What does psoriasis look like when it first appears?



What is psoriasis?

Psoriasis is a chronic skin disorder that produces thick, pink to red, itchy areas of skin covered with white or silvery scales. The rash usually occurs on the scalp, elbows, knees, lower back and genitals, but it can appear anywhere. It can also affect the fingernails.

Psoriasis usually begins in early adulthood but it can start later in life. The rash can heal and come back throughout a person’s life. Psoriasis is not contagious and does not spread from person to person. In most people, the rash is limited to a few patches of skin. In severe cases, it can cover large areas of the body.

How does the rash start?

Psoriasis starts as small red bumps that grow in size, on top of which scale forms. These surface scales shed easily, but scales below them stick together. When scratched, the lower scales may tear away from the skin, causing pinpoint bleeding. As the rash grows larger, “plaque” lesions can form.

What are less common forms of psoriasis?

Inverse psoriasis – Psoriasis found in skin folds. This form may present as thin pink plaques without scale.

Guttate psoriasis – Small, red, drop-shaped, scaly spots in children and young adults that often appear after a sore throat caused by a streptococcal infection.

Pustular psoriasis – Small, pus-filled bumps appear on the usual red patches or plaques.

Sebopsoriasis – Typically located on the face and scalp, this form is made of red bumps and plaques with greasy yellow scale. This is an overlap between psoriasis and seborrheic dermatitis.

What causes psoriasis?

The cause of psoriasis is unknown. The condition tends to run in families, so it may be passed on to children by parents. Psoriasis is related to a problem of new skin cells developing too quickly. Normally, skin cells are replaced every 28 to 30 days. In psoriasis, new cells grow and move to the surface of the skin every three to four days. The build up of old cells being replaced by new cells creates the hallmark silvery scales of psoriasis.

What causes psoriasis outbreaks?

No one knows what causes psoriasis outbreaks. How serious and how often outbreaks happen varies with each person. Outbreaks may be triggered by:

  • Skin injury (for example, cuts, scrapes or surgery)
  • Emotional stress
  • Streptococcal and other infections
  • Certain prescription medicines (for example, lithium, and certain beta blockers)

What are the symptoms of psoriasis?

As well as the symptoms described above, the rash can be associated with:

  • Itching
  • Dry and cracked skin
  • Scaly scalp
  • Skin pain
  • Pitted, cracked, or crumbly nails
  • Joint pain

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What’s the difference between eczema and psoriasis?

Amy Paller, MD, FAAD, a dermatologist, talks about the differences between these two diseases.

What’s the difference between eczema and psoriasis?

  • Children get eczema. They can also get psoriasis.

  • While more children develop eczema than psoriasis, almost 1% of children have psoriasis.

  • It’s not always easy to tell whether a child has eczema or psoriasis. A study conducted in Australia found that most children who had psoriasis were initially diagnosed by their primary care doctor as having another disease, often eczema.

  • To a dermatologist’s trained eye, psoriasis and eczema tend to look quite different.

Learning the differences between eczema and psoriasis

  • Psoriasis causes well-defined, thick, red, scaly patches, commonly in areas like the elbows and knees. It is common to see psoriasis on the face, buttocks, and scalp of a child. You’ll also commonly see thick patches of skin with overlying redness.

  • Eczema tends to appear in the crooks of the knees and the elbows.

  • Children who have psoriasis tend to have mild itching. In eczema, the itching can be intense.

  • There are many ways for a dermatologist to tell the difference between eczema and psoriasis, including what one sees on the skin, the amount of itch, and where the disease appears on the skin.

There can be overlap between eczema and psoriasis

  • Still in some children, it’s hard to tell the difference. In this case, a dermatologist might diagnose the child with “psoriasiform dermatitis.”

  • Sometimes, a child has both eczema and psoriasis, so there can be some overlap.

  • A dermatologist, however, will generally be able to differentiate between these two relatively common skin disorders.

All content solely developed by the American Academy of Dermatology

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5 Ways to Fix Your Bumpy, Dry Elbows

Is there a sillier part of the body than the elbow? It’s for the best that it’s so hard to see those odd, wrinkly, stretchy, pointy things unless we try really hard. And yet, if neglected—particularly as the cold air of winter begins to dry us out from head to toe—those elbows can begin to cry out for help.

