What Is Plaque Psoriasis?
Getty Images / Tanja Ivanova
Medically reviewed by Brendan Camp, MD
Plaque psoriasis is the most common type of psoriasis that occurs when the immune system becomes abnormally activated causing skin cells to multiply more rapidly. As the cells multiply, they create discolored skin patches that appear with white or silver-colored scales. These patches (also called plaques) can eventually become inflamed and itchy.
Plaque psoriasis typically forms on the scalp, trunk, elbows, and knees. Treating plaque psoriasis will depend on the severity of your condition and treatments can include topical, oral, and systemic medications.
Psoriasis is a common condition affecting 1% to 8% of people worldwide. This condition can affect all genders, but it typically begins a few years earlier in those assigned female at birth. Most people who develop psoriasis experience symptoms sometime between the ages of 15-22. It can also occur in really young people and older adults.
Plaque Psoriasis Symptoms
Psoriasis plaques can appear anywhere on your body but most often appear on the scalp, knees, elbows, and trunk. Your plaques can become dark in color and thicker on your skin. These patches may be purple, dark brown, or gray on darker skin and pink or red on lighter skin.
Plaques that develop on your lower limbs (such as your legs) tend to be thicker. The plaques will typically but not always appear symmetrically, meaning if they appear on the elbows, they will affect both the right and left elbows.
Plaques can appear raised and inflamed and may become itchy or painful. The patches may also have a silvery-white appearance from the buildup of dead skin cells, which are known as scales. Fissures, or cracks in the skin that bleed, are common if you develop plaques on the hands and feet—a subtype of this condition known as palmoplantar psoriasis. Keep in mind: symptoms of plaque psoriasis can flare up or worsen before remission, which is a period when the plaques start to improve.
Causes
When the immune system becomes accidentally overactivated, it can cause harmful cells to mistakenly attack healthy cells in your body. Your body then rapidly creates new skin cells to repair the damaged tissue. This overproduction of new tissue creates thick, itchy, red patches on the skin.
Risk Factors
Scientists don't fully understand what causes the body's immune system to become overactivated, but they do have some ideas on what could put someone at risk for plaque psoriasis. Risk factors may include:
Genetics: If one of your parents has this condition, your risk of developing plaque psoriasis is much higher.
Trauma: Damage to the skin, like excessive scratching, can trigger plaque psoriasis or the Koebner phenomenon, which is when plaques develop at the site of trauma.
Medications: Beta-blockers, lipid-lowering drugs, antimalarials, and some medicines that treat mental health conditions might also trigger plaque psoriasis.
Infections: Pharyngeal streptococcal (strep throat) and human immunodeficiency virus (HIV) can increase your risk of developing plaque psoriasis.
Lifestyle factors: Smoking, consuming alcohol, and experiencing high stress can all increase your chances of developing plaque psoriasis.
Diagnosis
A healthcare provider or dermatologist (or, a doctor who specializes in conditions of the skin, nails, and hair) will perform a physical exam and ask about your family history of skin conditions to help reach a diagnosis for plaque psoriasis. Your provider may also order some diagnostic tests that can help confirm your condition. These tests may include:
Dermoscopy: A noninvasive way to look at the skin through a handheld microscope. A dermoscope can visualize your skin down to the reticular dermis, one of the thickest layers of your skin.
Biopsy: Your provider may order a skin biopsy if plaques are hard to detect. During this test, they will remove a small sample of your skin to examine it under a microscope to check for signs of plaque psoriasis.
Blood and imaging tests: Diagnosing plaque psoriasis usually does not require a blood test. If your healthcare provider thinks you also have psoriatic arthritis, they may want to order tests such as a C-reactive protein (CRP), beta-blockers, or an erythrocyte (red blood cell) sedimentation rate (ESR) to check for inflammation in your blood.
Plaque psoriasis is typically easy to diagnose because the plaques have a well-defined border and discolored scales that tend to occur equally on both sides of the body. However, because symptoms of plaque psoriasis can mimic other conditions, your healthcare provider may want to rule out seborrheic dermatitis or atopic dermatitis before diagnosing psoriasis.
Treatments
The goal of treatment is to clear most if not all of the plaques from the skin to successfully treat plaque psoriasis. Usually, healthcare providers want to decrease your plaques until they cover 1% of your skin or less within 3-4 months after starting a new therapy. Your healthcare provider will determine how best to treat your plaque psoriasis based on the severity of your condition.
