Symptom Smackdown! Six Most Difficult to Manage Symptoms
In our Psoriasis In America 2016 survey, we asked people what symptoms they had in the past three months that they find the most difficult to manage. Almost all survey participants–99%–experienced psoriasis symptoms in the past 3 months. There were six symptoms that were all identified by over 50% of people with psoriasis. The top six most difficult to manage symptoms are in order of frequency:
- Itching (73%)
- Thickened, pitted or ridged nails (66%)
- Scale/crust/lesions on the scalp (60%)
- Bright red smooth, shiny patches on skin (58%)
- Plaques (53%)
- Soreness of the skin (51%)
The itching caused by psoriasis is different than that of other inflammatory skin conditions. It tends to happen more frequently, and the sensation can be more severe, with a burning quality. Some patients compare this burning feeling to the intensity of fire ant bites. Clinical data shows that the severity of psoriasis is not necessarily related to the amount of itching one feels. Symptoms of itching can even occur in areas that do not have visible plaques or patches of inflamed skin.
Itching happens when something irritating comes into contact with the skin and activates what are called itch receptors. Scratching can initially interrupt the itch receptors and “feel good,” but this relief is temporary. Scratching can actually make the itching sensation worse and more intense. This is called the itch-scratch cycle. Stress can trigger a psoriasis flare-up, as well as worsening the itching and burning.
Read more about how itching is a frustrating psoriasis symptom.
Thickened, Pitted, or Ridged Nails
About half of people with psoriasis have symptoms that affect the nails. People who have psoriatic nail changes may also have plaque psoriasis and/or psoriatic arthritis at the same time. In fact, nail changes are often an early warning sign that someone with psoriasis may also develop psoriatic arthritis.
Pitting is a common nail change, which leaves small indentations on the surface of the nail. Lines or ridges can also appear on the nail. Some people may have nails that weaken, split or crumble apart. Scaling between the nail and the nail bed can cause the nail to lift up and separate from its bed.
These nail symptoms can cause pain and discomfort. Nail psoriasis that affects the fingernails can make it difficult to work or carry out daily activities like picking up small objects, typing, or tying your shoes. It can also cause embarrassment or self-consciousness while out in public, especially in situations where the nails cannot easily be hidden from view.
Scale/Crust/Lesions on the Scalp
The scalp is one of the most common places affected by plaque psoriasis. About half of people with psoriasis have symptoms on their scalps. The back of the head is a particularly common place for symptoms, but they can occur anywhere on the scalp, around the hairline, around the ears, or on the back of the neck. Most people with only scalp psoriasis have a mild form of the condition that often responds well to treatment.
Plaques on the scalp are usually covered by hair and not very visible to others, but the scale on top of the plaque can tend to flake and fall off in small pieces. This can look much like regular dandruff, even though it is not the same thing. Just like other symptoms of psoriasis, dandruff-like flaking can come and go as psoriasis flares up for a period of time, and then symptoms go away for a while.
Bright red smooth, shiny patches on skin
Red or pink shiny patches on the skin are often a sign of inverse psoriasis or skin fold psoriasis. Unlike traditional plaque psoriasis lesions, these are smooth rather than scaly, and not raised above the surrounding skin. The affected areas of the skin are places where the skin is folded or touching other skin, such as the underarms, the arm fold opposite the elbow, behind the knees, buttocks, groin, upper thighs, and under the breasts. Sweating and the rubbing/chafing of skin that frequently occurs because of the location on the body may worsen these symptoms.
Pink shiny patches on the skin are also how psoriasis most often presents on skin in the genital areas. Treating genital psoriasis is complicated because the skin in that area is very sensitive. Healthcare providers will usually recommend a lower strength topical treatment because of the sensitivity and thinness of the skin involved. It is important to watch out for any infections in the genital area during treatment, and let your healthcare provider know if you have any new symptoms.
Plaques are patches of skin that have a very dry, thickened texture and are raised higher than the surrounding skin. These patches are usually inflamed and reddish in color and can become covered with a layer of silvery scales on the surface. In people with dark skin, such as African Americans, plaques may appear with a more purple colored hue.
Plaques can feel very itchy, sore, and often painful. They sometimes crack and bleed. When scratched or scraped, tiny spots of blood can appear on the plaque, and is one of the signs that healthcare providers use when making a diagnosis of plaque psoriasis.
Plaques usually begin as patches that are very small (about the size of a pinhead), which grow in size to cover larger areas of skin. During a flare-up, different patches can combine to form larger areas of plaque. Some people have plaque patches that are the shape of a ring, with healthy skin in the center encircled by a wavy, thickened and scaly border.
Read more about how plaques form.
Soreness of skin
For many patients, living with psoriasis can cause a great deal of discomfort and pain. Plaques can be painful, especially when they become cracked and start bleeding. The pain can make carrying out everyday activities very difficult, particularly when plaques are located on or around the joints, palms, or soles of the feet. Studies suggest that more than 40% of psoriasis patients experience frequent pain due to the condition.
One source of pain caused by psoriasis is the tissue damage the condition causes, such as cracks (also known as fissures). Nerve endings in the skin are sensitive due to inflammation in the damaged tissue and trigger pain signals in the brain. The inflammation caused by psoriasis is thought to affect how these pain signals are processed by the brain.
Read more about how chronic inflammation of psoriasis contributes to feelings of pain.
The Treatment Smackdown
Managing psoriasis symptoms is difficult partly because there is such a broad range of symptoms and affected body areas, each of which does not respond equally to available treatments. Some treatments may cause symptoms to flare-up briefly, prior to achieving skin clearance, and other medications may need to be used in combination with other medications in order to maintain skin clearance and minimize other symptoms of inflammation. For example, phototherapy is often used for first-line treatment, and it can be combined with topicals or other medications when your healthcare provider thinks it is appropriate.
Managing stress, exercise, and eating foods that help manage inflammation may also be important ways to improve your long-term treatment outcomes. Even if you are maintaining clear skin with treatment, the chronic inflammation that comes with psoriasis may cause other symptoms, such as fatigue, eye problems, or other health conditions.
Ask your healthcare provider about things that you can do help identify your psoriasis triggers and how to best manage them. It is important to talk to your healthcare provider before starting or stopping any new treatments, including over-the-counter and alternative treatments since discontinuing a therapy can also cause a flare-up.