Doctors call the skin on the outside of the elbow an “extensor surface,” which refers to all the places that have to stretch when you bend your joints (like your knees and knuckles too). That’s why they’re a completely different texture from the rest of your skin. Since most humans do almost everything with their arms, the elbows get rubbed, bumped, and leaned on a whole lot. If that elbow skin begins to itch or hurt, or you can see they’re looking really dark or bumpy (when you crane your neck and bend your arm just so), here’s what you’ll need to do:

1. Don’t scratch, pick, or rub it.

“A lot of people, especially with symptoms like scaling, want to pick the skin off,” says dermatologist Sejal Shah, M.D. “That’s aggravating it and makes the skin worse.”

And pay attention to the ways you might be inadvertently irritating your elbows too. “There are plenty of things people do without realizing how it may be affecting their skin,” says Bella Schneider, founder of LaBelle Day Spas & Salons in California. “For example, not wearing SPF while outdoors, using detergents with harsh ingredients, taking hot showers, applying abrasive scrubs, or waxing your arms. Additionally, working at a desk can cause a lot of friction to the elbow area, which is sometimes unavoidable.”

2. If you have bumps or scales, see a dermatologist.

You can google your symptoms all you want, but you run the risk of misdiagnosing yourself. If you’ve got something like psoriasis or eczema (both of which commonly appear on elbows and knees) and don’t know it, your self-prescribed treatment might irritate your skin even more. Bumps can be anything from totally benign keratosis pilaris or granuloma annulare, to something like dermatitis herpetiformis, which is an autoimmune disease that may be caused by a gluten allergy.

“It’s always good to get a diagnosis,” says dermatologist Doris Day, M.D. “The dermatologist can take a look and figure out if there’s an underlying cause.”

3. Moisturize with a keratolytic lotion.

That’s a fancy term for ingredients such as lactic acid, urea, and salicylic acid. “Those are going to help take off some of the surface layers of the skin, but they also have a humectant property so they will bring moisture,” Shah says. Just make sure that you really don’t have psoriasis or eczema, she warns, because keratolytics will irritate those conditions.

There’s no cure for keratosis pilaris, that gooseflesh you might have on your upper arms and legs caused by ingrown hairs, but like with elbows, gently exfoliating and moisturizing improves the situation greatly.

For arms and elbows, Day likes to recommend Amlactin Ultra (with lactic acid) and, for a more moisturizing effect, SkinFix 12-hour miracle ointment. She also suggests exfoliating with something like these Buff and Brighten pads from SweetSpot Labs.

4. Hit the spa.

“There are plenty of spa treatments that will help with dry elbows,” Schneider says. “When treating dry elbows and arms, I recommend starting out with a gentle exfoliant; a microdermabrasion ointment, such as biafine or shea butter; a coconut- or olive oil-based cream; and of course, SPF.”

5. Choose the right natural remedies.

For those of you who like to get homemade skin-care recipes from the internet, Day has some guidelines: “Avocado oil, coconut oil, or olive oil can help soften that skin,” she says. “I wouldn’t rub lemon on it, because that can make you more sensitive.”

The natural cure might be even simpler than you expect—like Schneider’s tip to wear cotton shirts under those cozy-but-scratchy wool sweaters. When winter comes, here’s how she protects herself: “I make sure to drink plenty of water, cut down on my shower time, and avoid products with fragrance.”

Sabrina Rojas Weiss lives in Brooklyn, surrounded by her fellow freelance writers and competitive stroller-pushers. Follow her on Twitter @shalapitcher.

Ringworm: Signs and symptoms

Is it ringworm?

What do athlete’s foot, jock itch, and barber’s itch all have in common? They are all cases of ringworm. However, despite its name, ringworm is a skin infection caused by a fungus, not a worm. It is very common, and your risk increases in hot, humid weather.
If you have a rash and notice any of the symptoms in this video, see a board-certified dermatologist for treatment.

What are the signs and symptoms of ringworm?

Ringworm is an infection caused by fungus. You can get ringworm anywhere on your skin.

On most areas of the skin, it causes ring-shaped patches. What you see, however, changes when ringworm grows on the feet (bottoms and sides), palms, nails, groin, beard area, or scalp.

