arthritis (PsA) is a condition where both psoriasis and arthritis (joint inflammation) occur together. It is a painful and physically limiting condition, affecting between 30% and 33% of individuals with psoriasis. PsA has five subtypes, each with varying symptoms.
Common symptoms of psoriatic arthritis include:
Painful, stiff joints, which are worse in the morning or after periods of rest
Sausage-like swelling of the fingers and toes
Warm joints that may appear discoloured
Treatments for psoriatic arthritis may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, to help reduce swelling and pain.
Oral corticosteroids, which can be prescribed to reduce inflammation associated with psoriatic arthritis.
Disease-modifying antirheumatic drugs (DMARDs), a class of medications that help reduce inflammation and prevent joint damage.
Biologics, a subcategory of DMARDs, which target inflammation at a cellular level for more effective symptom control.
Impact of Psoriasis on Quality of Life
In addition to the physical challenges, psoriasis can also affect a person’s emotional and social well-being. Many individuals may feel self-conscious or embarrassed about the appearance of their skin. It’s crucial for those with psoriasis to seek support from friends, family, or support groups to help manage these emotional and social impacts.
When psoriasis lesions heal, dark or light spots may be left behind on the skin. These pigmentation changes can be more noticeable in people with darker skin tones. Dermatologists may recommend topical treatments to help address these spots, though they may gradually fade over time, some may remain.
Psoriasis tends to flare up and subside, so understanding and avoiding triggers is key to controlling symptoms. For some individuals, extreme weather—both cold and hot—can trigger flare-ups. Moisturising more regularly in winter or limiting sun exposure can help manage this. Skin injuries such as shaving, tattoos, piercings, or insect bites can also trigger flare-ups. Identifying these triggers and taking steps to avoid them can help maintain better control over the condition.
What are Novel and Emerging Treatments for Psoriasis
Although there is no permanent cure for psoriasis, scientists are continually developing new treatments to help manage the symptoms effectively.
Biologic treatments are a revolutionary approach to managing psoriasis, targeting specific parts of the immune system that contribute to the clinical condition. The latest biologic treatments for psoriasis include:
Bimekizumab
Risankizumab-rzaa
Ebdarokimab
New topical treatments for psoriasis include:
Roflumilast
Tapinarof
Wynzora
Additionally, the development of biosimilars is advancing. Biosimilars are created by reverse-engineering biologic medications once their patents have expired. Similar to generic drugs, biosimilars typically offer a more affordable alternative to the original biologic treatments. The latest biosimilars for psoriasis include:
Biosimilars to adalimumab
Biosimilars to infliximab
These new therapies and treatment options are offering improved ways to manage psoriasis at a lower cost.
Conclusion
Psoriasis presents in various forms, each with distinct characteristics and location of incidence. Recognising the specific type is vital for working with your doctor to develop a personalised treatment plan, ensuring more effective symptom management and an enhanced quality of life.
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