Psoriasis symptoms, there are actually these types

Psoriasis is what we often call psoriasis, which often starts with one or more small psoriatic plaques with a large amount of scales on them. Small papules may appear around the plaques. Although the first plaque may disappear on its own, others may soon appear. Some patches remain the size of a thumbnail, while others grow larger, sometimes taking on a distinct ring or multiple rings.

1. Symptoms of psoriasis:

Psoriasis begins as one or more small, silvery plaques with abundant scaling. Small papules may appear around the plaques. Although the first plaque may disappear on its own, others may soon appear. Some patches remain the size of a thumbnail, while others grow larger, sometimes taking on a distinct ring or multiple rings. Psoriasis can also occur around and under the nails, causing them to thicken and become deformed. The eyebrows, armpits, umbilicus, and groin may also be affected.

Usually, psoriasis only causes scaling, and even itching is not common. After the desquamated area heals, the skin becomes completely normal again and the hair grows as usual. Most people with localized psoriasis have few symptoms other than scaling, which can be embarrassing in terms of the appearance of the skin. Some psoriasis can spread over a large area or have serious effects. The symptoms of psoriatic arthritis are very similar to those of rheumatoid arthritis. In rare cases, psoriasis spreads throughout the body and causes psoriatic exfoliative dermatitis. This type of psoriasis is serious because it acts like a burn and the skin is unable to function as a protective barrier against damage and infection. Another rare form of psoriasis is pustular psoriasis, in which pus-filled blisters of varying sizes form on the palms of the hands and soles of the feet and sometimes spread throughout the body.

2. Psoriasis is generally divided into 4 types: vulgaris, pustular, arthritis and erythrodermic.

1. Psoriasis vulgaris: the most common. At the beginning, it appears as light red or bright red papules or maculopapules ranging in size from a pinhead to a mung bean, with clear boundaries and covered with multiple layers of dry silvery-white scales in a mica-like state, surrounded by a red halo, and with obvious base infiltration. The rash gradually increases, expands or merges into plaques, the scales thicken and are easy to scrape off, revealing a layer of light red, shiny, translucent membrane, which is called the thin film phenomenon. When the thin film is scraped off, punctate bleeding may be seen, which is called Auspitz sign.

Skin lesions can form various forms, such as guttate psoriasis, nummular psoriasis, geographic psoriasis, gyrate psoriasis, verrucous psoriasis, flexural psoriasis, etc. A few skin lesions have exudation, which forms dirty brown scaly crusts in the shape of oyster shells after drying, which is called oyster shell psoriasis. Patients experience varying degrees of itching.

The skin lesions often occur on the scalp and the extensor sides of the limbs, such as in front of the knees and behind the elbows, but can also spread to other parts of the body. Symmetrical distribution. In a few cases, the skin lesions are confined to a certain part for a long time, such as the scalp, vulva or calves, and appear as thickened plaques, which is called chronic hypertrophic psoriasis. If it occurs on the scalp, the lesions have clear boundaries and thick scales on the surface that cause the hair to be bundled, but there is no hair loss or breakage. Rudular or eczematous changes. Psoriasis on the palms and soles is rare. It presents as brown-yellow keratotic plaques or guttate hyperkeratosis with clear borders, surrounded by a red halo. The plaques may have white scales or punctate depressions, and are prone to cracking. Psoriasis on the lips and glans penis appears as light red or grayish white infiltrated patches with clear borders, which, when scraped, reveal white scales and punctate bleeding. Nail psoriasis is common. The nail plate often has "thimble-like" depressions and loses its luster. It may have longitudinal ridges, transverse cracks, hypertrophy, and even destruction and shedding.

