What type of psoriasis do you have?

I have been asked this question a few times recently and the honest answer for a long time was… I don't know! 

Psoriasis is just psoriasis, right? Wrong. 

I was recently asked to take part in a survey about my condition, where once again I was asked this question and the different types were listed out in a series of tick boxes... whilst some were pretty obvious, others were not and it shocked me at how severe some were. 

What I learnt was that over the years I've actually had several types of psoriasis, which I will go on to explain below, but it's probably easiest to start at the beginning. 

When I was five I caught chickenpox from a kid in my nursery. As an older sister this was a double nightmare from my mum as Danielle also caught it a few days after. Whilst Danielle was lucky enough to only catch a few spots which cleared pretty quickly, I was covered from head to toe! After a couple of weeks Danielle was back in school but I was still home with an increasing amount of spots. After a visit to the doctor, he told us that he was fairly certain these spots were actually psoriasis and a few weeks later a dermatologist confirmed that it was indeed guttate psoriasis. 

Over the years my condition worsened, the spots grew and joined to make larger plaques, they became red and angry sometimes bleeding and I became more aware of it. It had developed into the most common form, plaque psoriasis. 

At the same time I also noticed patches of psoriasis appearing on my scalp and neck, forehead, behind and inside my ears and worst of all, under my nails. Some research class these as part of plaque psoriasis, but for the sake of treatment I class them as separates. 

And that's where I am now - I currently have widespread plaque psoriasis covering most of my torso and parts of my arms and legs. I also have it on my scalp, forehead, ears and neck and most recently my eyelids, as well as my finger and toes nails. 

So here's what I now know about the different types of psoriasis that I've had and a couple of typical treatments have been offered and have worked - 

Guttate psoriasis often starts in childhood or young adulthood. It appears as small, red, separate spots on the skin, usually on the trunk and limbs. They can sometimes appear on the scalp, face and ears. The lesions do not tend to be as thick as those of plaque psoriasis. This form can precede or appear alongside other forms of psoriasis such as plaque. 

This type of psoriasis often comes on quite suddenly, with known triggers including:

• Upper respiratory infections
• Streptococcal infections  - such as chickenpox and tonsillitis 
• Stress
• Injury to the skin

Suggested treatment: Topical creams (I've tried millions over the years, none have had a lasting effect), Sun treatment (have had two rounds that have cleared it for six month periods) 

Plaque psoriasis is the most common form of psoriasis and appears as raised, red patches covered with a silvery white buildup of dead skin cells or scales (often referred to as scabs). These patches most often appear on the scalp, knees, elbows and lower back. They're itchy and painful, and they can crack and bleed.

This type of psoriasis often comes develops over time, with known triggers including:

• Inheritance
• Sunlight: psoriasis is often much better and more manageable in the summer when exposed to sunlight, and worse in the winter without 
• Stress 
• Streptococcal infections 
• Hormonal changes (particularly after childbirth)
• Smoking and alcohol.
• Trauma - psoriasis may be spread to uninvolved skin by various types of trauma

Suggested treatments: Topical creams (the majority I have been prescribed have been steroid based and whilst they work short term, the cause havoc when trying to come off them) Sun treatment (again, has completely cleared it for 6 month periods but can be difficult to find time to do this around a full time job) 

Scalp psoriasis makes raised, reddish, often scaly patches on your scalp and can often spread to your forehead, the back of your neck, or behind your ears.

Symptoms of scalp psoriasis include; scaly, red, bumpy patches, silvery-white scales, dandruff-like flaking, dry scalp, itching, burning or soreness and in some cases hair loss.

Scalp psoriasis itself doesn’t cause hair loss, but scratching a lot or picking at the scaly spots, harsh treatments, and the stress that goes along with the condition can lead to temporary hair loss. Fortunately, your hair usually grows back after your skin clears.

This type of psoriasis can appear with or without other types, with known triggers including:

• Inheritance
• Stress 
• Streptococcal infections 
• Smoking and alcohol

Suggested treatment: Coal tar based shampoos (I have tried lots over the years, the one that I find works best is Alphosyl 2in1, medicated creams, gels, oils (have tried a few but none have been as effective as the shampoo and are a real pain to wash out) 

Nail psoriasis - psoriasis can affect fingernails and toenails. You can usually spot it easily, but it can sometimes be mistaken for a fungal infection. 

Common traits include; 

• Pitting of the nails - small pits appear on the surface of the nail
• Onycholysis - the nail separates from the skin underneath the nail. At first this looks like a white or yellow patch at the tip of the nail. This patch gradually gets bigger and reaches the base of the nail. The gap between the nail and the skin underneath the nail can become infected and change colour.
• Subungual hyperkeratosis - chalk-like material builds up under the nail. The nail becomes raised and often tender.
• Discolouration of the nail, turning to yellow-brown
• Thickening of the nail 

There are steps that you can take to reduce the discomfort and prevent the condition from worsening, such as; 

• Keeping your fingernails and toenails short
• Keeping your nails as dry as possible
• Protecting your nails by wearing gloves when doing any manual work
• Avoid a manicure of the base of the nail. This may cause an infection
• Avoid false nails or varnish containing acetone as it can cause damage to the nail

Treatments for severe nail psoriasis include:

• Antifungal treatment - this may be required for fungal nail infection if this is also present.
• A steroid injected into the nail - this may be effective for some types of nail psoriasis but it is painful
• Phototherapy (light therapy) 
• Removing an affected nail (in extreme cases) 

So, the next time somebody asks me that question I can confidently say I have several types of psoriasis, each of which should be approached and treated differently! 

Has this been helpful? I’d love to hear your thoughts – please do get in touch!