Psoriasis symptoms: skin, nails, joints and warning signs

This guide walks through the signs of psoriasis one by one: skin, itch, nails, joints and the rarer types that need urgent care. It can help you describe what you notice to a doctor. It can't tell you whether you have psoriasis — other skin conditions can look similar, and only a doctor can say what it is.

The main skin symptoms

The American Academy of Dermatology (AAD) says the most common sign is patches of skin that are dry, thick and raised, often with a silvery-white scale. Doctors call these patches plaques.

Other skin symptoms listed by the NHS, NIAMS and the National Psoriasis Foundation (NPF) include:

• flaky skin and scale that sheds
• itching, burning or stinging
• soreness
• dry skin that can crack or bleed
• small pus-filled bumps (in some types)

The NHS says patches are often about 1 to 2 cm across, oval or irregular in shape. Most people only get a few patches, but some have large areas or many small ones. The AAD adds that small plaques can join into bigger ones.

The AAD also notes that symptoms depend on the type of psoriasis, where it is on the body, and how much skin it covers.

How psoriasis looks on different skin tones

• On white or lighter skin, patches usually start pink or red with silvery-white scale. The NHS says they can also turn a waxy yellow or orange-brown.
• On brown or black skin, the NHS says patches can look grey and may leave dark marks after they clear. The NPF says plaques on skin of colour may look purple, greyish or a darker brown, and can look thicker.

The NHS notes that redness can be harder to see on brown or black skin. Raised, scaly skin that looks darker or greyer than the skin around it is worth showing a doctor.

Does psoriasis itch?

Often, yes. The NPF calls itch a common symptom, and doctors take it into account when they make a diagnosis. The NPF also lists irritation, burning and stinging.

Scratching can make things worse. The AAD says scratching can make the patches thicker, and that dermatologists recommend treating the psoriasis to stop the itch. NIAMS also lists poor sleep among the symptoms of psoriasis.

Where symptoms appear

Psoriasis can appear almost anywhere. The places mentioned most often are:

• the scalp, hairline and behind the ears
• elbows and knees
• the lower back, chest and tummy
• the bottom and lower legs
• hands, feet, palms and soles — the NHS says small brown and yellow spots can appear on the palms and soles
• skin folds, such as the armpits, groin, genitals and under the breasts
• the face and nails

Some places affect daily life more than their size suggests. The NPF says around half of people with psoriasis have it on the scalp, the face or both. Up to two-thirds have psoriasis on the genitals. That's common — and worth mentioning to your doctor, even if it feels awkward.

Symptoms by type of psoriasis

There are five main types. You can have more than one, at the same time or at different points in life. Our guide to the types of psoriasis goes into more detail.

• Plaque psoriasis is the most common type: about 80 to 90 out of every 100 people with psoriasis have it. It causes thick, raised patches, often with scale.
• Guttate psoriasis shows up suddenly as many tiny, scaly spots, salmon to pink in colour, mostly on the chest, back, arms and legs. The AAD says it often follows an infection such as strep throat in children and young adults, and usually clears within weeks or months.
• Inverse psoriasis affects skin folds. Instead of scale, it causes smooth, red, raw-looking patches that can be sore. NIAMS says rubbing and sweating can make it worse.
• Pustular psoriasis causes pus-filled bumps (pustules) surrounded by red, swollen, very sore skin, usually on the hands and feet. The AAD says the bumps are not an infection. It can make typing or walking painful.
• Generalised pustular psoriasis is a rare form that the AAD calls serious and life-threatening. Dry, red, tender skin is covered with pus-filled bumps over most of the body within hours, and people often feel very ill, with fever, headache or muscle weakness.
• Erythrodermic psoriasis ("red skin" psoriasis) is rare, and the AAD calls it life-threatening. Skin over most of the body looks burnt, often with chills, fever, severe itch, muscle weakness and a fast pulse. The AAD says most people who get it already have another type. Psoriasis that is getting worse, or not improving with treatment, is a reason to see a dermatologist.

The last two types need medical care straight away — see the warning signs at the end of this article.

Nail symptoms

Nail changes are common. The AAD says about half of people with plaque psoriasis notice signs in their fingernails at some point. Look out for:

• tiny dents in the nail (pitting)
• white, yellow or brown discolouration
• nails that crumble or feel rough
• a nail lifting away from the skin underneath
• a build-up of skin under the nail

Nail changes can have other causes too, so let a doctor look at them.

Joint symptoms: psoriatic arthritis

Psoriasis can also affect the joints. This is called psoriatic arthritis. The NPF says about one in three people with psoriasis may develop it. The AAD notes that most people have skin symptoms for years before joint symptoms start, but joints can come first.

Early signs can be easy to brush off. The AAD, the NPF and NIAMS list:

• a swollen, tender joint, often in a finger or toe
• a whole finger or toe that swells up like a sausage
• stiffness that is worse in the morning or after resting, and eases during the day
• heel pain, or swelling just above the heel at the back of the leg
• pain in the lower back or neck

NIAMS says untreated psoriatic arthritis can cause joint damage that can't be reversed. The NPF says early diagnosis may help prevent permanent damage. So tell your doctor about joint pain even if your skin is calm. The NPF says how severe your skin psoriasis is says little about how severe joint symptoms may be. Read more in Psoriatic arthritis symptoms.

How symptoms change over time

MedlinePlus says psoriasis can appear suddenly or slowly, and it often gets better for a while and then comes back. NIAMS describes flares that last a few weeks or months, followed by calmer periods.

It can start at any age. The NHS says it often begins between 15 and 25, or between 50 and 60. Flares can be set off by things like stress, infections, skin injuries and some medicines — we cover this in What causes psoriasis?

How a doctor checks for psoriasis

According to MedlinePlus and the NPF, a doctor can usually recognise psoriasis by examining your skin and asking about symptoms such as itch. If it isn't clear, they may take a small skin sample (a biopsy) to rule out other conditions. If you have joint pain, they may arrange scans. The NPF says there is no single test for psoriatic arthritis, so it may take a few appointments with a rheumatologist (a joint specialist).

Psoriasis can look like other conditions, such as eczema. If you're wondering which one you have, see our article on psoriasis vs eczema — and remember that only a doctor can tell.

Tracking your symptoms

Symptoms that come and go are hard to describe in a short appointment. Simple notes, kept in a notebook or an app like Velvi, give your doctor a clearer picture. Useful things to record:

• where the patches are and roughly how big
• itch and soreness, each from 0 to 10
• how you slept
• any nail changes
• joint pain, swelling or morning stiffness — and how long the stiffness lasts
• anything new: an illness, a new medicine, a stressful week
• a photo of the same area every week or two, in similar light

Example entry: Thursday. New small spots on my back and arms, 2 days after a sore throat. Itch 4/10. Left middle finger swollen, stiff for about 45 minutes after waking.

A note like the last one is a reason to book a doctor's appointment, not just to write it down: joint swelling should be checked promptly.

Symptom checklist for your appointment

• Which areas are affected now, and which have been affected before
• When it started and how it has changed
• How much it itches or hurts, and whether it affects sleep
• Nail changes
• Any joint pain, swelling or stiffness
• Anything that seems to set off a flare

Questions to ask your dermatologist

• Is this psoriasis, and which type?
• How much of my skin is affected, and how severe is it?
• Should my nails or joints be checked for psoriatic arthritis?
• Which new symptoms should make me contact you sooner?
• What should I track before our next visit?