Subtypes of Psoriasis
Subtype | Description | Treatment and Prognosis |
|---|---|---|
Acrodermatitis continua of Hallopeau | Pustular psoriasis confined to distal fingers or toes, sometimes to just one digit Replaced by scale and crust when it resolves | Treatment: Systemic retinoids, vitamin D3 analogs (eg, calcipotriol), topical corticosteroids, systemic immunosuppressants (eg, biologics, small molecules) Prognosis: Waxes and wanes |
Erythrodermic psoriasis | Gradual or sudden onset of diffuse erythema, usually in patients with plaque psoriasis (possibly the first manifestation of erythrodermic psoriasis); typical psoriatic plaques less prominent or absent Most commonly triggered by inappropriate use of topical or systemic corticosteroids or light therapy | Treatment: Prognosis: Good with elimination of triggering factors |
Generalized pustular psoriasis | Explosive onset of widespread erythema and sterile pustules | Treatment: Prognosis: If untreated, can be fatal due to high-output heart failure |
Guttate psoriasis | Abrupt appearance of multiple plaques 0.5 to 1.5 cm in diameter, usually on the trunk in children and young adults after streptococcal pharyngitis | Treatment: Antibiotics for underlying streptococcal infection as needed Possibly topical and/or systemic treatment after antibiotics Prognosis: Excellent, often with permanent cure May progress to plaque psoriasis |
Inverse psoriasis | Psoriasis of intertriginous areas (usually the inguinal, gluteal, axillary, inframammary, and retroauricular folds and the glans of the uncircumcised penis) Possibly formation of cracks or fissures in the center or edge of involved areas Possibly absence of scales | Treatment: Topical corticosteroids of minimal effective potency, with or without vitamin D3 analogs (eg, calcipotriol) Prognosis: Waxes and wanes |
Nail psoriasis | Pitting, stippling, fraying, discoloration (oil spot sign), and thickening of the nails, with or without separation of the nail plate (onycholysis) May resemble a fungal nail infection Affects 30–50% of patients with other forms of psoriasis | Treatment: Responds best to systemic therapy with immunosuppressants (eg, biologics, small molecules) For brave or stoic patients, possibly intralesional injection of nail folds with corticosteroids Prognosis: Often unresponsive to treatment |
Palmoplantar psoriasis | Hyperkeratotic, discrete plaques on palms and/or soles that tend to become confluent | Treatment: Prognosis: Waxes and wanes Rarely resolves completely, even with treatment |
Plaque psoriasis | Gradual appearance of discrete, erythematous papules or plaques covered with thick, silvery, shiny scales Lesions that remit and recur spontaneously or with appearance and resolution of triggers | Treatment: Topical corticosteroids of minimal effective potency, with or without vitamin D3 analogs (eg, calcipotriol) Prognosis: Waxes and wanes |
Palmoplantar pustulosis (pustular psoriasis of the palms and soles) | Gradual appearance of deep pustules on palms and soles Flares may be painful and disabling Typical psoriatic lesions possibly absent | Treatment: Systemic retinoids or psoralen plus ultraviolet A (PUVA) therapy Prognosis: Waxes and wanes |