Skin with ringworm infection

  • Roundish, flat patches that have a raised, scaly border

  • On light-colored skin, the patches tend to be red or pink

  • On skin of color, the patches are usually brown or gray

  • Patches can grow slowly, increasing in size and appearing on more areas of the body

  • The center of a patch tends to clear first

  • The patches can be intensely itchy

Ringworm infection on the skin

A ringworm infection on the skin is indicated by roundish, flat patches that have a raised, scaly border.

Feet with ringworm infection (athlete’s foot)

  • Itching, burning, and stinging on your soles and between your toes

  • Dry, scaly skin that usually begins between the toes and can spread to the bottom of the feet, sides, or both

  • Peeling skin​

  • Blisters, painful cracking skin, bleeding, and thick patches of red and scaly skin

  • Skin between the toes turns white, becoming soft and mushy

  • Foul odor

  • Rash on one or both hands because touching the infected foot can spread the infection to your hands

Ringworm infection between the toes

Signs of a ringworm infection on the feet can be indicated by itching, burning, and stinging on your soles and between your toes.

Ringworm infection on the sole of foot

Dry, scaly skin that usually begins between the toes can spread to the bottom of the feet, sides, or both.

Hand with ringworm infection

  • Widespread, dry skin on the palm

  • Deep cracks on the palms

  • Infection may spread to the fingernails (see nails below)

  • Can be mistaken for extremely dry skin or dry, thick skin due to working with hands

  • Ring-shaped patches on the back of the hand

  • May get athlete’s foot from touching your feet

Ringworm infection on the hand

Signs of a ringworm infection on the hands can be widespread, with dry skin and deep cracks on the palm. There may also be ring-shaped patches on the back of the hand.

Nails with ringworm infection

  • Can infect one or several nails

  • Begins with thickening of the tissue under the nail (nail bed)

  • Nails discolor and thicken

  • Thickened nails may start to lift away from the nail bed

  • Crumbling nails

  • Disappearing nails (in time, you see less of the nails)

  • Toenails more likely than fingernails to become infected

  • Often develops in people who have athlete’s foot for a long time

Signs of a ringworm infection on the nails begins with thickening of the tissue under the nail. Nails will also discolor and may start to lift away from the nail bed.

Ringworm infection on several nails

A ringworm infection can infect several nails.

Groin with ringworm infection (jock itch)

  • First sign: A red (brown or gray in dark skin) rash with swelling and itch in the crease where the leg meets the body

  • Rash spreads to the groin then slowly reaches the inner thigh (shown here), waist, and buttocks

  • Infected skin often feels scaly and has a raised border

  • Skin can flake, peel, and crack

  • Infected skin can be intensely itchy and painful, but not always

Groin with ringworm infection

The first sign of a ringworm infection in the groin is a red (brown or gray in dark skin) rash with swelling and itch in the crease where the leg meets the body.

Beard area with ringworm infection

This develops in men who can grow facial hair. Most men get it when they have contact with infected animal, which may explain why farmers and ranchers seem to develop it more often. Signs and symptoms appear on the bearded area of the face and neck, and you may notice:

  • Intense redness and swelling

  • Pus-filled bumps

  • Hair loss (hair often returns when ringworm is treated)

  • Swollen lymph nodes

  • Raw, open skin

  • Raised soft, spongy skin that weeps fluid

  • A skin problem that looks like acne, folliculitis, or another skin condition

  • Some men feel tired and rundown

A ringworm infection can develop in men who can grow facial hair. Signs appear on the bearded area of the face and neck.

Scalp ringworm

  • A scaly bald patch

  • Widespread baldness with thick, crusty patches on the scalp

  • Black dots in the bald area

  • Open sores oozing pus

  • Raised soft, spongy, inflamed area

  • Swollen lymph nodes

  • Intense itch

Signs of a ringworm infection on the scalp can include widespread scaly patches, in addition to baldness with thick, crusty patches on the scalp.

If you notice any of these signs or symptoms, you should see a dermatologist. You could have ringworm or another type of skin infection. Treatment can cure a skin infection.

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Verma S and Heffernan MP. “Superficial fungal infections.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008: 1807-16.

Expert Advice on How to Get Rid of Ringworm

I’ve Got an Itchy, Red Rash! Is It Ringworm?

Your skin is your body’s largest organ, and while its primary function is to protect your body from infection, it can sometimes become infected itself. Knowing the difference between various skin infections can help you determine your best course of treatment and whether medical attention is necessary.

If you or a family member develops an itchy, red rash, it could be a sign of dermatophytosis — more commonly known as ringworm.