The disease has a long course and can last for several years to decades, during which time the disease may recur. It is generally divided into three stages: ① Progressive stage: It is the acute attack stage, new skin lesions continue to appear, the original skin lesions continue to expand, and scales accumulate. Significant inflammation. There is a blush around it. Stimulation such as acupuncture, trauma, or application of strong drugs can induce new skin lesions with the same nature as the primary disease at the stimulated site, which is called "isomorphic reaction" or Koebner's sign. ②Stable period: Inflammation is relieved. There are no new skin lesions and the patient's condition is stable. ③Regression stage: skin lesions gradually subside. The color becomes lighter, and after the skin lesions disappear, hypopigmented or hyperpigmented spots remain.

2. Pustular psoriasis (psoriasis pustulosa): less common. There are 2 types: generalized and palmoplantar.

(1) Generalized pustular psoriasis (Zumbusch type): Most cases have an acute onset and are often accompanied by systemic symptoms such as malaise, remittent fever, joint swelling and pain. The rash can spread throughout the body within a few weeks. At the onset, it is an inflammatory erythema, and then on this basis, dense yellow-white shallow sterile pustules ranging in size from needle tips to millet grains appear. The surface is covered with scales, and some of them fuse or enlarge into "pus lakes". They are characteristic and often rupture due to friction, causing erosion and exudation. After a few days, the pustules dry up and form scabs. Skin lesions may appear in batches and recur periodically. Conscious itching or pain. The skin lesions are widely distributed, but are more common on the flexor sides and folds of the limbs. The oral mucosa and nail beds may also be affected. The nails become cloudy, thickened, and even broken and dissolved. Often has a grooved tongue. This disease is more common in young and middle-aged people. It may be triggered by infection, fatigue, menstruation, sudden discontinuation of long-term use of corticosteroids for psoriasis vulgaris, or stimulation by topical medication during the progressive stage. After the pustules subside, psoriasis vulgaris lesions may appear or may transform into erythroderma.

(2) Palmoplantar pustular psoriasis (Barber type): The lesions are limited to the hands and feet, most commonly on the palms and soles. It starts at the thenar and hypothenar eminences as symmetrical erythema, and soon millet-sized sterile pustules appear with thick blister walls that are not easy to rupture. After 1 to 2 weeks, it will dry up and form a brown scab, which will fall off and small scales will appear. Later, groups of new pustules may appear under the scales. The nails are often invaded and become deformed, cloudy, thickened, and even have pus under the nail. Conscious itching and pain. Psoriasis lesions are often seen on other parts of the body. This type of skin lesions are stubborn and recur repeatedly.

3. Psoriasis arthropathica: also known as psoriatic arthritis, it often occurs secondary to psoriasis vulgaris or after repeated exacerbations. It may also first appear in joint symptoms or be complicated by pustular and erythrodermic psoriasis. Joint symptoms are parallel to psoriasis lesions. Mainly asymmetric peripheral polyarthritis. It is common in small joints of the hands, wrists, feet, especially the distal joints of the fingers and toes, and may also affect the spine. The affected joints are red, swollen and painful, with morning stiffness, limited movement, deformity, and even ankylosis. In severe cases, both large and small joints may be affected, with effusion in large joints, progressive para-articular erosion and osteolysis, and joint destruction and deformity (mutilating arthritis). Accompanied by systemic symptoms such as fever and anemia. It may be complicated by visceral damage such as ulcerative colitis, rheumatic heart disease, nephritis, hepatosplenomegaly, lymphadenopathy and conjunctivitis. 80% are accompanied by nail damage. X-ray examination shows some changes of rheumatoid arthritis, but rheumatoid factor is often negative.

4. Erythrodermic psoriasis: It is common in cases of improper treatment of psoriasis vulgaris or after the regression of pustular psoriasis. The skin of the whole body is diffusely flushed, infiltrated, and swollen. The surface is covered with a large number of bran-like scales that constantly fall off, and there may be flaky normal "skin islands" in between. After erythroderma subsides, psoriasis vulgaris lesions reappear.

5. Other subtypes: seborrheic psoriasis, eczematoid psoriasis, photosensitive psoriasis, diaper psoriasis, etc.