Plaque psoriasis: what is it, symptoms, treatment

When the immune system attacks healthy tissue and triggers inflammation, many symptoms—and potentially, complications—can arise. One example of an immune-mediated inflammatory condition is plaque psoriasis, a chronic skin disease that can cause large, red scales, called plaques, to appear on the skin (Badri, 2021). 

Beyond the physical skin symptoms it causes, plaque psoriasis can also take a toll on someone’s mental health, even contributing to depression (Wu, 2018). That’s one reason why it’s important to seek care and treatment from a healthcare provider. 

Read on to learn more about what causes plaque psoriasis, psoriasis symptoms, and various treatment options.

Healthier skin

Custom Rx treatment for your skin type and skin goals

Start now

There are several types of psoriasis. As a whole, psoriasis is a chronic, inflammatory condition that affects the skin. The most common form of psoriasis is plaque psoriasis, and it affects 80-90% of people with psoriasis. It’s characterized by large, oval, or circular areas on the skin called plaques. Often, these plaques occur on a person’s scalp, trunk, and skin over the joints (Wu, 2017; Badri, 2021).

Plaque psoriasis can affect the skin, joints, or in some cases, both (Sbidian, 2017). When it involves the skin, it’s characterized by distinct red patches called plaques covered by silvery scales and can occur on different areas of the skin. On black skin, the lesions can appear as purple patches with gray scales or as a dark brown color (Albaghdadi, 2021; Nair, 2021).

Itching is common, and some people also experience soreness or pain, especially on the palms and soles of the feet. Most people experience flare-ups and relapses with plaques often recurring in the same locations (Benezeder, 2019; Badri, 2021). Nearly 80% of people with plaque psoriasis have co-occurring nail psoriasis, which leads to changes in how your toenails and fingernails look. They can get thick and change color or shape (Manhart, 2015).

Some people with this type of psoriasis also develop psoriatic arthritis, a chronic inflammation of the joints that resembles rheumatoid arthritis (Badri, 2021). 

Like other types of psoriasis, plaque psoriasis is often linked to other conditions, such as cardiovascular disease. It’s not entirely clear why other diseases are linked to psoriasis, but experts think chronic inflammation, lifestyle factors, and the adverse effects of therapies might play a role (Armstrong, 2020).

It can also take a toll on people’s mental health and overall well-being. Even its localized forms can be impairing and lead to mental stress. In fact, many people with it also develop depression or anxiety (Wu, 2018).

Plaque psoriasis can be genetic, which means you may be more likely to get it if you have family members with the condition. It has a much higher prevalence in Caucasian people and is linked to specific risk factors, such as obesity, stress, alcohol, and smoking (Albaghdadi, 2017).  

Some drugs can worsen plaque psoriasis, particularly antimalarials, beta-blockers, and lithium (Balak, 2017). Excessive scratching can also trigger or worsen psoriasis, and some plaque psoriasis is aggravated by sunlight (Badri, 2021).

If you have scaly, red, symmetrical plaques on your skin, your healthcare provider—typically a dermatologist—may consider a plaque psoriasis diagnosis. They may also use a tool called a dermascope to take a closer look at the plaques before diagnosis. 

It’s also important for a healthcare provider to examine the skin for other diseases and monitor other medical conditions that can co-occur with it, particularly heart conditions and arthritis (Oji, 2015).

Plaque psoriasis isn’t life-threatening; however, it can be pretty challenging to treat in some cases. For example, severe cases can evolve into another subtype of psoriasis called pustular psoriasis. How a healthcare provider treats plaque psoriasis depends on the severity of the disease, such as how much of the body is covered (Clebak, 2020). 

Sometimes, healthcare providers use scoring systems that measure a person’s severity, body surface area, and life quality to determine the best treatment (Oji, 2015). 

Treatments for plaque psoriasis include:

• Topical treatments: For mild or “limited” forms of psoriasis, topical treatments—or medication applied directly to the skin—may work. Common topical treatments include corticosteroids and Vitamin D analog (Vitamin D cream) (Armstrong, 2020). 

• Biologic drugs: For moderate to severe psoriasis, the American Academy of Dermatology-National Psoriasis Foundation recommends biologics that target specific parts of your immune system as the first line of treatment. Examples of biologics used to treat psoriasis include etanercept, adalimumab, certolizumab, and infliximab (Armstrong, 2020). In studies, biologic drugs are more effective than placebo for treating moderate or severe psoriasis (Albaghdadi, 2017).

• Systemic therapies: Conventional systemic drugs like methotrexate are often used for various forms of psoriasis, including psoriasis of the nails and psoriatic arthritis (Nair, 2021). 

• Light therapy or “phototherapy”: When topical treatments aren’t effective, some healthcare providers recommend light therapy for mild forms of psoriasis. Using ultraviolet (UV) light, light therapy targets areas of the skin affected by psoriasis. Long-term treatment with light therapy can increase the risk of skin cancer, so it’s important to discuss the risks of phototherapy with a healthcare provider (Zhang, 2018).

When prescribing treatments, medical providers will also consider the long-term side effects of plaque psoriasis treatment, especially with immuno-suppressive drugs like corticosteroids.

It’s not possible to prevent plaque psoriasis. However, altering your lifestyle to decrease risk factors may help reduce the number of psoriasis flare-ups. For example, smoking and drinking are associated with plaque psoriasis. Losing weight may also improve plaque psoriasis and prevent future complications (Albaghdadi, 2017).

Plaque psoriasis can affect people’s quality of life and present other medical problems. So it’s important to consult with a healthcare provider if you’re experiencing symptoms (Armstrong, 2020). Your primary care provider can work with other medical professionals, such as a dermatologist, to pinpoint the best course of treatment to improve your symptoms and well-being.

---

How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Editorial Guidelines | Medical Review Process

Current version

September 16, 2021

Written by

Ashley Abramson

Fact checked by

Felix Gussone, MD

---

About the medical reviewer

Felix Gussone, MD, Ro

Felix Gussone is a physician, health journalist and a Manager, Medical Content & Education at Ro.