Ringworm is a fungal skin infection that can infect up to 20% of the U.S. population at any given time. It’s also usually localized to a particular area of the body, and depending on where it originates, determines what it’s called.

Curious about the different types of ringworm? Here’s a complete list, including what you should look for and how to get rid of an infection.

There are 7 Common Types of Ringworm

1. Tinea Corporis

Body Part Affected: Torso, arms or legs

Signs and Symptoms:

  • Classic round spots typical of ringworm that can have a more pronounced outer border
  • Starts with a red, itchy and scaly area of skin that is slightly raised
  • A kerion or blister-like lesion can appear

Treatment: Generally treated with nonprescription antifungal cream, lotion or powder for two to four weeks.

2. Tinea Pedis, or Athlete’s Foot

Body Part Affected: Feet

Signs and Symptoms:

  • Round, dry patches on the top of the foot
  • Clusters of blisters on the side of the foot
  • Moist, peeling and irritable skin between the toes
  • Entire sole, heel and sides of the foot may become dry but not inflamed

Treatment: Generally treated with nonprescription antifungal cream, lotion or powder for two to four weeks.

3. Tinea Unguium, or Onychomycosis

Body Part Affected: Fingernails or toenails

Signs and Symptoms:

  • White or yellow streaks on the fingernails or toenails
  • Crumbly nail that may lift up easily
  • Flaky white patches on the top of the nail plate

Treatment: Generally treated with prescription antifungal medication taken by mouth for several months; a topical medical nail lacquer might also be suggested.

4. Tinea Cruris, or Jock Itch

Body Part Affected: Groin

Signs and Symptoms:

  • Reddish-brown rash that starts in the folds of the groin and can spread to one or both thighs or the buttocks

Treatment: Generally treated with nonprescription antifungal cream, lotion or powder for two to four weeks.

5. Tinea Barbae

Body Part Affected: Facial hair areas

Signs and Symptoms:

  • Red, lumpy blisters
  • Crusting around the beard or moustache area that can be itchy
  • Facial hair is easily pulled out

Treatment: Generally treated with prescription antifungal medication taken by mouth for one to three months.

6. Tinea Capitis

Body Part Affected: Scalp

Signs and Symptoms:

  • Round, itchy and scaly spots
  • Dry, scaly skin; similar to dandruff
  • Bald spots from hair loss
  • A kerion or blister-like lesion can appear

Treatment: Generally treated with prescription antifungal medication taken by mouth for one to three months; topical antifungal shampoo might also be suggested to prevent spreading of scalp ringworm.

7. Tinea Faciei

Body Part Affected: Face (excluding the facial hair and scalp areas)

Signs and Symptoms:

  • Round or oval itchy spots on the cheeks
  • Edges of the spots may be raised
  • Spots may include bumps, blisters or scabs

Treatment: Generally treated with nonprescription antifungal cream, lotion or powder for two to four weeks.

What Causes Ringworm?

Despite what the name may suggest, ringworm isn’t actually caused by parasitic worms. It’s the result of an infection from one of about 40 kinds of dermatophytes — or groups of fungi.

The 3 most typical are:

  1. Trichophyton
  2. Microsporum
  3. Epidermophyton

Ringworm fungi are believed to live as spores in soil for extended periods. When these mold-like parasites come in contact with a human (or animal) body, they choose to inhabit the cells on the outer layer of the skin.

So, how do you become infected? Here are the 4 methods for contracting ringworm:

  • Person-to-person contact – The most common way to contract ringworm is through contact with another person who is infected. Because symptoms don’t develop until four to fourteen days after initial exposure, you or a family member could be in contact with someone who doesn’t know they’re infected.
  • Animal-to-person contact – Ringworm can also spread by touching an animal with ringworm. Household pets like cats and dogs can contract ringworm and so can farm animals.
  • Object-to-person contact – You can also get ringworm by coming in contact with items or surfaces an infected person or animal has also had contact with. Such objects include clothes, towels, bedding or brushes.
  • Soil-to-person contact – It is rare, but sometimes ringworm can spread through contact with infected soil. This would most likely happen only from extended contact with soil that’s highly infected.

There are also some conditions that put you at higher risk for getting ringworm. Since fungi thrive in warm, moist environments, you’re more likely to contract an infection if you live in a warm climate, or frequent locker rooms or swimming pools.