Topical Medications
Topical medications are those that you apply directly to the skin. These types of medications work by slowing down excessive cell reproduction and decreasing inflammation. Steroids are usually the first line of treatment. You can also purchase over-the-counter (OTC) topical medications in the form of lotions, foams, tars, and shampoos.
Phototherapy
Phototherapy is a routine light therapy process that exposes your plaques to ultraviolet (UV) light. Common types of phototherapy include the use of ultraviolet light B (UVB) or ultraviolet light A (UVA) with psoralen, which is known as PUVA. UVB is the most effective type of phototherapy for psoriasis. Sunlight contains UVB, but UVB phototherapy uses artificial light on your skin.
PUVA is only effective for psoriasis when combined with psoralens. Psoralens is an agent that helps the UVA slow down excessive cell growth. Dermatologists prescribe PUVA as a topical cream, orally, or to use in water for bathing.
Oral Medications
Generally, medications taken by mouth are prescribed by healthcare providers for moderate-to-severe plaque psoriasis. They can also be for people for whom topical medications or light therapy have not worked. Oral medications target inflammation, decreasing redness, psoriasis scales, tenderness, and swelling. Common oral medications include:
Gengraf (cyclosporine)
Otezla (apremilast)
Sotyktu (deucravacitinib)
Otrexup (methotrexate)
Biologics
Biologics block a specific type of immune cell called T-cells—a type of protein in the immune system that helps your body fight infection. You can take these medications via injection or intravenous (IV) infusion (into the bloodstream through the vein). Common biologics include:
Enbrel (etanercept)
Humira (adalimumab)
Remicade (infliximab)
How To Prevent Flares
You can't prevent plaque psoriasis from developing, but you can manage flares, or periods where symptoms are most active. At some point, most people with this condition will experience a flare. Unfortunately, these flares can be so severe that they can cause white or yellow, painful pus-filled bumps called pustular psoriasis.
Limiting your triggers can help reduce your risk of flares. What exactly triggers plaque psoriasis will vary from person to person. However, the following tips can help you minimize the risk of triggering a flare:
Reduce stress by trying yoga, meditation, journaling, or spending time with your loved ones
Avoid scratching your skin
Protect your skin from bug bites or wounds by wearing long sleeves when you’re outdoors
Limit your alcohol intake
Keep your skin moisturized, especially during the colder months of the year
Wear sunscreen with an sun protection factor (SPF) of at least 30 when you’re outside
Talk to your healthcare provider if your treatment plan isn’t working for you so they can adjust your dosage
It’s worth noting that infections such as strep throat, ear infections, or bronchitis can increase your risk of a flare. Getting treatment for these infections as soon as possible can prevent a serious flare from developing.
Flares can occur for different reasons and can vary from person to person. Monitor your flares by keeping track of potential triggers that may have caused your episode, noting the situations that took place before the episode. Discuss symptoms with your healthcare provider, especially if you notice that your flares are worsening.
Related Conditions
Some people will experience comorbidities, or other conditions that coexist with plaque psoriasis. For example, psoriatic arthritis is a type of arthritis that causes stiffness, swelling, and pain in the joints and may also cause plaques on your skin. Other conditions that can co-occur with plaque psoriasis are:
Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis
Heart diseases, such as atherosclerosis (thickening of the arteries) or a heart attack
Certain mental health conditions, like depression and anxiety
Lifestyle factors like smoking tobacco and increased alcohol consumption can increase the chances of comorbidities. Some medications may also increase your risk of developing other conditions, so it’s important to talk to your healthcare provider about your personal risks.
Living With Plaque Psoriasis
Plaque psoriasis is a chronic condition without a current cure. This condition isn’t life-threatening, but visible skin patches during flares can negatively affect your quality of life when left untreated. Factors that tend to increase flares include high stress, family history, and developing plaque psoriasis earlier in life.
Healthcare providers can effectively manage your symptoms and reduce flares with treatment. If you experience negative emotional effects due to your condition, talking with a mental health provider or joining a psoriasis support group may help you feel more at ease.
Frequently Asked Questions
Can you scrape off plaque psoriasis?
You should avoid trying to scrape off or scratch the psoriasis plaques because this can cause trauma to the skin and cause flare-ups.
Can plaque psoriasis go away on its own?
Plaque psoriasis is a life-long condition and can have periods of remission, but it needs treatment for the skin to be clear.
What happens if plaque psoriasis goes untreated?
Plaque psoriasis can lead to serious conditions like heart disease or progress to psoriatic arthritis if left untreated.
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