What are the Symptoms of Psoriasis and Flares?

Psoriasis Symptoms, and Causes of Flares

Psoriasis flare
What are the symptoms of psoriasis and flares?. VOISIN/PHANIE / Getty Images

What are the symptoms of the different types of psoriasis? What exactly is a "flare" of psoriasis and what are the causes? How are flares treated, and better yet, avoided?

Psoriasis

Psoriasis is a skin condition which affects over 2 percent of the population and is characterized by a scaly rash which is most common on the extensor surface of the arms and legs and the scalp. It tends to run in families and is often triggered by environmental factors such as the weather and infections.

The rash often consists of scaly plaques which are present over a reddened base. The edge of the lesions is usually distinct, and in this may mimic ringworm infections.

Psoriasis Symptoms

The skin lesions with psoriasis vary based on the type of psoriasis (discussed below) but may include:

  • Silvery scaly patches anywhere on the body (but more common on extensor surfaces and the scalp) on top of a reddened base. Sometimes these plaques widen and eventually blend together as large patches. The scales are often loose and bleed when they are rubbed or scratched.
  • Burning, dryness, cracking and soreness of the skin surrounding the scaly patches.
  • Pitting and thickening of toenails and fingernails.

The particular symptoms you have based on the type of psoriasis you have may include:

  • Chronic plaque psoriasis - Chronic plaque psoriasis is the most common type of psoriasis and affects up to 5 percent of the population at some time during their lifetime. It consists of dry plaques on the skin of variable size, which can persist for lengthy periods of time.
  • Scalp psoriasis - Scalp psoriasis can sometimes look like dandruff (seborrheic dermatitis) but is also different in many ways. While seborrheic dermatitis has an oily appearance, however, scalp psoriasis usually has a dry, silvery shine. It may be mild, with small patches on the back of the head and neck, or generalized, affecting the whole head.
  • Guttate psoriasis - Guttate psoriasis is a common form of psoriasis which is usually seen in children a few weeks after a viral or bacterial infection (such as strep throat.) The rash consists of tiny pink dots (guttate means drop) on the skin that are covered with tiny scales.
  • Inverse psoriasis - Inverse psoriasis is a form of psoriasis which is found in skin folds. The rash often looks like smooth red patches that occur anywhere there are folds in the skin, such as in the armpits and under the breasts.
  • Pustular psoriasis - Pustular psoriasis, including one type of psoriasis known as Von Zombusch psoriasis is an uncommon form of psoriasis which can lead to many other complications. The rash consists of pus filled lesions on the skin. With this form of psoriasis, symptoms such as a fever, chills, fatigue, anemia, and other systemic symptoms may be present. The pus filled blisters are most common on the hands and feet.
  • Fingernail and toenail Psoriasis - Psoriasis of the nails can have many different appearances as these are often combined with fungal infections. Pitting of the nails along with thickening is very common.
  • Erythrodermic psoriasis - Erythrodermic psoriasis is also known as exfoliative psoriasis
  • Psoriatic arthritis - With psoriatic arthritis, psoriasis lesions on the skin are accompanied by inflammation of the joints. In addition to the skin lesions and swollen joints, people may develop sausage-appearing fingers, nail changes, and conjunctivitis (red eyes.)

Psoriasis Flares

One of the more distressing features of psoriasis is the occasional sudden and severe worsening of symptoms, often without any obvious cause. A closer look, however, may yield several clues as to possible inciting factors. Treatment of flares can be challenging, and in worst cases, may require a brief hospitalization.

Most psoriasis flares can be handled with psoriasis medications including a combination of topic therapies, systemic medication, and other treatments such as phototherapy.

Causes of Flares

Several triggering factors have been identified as contributing to worsening psoriasis:

  • External factors: Nearly any injury to the skin (even tattooing) can result in the development or worsening of psoriasis including sunburn, other rashes, like allergic reaction to drugs, surgery, cuts or scratches, and viral rashes. The worsening of psoriasis after injury is known as the Koebner phenomenon.
  • Infections: Most notoriously, streptococcal infections such as strep throat can trigger the disease, especially an outbreak of guttate psoriasis. HIV infection is another condition known to aggravate psoriasis.
  • Psychological stress: Job loss, divorce, death or other major emotional upsets have been known to flare psoriasis weeks or months after the stressful event. Those who are living with psoriasis can often benefit from learning about stress management.
  • Physical stress: Physical stress, such as that associated with major surgery or an illness can trigger a flare.
  • Medications: Many medications are known to trigger psoriasis and should be avoided if possible in people with the disease. Examples include beta-blockers, ACE inhibitors, angiotensin receptor blockers, lithium, tetracycline antibiotics, non-steroidal anti-inflammatory medications, and antimalarials.
  • Alcohol consumption and cigarette smoking also appear to have a role in triggering flares.

Treating Psoriasis Flares

At one time, hospitalization for psoriasis flares was common. Due to changes in insurance reimbursement (Medicare only allows so many days of hospitalization for a skin condition) and more powerful and faster-acting drugs, most flares are now treated in the outpatient setting.

Drugs commonly used for severe flares include cyclosporine, Remicade (infliximab), and for pustular flares, Soriatane (acitretin). When psoriasis flares, don't delay—seek treatment urgently with a qualified dermatologist.

Bottom Line on Psoriasis Symptoms and Flares

The rashes of psoriasis are often annoying and chronic, though the specific type of rash varies tremendously depending on the type of psoriasis. Psoriasis flares are common and can be caused by a wide variety of stressors. At times, especially with pustular psoriasis, psoriasis symptoms can include systemic symptoms such as a fever and more, and hospitalization may be needed. That said, advances in treatment (stronger medications) have made treatment as an outpatient much more common.

For those who are living with psoriasis, the ideal "treatment" is to prevent flares in the first place. Familiarize yourself with the causes of flares. Make sure you are seeing a doctor who is aware of your condition and understands the medications which can worsen symptoms. If you notice your symptoms worsening, don't wait. When flares are caught earlier than can often be minimized with aggressive treatment.

Sources:

Kim, W., Jerome, D., and J. Yeung. Diagnosis and Management of Psoriasis. Canadian Family Physician. 2017. 63(4):278-285.

Korman, N., Zhao, Y., Roberts, J., Pike, J., Sullivan, E., Tsang, Y., and T. Karagiannis. Impact of Psoriasis Flare and Remission on Quality of Life and Work Productivity: A Real-World Study in the USA. Dermatology Online Journal. 2016. 22(7).

Relvas, M., and T. Torres. Pediatric Psoriasis. American Journal of Clinical Dermatology. 2017 May 24. (Epub ahead of print).

Continue Reading