You can also get ringworm through contact sports that involve skin-to-skin contact and through wearing tight or restrictive clothing.

While ringworm doesn’t usually spread below the surface of the skin, people who are immunocompromised — carriers of infectious diseases like HIV/AIDS, for example — may find it more difficult to get rid of an infection.

How Do I Get Rid of Ringworm?

Oral and topical medications are your best bet for clearing ringworm fast. However, fungal diseases are highly contagious, so early intervention is critical to preventing it from spreading to other areas of your body or infecting others.

When to Seek Medical Advice

Typically, it takes two to four weeks for a skin infection to clear up. Infections of the scalp, facial hair area and nails, however, tend to last for a few months. If you’ve begun an antifungal treatment and it’s not better within two weeks, or your infection has spread to other body parts, visit your doctor or an urgent care center.

Healthcare professionals, like those at GoHealth Urgent Care, can examine your infected area(s). Before giving you a diagnosis, the doctor may send a skin sample to the lab to confirm it’s a fungus that causes ringworm of the body.

If deemed necessary, your provider might give you a prescription for a stronger medication.

Want to find a GoHealth Urgent Care location in your neighborhood? Search our handy location widget below.

Can I Prevent Ringworm from Spreading?

Besides taking fungal medicine for as long as recommended, or trying some home remedies for ringworm, there are other tips that can help you receive the best results from treatment and spare others for getting your infection.

  • Wash your hands after touching any part of your body with ringworm. This can prevent the spread of infection to other areas.
  • Keep all infected areas clean and dry. When showering, wash affected areas and dry them with a clean towel. Use a different towel for other areas of your body. Since fungi love moist environments, this is particularly important after a workout.
  • Treat all areas infected. If your ringworm has spread to other areas, it’s important to use cream, lotion, powder and/or oral medicine as directed on all infected body parts. For example, if you’re suffering from both jock itch and athlete’s foot, use antifungal lotions and powders for both infections.
  • Thoroughly clean infected items. Ringworm can survive for a long time, so to avoid reinfecting yourself or someone else, wash your clothes, shoes (with athlete’s foot), towels, bedding, etc. Wear clothes, such as socks or shirts, only once if you wore them the day before.
  • Use flip flops or waterproof shoes in public showers, pool areas and locker rooms. Don’t go barefoot if you have athlete’s foot because you could easily spread the infection to others.

Other Skin Conditions

Just because you have an itchy, red rash doesn’t necessarily mean it’s ringworm. There are several reasons for skin irritation besides a fungal infection, such as allergens, chemicals, drugs, viruses and temperature.

Many skin conditions may present like ringworm but are in fact “ringworm look-alike.” Nummular eczema, for example, forms as a coin-shaped patch of scaly, dry skin on your torso, arms, legs or hands. While the cause of this form of eczema is unknown, it can result from dry skin in the winter, poor blood flow, inflammation, metal materials and medications like topical antibiotic creams.

Psoriasis can also look-alike ringworm, with dry, cracked skin that may bleed. It ranges from a few spots to major eruptions of red patches of skin that cover large areas, from your feet and nails to your torso and scalp.

The cause for psoriasis is also not fully understood, but it’s thought to be related to an immune system deficiency. Certain triggers – strep throat, smoking or heavy alcohol consumption, vitamin D deficiency, stress and medications like lithium – can start or worsen the symptoms.

Psoriasis can also put you at higher risk for developing other diseases like psoriatic arthritis, obesity, type 2 diabetes and cardiovascular disease.

Actinic keratosis or solar keratosis, are scaly patches of skin caused by high-exposure to the sun. They can be an early warning sign of skin cancer and doctors recommend early treatment to prevent the development of squamous cell skin cancer.

Other skin conditions that are similar to ringworm include granuloma, pityriasis rosea, impetigo, cellulitis and seborrhea.

Ringworm Essentials

The unfortunate thing about ringworm is that it’s very contagious. The good thing is that it’s treatable. Regardless of what type of ringworm infection you or your family member has, by taking the appropriate antifungal medication, you can get rid of it quickly.

In addition, there are several home remedies and lifestyle choices you can make to prevent fungi from spreading to your other body parts or other people and pets you come in contact with. Know that what you might think are unsightly spots or temporary hair loss from ringworm will resolve.

