Symptoms: Cracking and Bleeding

Reviewed by: HU Medical Review Board | Last reviewed: July 2016.

Psoriasis is a chronic autoimmune condition that causes symptoms to appear on the skin, such as plaques. Plaques are areas of thickened, dry, reddened skin that can develop a layer of silvery scales on the surface. In addition to itching and burning, plaques can crack and bleed, which can be quite painful. The symptoms of cracking and bleeding are commonly reported by people with plaque psoriasis1.

What causes the skin to crack and bleed?

Plaques can appear anywhere on the skin, and they can crack because the skin affected by plaques can be extremely dry. This dryness is caused by loss of moisture in the skin, and makes the plaques prone to developing tiny cracks called fissures. The cracks can grow and deepen over time as the plaque develops.1.

As the cracks get larger and deeper, they can extend down to a lower level of skin where the skin’s tiny blood vessels (called capillaries) are located. Bleeding happens when the cracks and fissures cause these blood vessels to break2.

What areas of the body are impacted?

Plaques anywhere on the body can develop cracks, but some of the most common locations for plaques are especially prone to cracking and bleeding, such as3:

  • Elbows
  • Knees
  • Palms of the hands
  • Soles of the feet

Areas around the joints, such as the knees and elbows, are areas that are more likely to have dry skin and more likely to crack and bleed because they are constantly moving and flexing during normal activities. Regular movements can cause the dry skin of the plaques to become stretched and lead to cracking. Rubbing, scratching, or scraping the skin can also cause plaques to crack and bleed4.

How is severe cracking treated?

There are two strategies for treating the cracking and bleeding of psoriasis plaques. The first is to treat the underlying condition that causes the plaques to form and grow. The second is to try to reducing scaling and apply as much moisture as possible to soften the skin because cracking usually occurs due to the very dry skin on the plaques. Softening the skin, especially on plaques around the joints, can make the skin more pliant and flexible and less prone to cracking2.

To treat psoriasis itself, patients have a range of treatment options depending on the severity of the condition. People with milder psoriasis often find that topical medicine applied directly to the skin in a lotion, ointment, or gel is effective in reducing plaques. Over-the-counter topical treatments include5:

  • Coal tar products, which can help to reduce inflammation and scaling by slowing down the skin cell growth that causes plaques to form
  • Salicylic acid products can help encourage the outer layer of the skin to shed, which helps to remove scales and soften the skin affected by the plaque

Prescription topical treatments can also be effective in treating plaques to reduce the chance of cracking and bleeding. These include corticosteroids, anthralin, Vitamin A analogues, and Vitamin D analogues. Phototherapy, which is treatment by exposure to certain types of light, can also help to reduce plaques6.

To help treat the dry skin that can lead to plaques cracking and bleeding, there is a range of strategies that patients can try. For example, applying a very thick cream or emollient (such as Vaseline or Cetaphil) after a bath can moisturize and soften the skin. Before applying, be sure to pat the skin dry, rather than rubbing, so that as much moisture as possible can penetrate the skin. Regular lotions are usually not effective enough for very dry skin. Some people find that body oils are the most effective for skin that is extremely dry7.

Another technique is called occlusion. This involves covering a topical treatment or moisturizer with a waterproof dressing, special gloves, cotton socks, or plastic wrap to seal it in and allow more to penetrate into the skin. Patients should check with a healthcare provider before trying occlusion with a topical medicine to make sure that it is safe to do so2.

People who have moderate to severe psoriasis may need treatment with stronger systemic or biologic medications. These drugs are taken orally or through an injection, and treat psoriasis by affecting the way a person’s immune system functions and reducing the inflammation that causes psoriasis symptoms. Some of these medications may be used along with topical treatments, but your healthcare provider will let you know which types of treatments are safe to combine7.

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