If you’re treating what you think is ringworm and it doesn’t seem to get any better, the doctors at any of our urgent care centers can perform an easy lab test to ensure your condition is in fact ringworm. With time, you’ll be fungus free!

Use the handy locator widget below to find a GoHealth Urgent Care nearest you!

GoHealth Urgent Care partners with these regional healthcare providers:

  • Northwell Health in New York City
  • Dignity Health in San Francisco
  • Legacy Health in Portland & Vancouver
  • Hartford HealthCare in Connecticut
  • Mercy Health in Arkansas, Missiouri and Oklahoma


11 triggers for psoriasis flares

Share on PinterestInjured skin can trigger a psoriasis flare.

Research into possible triggers for psoriasis flares is ongoing. There is evidence to suggest that certain factors can trigger flares in many people, including:

  • injury to the skin
  • stress
  • medication
  • infection

Some triggers link to a person’s overall health. Those who are overweight, regularly drink alcohol, or smoke may have more frequent or severe psoriasis flares than others.

Other triggers may not have a clear scientific link to flares, but people with psoriasis report that they cause flares, such as changes in temperature, weather, and diet.

Read on for 11 factors that may trigger psoriasis flares:

1. Stress

Stress can cause a person to have an outbreak of psoriasis for the first time. It can also provoke a psoriasis flare.

Finding ways to manage stress can help avoid flares. Some ways to reduce stress might include exercise, meditation, or attending a support group.

2. Medication

Doctors have linked certain medications to psoriasis flares, including:

  • antimalarial drugs, such as Plaquenil or chloroquine
  • Inderal, which people take for high blood pressure
  • indomethacin, a drug prescribed for arthritis
  • lithium, which people take for psychiatric disorders
  • quinidine, a heart medication

A flare caused by medication may not happen right away. It may appear several weeks after someone begins to take a course of drugs.

It is crucial to remember that these drugs are often key to treating medical conditions. If a person stops taking them, it could impact their health.

Instead, it is often better to continue to take the medication, and to seek guidance from a doctor or dermatologist who will be able to advise on whether medication may be causing a psoriasis flare.

In some cases, a medical professional may be able to offer alternative medication that does not cause psoriasis flares.

3. Infection

A person may experience a psoriasis flare 2 to 6 weeks after they have had an infection. Infections affect the immune system, and what causes psoriasis is closely linked to the immune system.

Common examples of infections that can cause a psoriasis flare include:

  • strep throat
  • respiratory infections
  • bronchitis
  • tonsillitis
  • ear infections

4. Injury

Psoriasis is more likely to affect skin that a person has injured. Such injuries could include:

  • cuts, bruises, or scratches
  • bug bites
  • a vaccination
  • sunburn

Quickly treating the injury can speed up healing and avoid a psoriasis flare. The flare might not happen immediately but could appear 10 to 14 days after someone injured their skin.

5. Smoking

Smoking is harmful to a person’s overall health, and tobacco can cause a psoriasis flare. Smoking can also make medication used to treat psoriatic arthritis less effective.

Smoking may increase a person’s risk for developing psoriasis, but more research is needed before scientists fully understand the link.

6. Alcohol

Share on PinterestConsuming alcohol can make psoriasis medications less effective.

Drinking alcohol can interfere with some psoriasis medications, such as methotrexate. Doctors most often use methotrexate to treat psoriatic arthritis.

Consuming too much alcohol could make symptoms worse and may prevent a flare from receding.

Avoiding excessive alcohol consumption is likely to help a person manage their psoriasis symptoms.

7. Weight gain

Recent research by the National Psoriasis Foundation looked at the link between psoriasis and diet. The key finding was that people who have psoriasis and are overweight are likely to be more at risk of severe symptoms.

The recommendation was that a person who is overweight should reduce the number of calories in their diet so that they lose weight. This should improve symptoms of psoriasis over time.

8. Diet

The foods that people eat may influence their psoriasis symptoms.

According to the National Psoriasis Foundation, studies suggest that some people with psoriasis notice improvements after cutting out alcohol, gluten, and nightshade vegetables, including tomatoes, potatoes, and eggplant.

People in the study also found that adding vegetables and vitamin D improved their symptoms, and some maintained that following a vegetarian, vegan, or Mediterranean diet could help.

9. Hormonal changes

A 2013 study suggests that changes in hormone levels in females may cause psoriasis symptoms.

Psoriasis flares tend to occur at times when the levels of certain hormones are low, such as during puberty, menopause, and after giving birth. Psoriasis symptoms may improve during pregnancy when some hormone levels are higher.

10. Weather

Some people find that certain types of weather or changes in temperature can trigger their psoriasis.

Some suspect that their psoriasis flares may a drop in humidity and temperature. Protecting skin from cold or dry weather, and using a humidifier in the home, may help to reduce flares.

Warm weather and sun exposure can also cause flares in some people.

11. Tattoos and piercings

Psoriasis may develop on the skin shortly after someone gets a tattoo or piercing because of the injury done to the skin.

A person with psoriasis may choose to avoid getting tattoos or piercings.



Psoriasis triggers

Many people’s psoriasis symptoms start or get worse because of a certain event, called a trigger. Knowing your triggers may help you avoid a flare-up.

Common psoriasis triggers include:

  • an injury to your skin, such as a cut, scrape, insect bite or sunburn – this is called the Koebner response
  • drinking excessive amounts of alcohol
  • smoking
  • stress
  • hormonal changes, particularly in women – for example, during puberty and the menopause
  • certain medicines – such as lithium, some antimalarial medicines, anti-inflammatory medicines including ibuprofen, and ACE inhibitors (used to treat high blood pressure)
  • throat infections – in some people, usually children and young adults, a form of psoriasis called guttate psoriasis develops after a streptococcal throat infection, but most people who have streptococcal throat infections don’t develop psoriasis
  • other immune disorders, such as HIV, which cause psoriasis to flare up or appear for the first time

Psoriasis is not contagious, so it cannot be spread from person to person.

What does a psoriasis rash look like?

There are several different types of psoriasis that can have different symptoms. However, the symptoms and types often overlap.

Plaque psoriasis

Share on PinterestWhat is this rash? Psoriasis can take many forms.

This is the most common form. According to the American Academy of Dermatology, 80–90 percent of people with psoriasis have this form.

A plaque psoriasis rash consists of red patches of plaque which has a silvery-white coating of scale.

It commonly appears on the scalp, the lower back, the elbows, and the knees. The patches can be sore and itchy, and they can get thicker.

Scalp psoriasis

With scalp psoriasis, plaques form on the scalp and possibly beyond the hairline, on the forehead, the back of the neck, and behind the ears.

There will be:

  • flakes form that may look like dandruff
  • red, itchy, and thickened skin
  • cracking of the skin
  • hair loss, in more severe cases

Anyone who has scalp psoriasis should see a doctor. Scalp psoriasis can lead to hair loss if symptoms become severe, and cracked and broken skin may cause infection. Medical help can reduce these risks.

Nail psoriasis

People with plaque or other types of psoriasis may develop nail psoriasis.

Finger and toenails may develop pits, and they may thicken, crumble or fall off.

Some people develop nail psoriasis without having another type of psoriasis.

Find out more here about how psoriasis can affect the nails.

Pustular psoriasis

Pustular psoriasis gives rise to painful, pus-filled bumps. They usually affect the palms of the hands and the soles of the feet. The skin surrounding the bumps becomes swollen and red.

When the bumps dry, they leave behind brown, scaly spots.

The person may also experience fever, chills, weak muscles, little appetite, extensive itching, and tiredness.

Inverse psoriasis

This form leads to red, shiny, and sore skin in areas where skin is in contact with skin, or skin folds.

These include:

  • the armpits
  • behind the knees
  • the groin
  • the buttocks
  • the genitals
  • under the breasts

Find out more about inverse psoriasis here.

Guttate psoriasis

Guttate psoriasis often develops after an illness, such as strep throat. It will affect around 10 percent of people with psoriasis at some time, according to the National Psoriasis Foundation.

A person with guttate psoriasis will typically develop small red spots all over the body, most often on the chest, legs, and arms.

Learn more about guttate psoriasis here.

Erythrodermic psoriasis

Erythrodermic psoriasis is a rare and severe condition. Individuals who develop symptoms should seek medical treatment immediately, as it can sometimes become life-threatening.

Symptoms include:

  • very red skin across a large area of the body, which looks like a burn
  • intense pain
  • itching
  • a rapid heartbeat
  • fluid loss, due to skin damage

A person may also feel very hot or very cold, as their body is not able to maintain a stable temperature

People who have reacted to severe sunburn, are taking particular medications, or have another form of psoriasis that has been left untreated or controlled can develop erythrodermic psoriasis.

Find out more here about erythrodermic psoriasis.

Recognizing and treating cutaneous signs of liver disease

Dysfunction in the body’s second largest organ, the liver, often yields changes in the body’s largest organ, the skin. If we can recognize these manifestations early, we are better able to promptly diagnose and treat the underlying liver disease, as well as the skin lesions.

The liver has many jobs: synthesizing proteins such as clotting factors, complements, and albumin; neutralizing toxins; and metabolizing lipids and carbohydrates. Insults to the liver can compromise any of these functions, affecting visceral organs, joints, gastrointestinal tissues, and the skin. Dermatologic signs of specific liver diseases include alopecia and vitiligo associated with autoimmune hepatitis, and xanthelasma in chronic cholestatic liver disease.

This article reviews the important cutaneous manifestations of specific liver diseases. We focus first on skin conditions that may represent liver disease, and then we discuss several major liver diseases and their typical cutaneous manifestations.


Figure 1. Characteristic yellowish discoloration of the sclera in the eye of a patient with end-stage liver disease.

Jaundice, the cardinal sign of hyperbilirubinemia, is usually recognizable when serum bilirubin levels exceed 2.5 or 3.0 mg/dL. The color of the skin typically reflects the severity of the bilirubin elevation.1,2 Jaundice due to mild hyperbilirubinemia tends to be yellowish, while that due to severe hyperbilirubinemia tends to be brownish (Figure 1).

Establishing whether the excess bilirubin is conjugated or unconjugated gives a clue as to whether the cause is prehepatic, intrahepatic, or posthepatic.3–8 One of the liver’s main functions is to conjugate bilirubin into a secretable form. Prehepatic causes of jaundice include hemolysis and ineffective erythropoiesis, both of which lead to higher levels of circulating unconjugated bilirubin.4 Intrahepatic causes of jaundice can lead to both unconjugated and conjugated hyperbilirubinemia.4,8 Posthepatic causes such as bile duct obstruction primarily result in conjugated hyperbilirubinemia.4


Pruritus can be multifactorial or the result of a specific dermatologic or systemic condition.9 A thorough history and physical examination are warranted to rule out hepatic or systemic causes of itching.10

The liver neutralizes toxins and filters bile salts. If its function is impaired, these materials can accumulate in the body, and deposition in the skin causes irritation and itching.11,12 In cholestatic liver disorders such as primary sclerosing cholangitis and obstructive gallstone disease, pruritus tends to be generalized, but worse on the hands and feet.13

Although the severity of pruritus is not directly associated with the level of bile salts and toxic substances, lowering bile salt levels can mitigate symptoms.11

Treatment. Pruritus due to liver disease is particularly resistant to therapy.

In a strategy described by Mela et al for managing pruritus in chronic liver disease,14 the initial treatment is the anion exchange resin cholestyramine (Questran) at a starting dose of 4 g/day, gradually increased to 24 g/day in two doses at mealtimes.

If the pruritus does not respond adequately to cholestyramine or the patient cannot tolerate the drug, then the antituberculosis drug rifampin (Rifadin) can be tried. Rifampin promotes metabolism of endogenous pruritogens and has been effective against cholestatic pruritus when started at 150 mg/day and increased up to 600 mg/day, depending on the clinical response.14

Third-line drug therapies include opioid antagonists such as naltrexone (ReVia) and nalmefene (Revex).14,15

Plasmapheresis can be considered if drug therapy fails.16 Experimental therapies include albumin dialysis using the molecular adsorbent recirculating system (a form of artificial liver support), antioxidant treatment, and bright-light therapy.15 Liver transplantation, when appropriate, also resolves cholestatic pruritus.14

Prurigo nodularis

Prurigo nodularis, distinguished by firm, crusty nodules, is associated with viral infections (eg, hepatitis C, human immunodeficiency virus), bacterial infections, and kidney dysfunction.17,18 The lesions are intensely pruritic and often lead to persistent scratching, excoriation, and, ultimately, diffuse scarring.19

Treatment. Although the exact cause of prurigo nodularis is not known and no cure exists, corticosteroid or antihistamine ointments control the symptoms in most patients with hepatitis.19 Low doses of thalidomide (Thalomid), a tumor necrosis factor antagonist, have also been used safely and effectively.18,19

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