Speak Clearly: Perspectives on Psoriasis

As you may already know, plaque psoriasis can affect any part of the body, including unexpected areas such as eyelids, ears, lips, skin folds, hands, feet and nails.¹ While no one likes surprises when it comes to psoriasis, successful management starts with being prepared. So, what are the most common “unexpected” psoriasis outbreak locations, and what can you do about them?  

Scalp Psoriasis

One of the more common areas for psoriasis to show up is on the top of the head or scalp. In fact, approximately 50 percent of patients living with psoriasis will experience itching and flaking of the scalp.² Symptoms of scalp psoriasis, such as itching and the silvery-white flakes that often appear in the hair, can often be mistaken for dandruff. However, the two burdensome conditions are not treated the same, so it’s important to tell your dermatologist if you suspect you may have scalp psoriasis.²

Looking for more information on scalp psoriasis? Take a look at this Speak Clearly post from psoriasis storyteller, Bernd.

Hand Psoriasis and Feet Psoriasis

Your hands and feet are some of the most sensitive parts of your body, making psoriasis flares here more painful and more impactful on your day-to-day life. Flares on the hands and feet often manifest as itchy, scaling, reddened plaques on the skin and may even cause swollen joints.^2,3 Minor cuts and scrapes can trigger these flares, so if you have psoriasis, it’s important to take extra care to avoid injury or minor skin irrations.^2,3 Consider using gloves when doing things like washing dishes or gardening, and wear cotton socks with comfortable footwear to reduce the risk of abrasions on the feet.

Nail Psoriasis

You may be wondering how it is possible to have psoriasis on your nails, but nail psoriasis is more common than you might think. In fact, approximately 50 percent of people who have plaque psoriasis develop nail psoriasis.⁴ Common signs may include tiny dents in your nail (referred to as “nail pits”), discoloration, crumbling nails, separation from your finger or toe and a buildup of blood under your nail^{.3, 5}

According to studies, nail psoriasis may be a predecessor of joint inflammation, often occurring a few years prior to the onset of psoriatic arthritis, so it’s important to tell your doctor if you notice any changes in your nails.^3,4,5,6

Genital Psoriasis

Psoriasis that appears in the pubic area, upper thigh or groin is referred to as genital psoriasis.⁷ Not only can genital psoriasis cause pain and discomfort physically, but it can also cause great amounts of anxiety.⁷ Why? Because it involves talking about private areas with your dermatologist and possibly having to explain your flares to intimate partners, which can be uncomfortable.⁷

First, if you’re affected by genital psoriasis, know you’re not alone and it is nothing to be ashamed of—up two-thirds of people with psoriasis experience plaques in their genital area.⁸ Second, while it might feel embarrassing, it’s important to talk about new plaques and flares in the genital area, whether it’s with your dermatologist or loved ones. Remember, your dermatologist is a professional and can help you figure out the best treatment for genital psoriasis and even offer advice about how to talk to a new partner about genital flares.

Prepare for Here, There or Anywhere

Now that you know about these different forms of psoriasis, perhaps you’re wondering what you can do to manage symptoms?

• Track your symptoms and flares – The more detail you can provide to your dermatologist, the better they can help you. Consider keeping track of symptoms in the calendar app of your phone, use a symptom tracking app or, if you’re old school, keep notes in an agenda or notebook.
• Inform your dermatologist of changes to your skin – It is important to remember that these are just some of the various forms of psoriasis and flare-ups can affect any part of the body. Stay in touch with your dermatologist and your health care team for information about new psoriasis management approaches, and you’ll be ready for the unexpected. Learn how you can start the conversation with your dermatologist about the best management plan for you here.

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References:

1. National Psoriasis Foundation. About Psoriasis. Accessed on June 14, 2022. Available at: https://www.psoriasis.org/about-psoriasis/
2. Merola, J., et al. Underdiagnosed and undertreated psoriasis: Nuances of treating psoriasis affecting the scalp, face, intertriginous areas, genitals, hands, feet, and nails. Dermatol Ther. 2018 May;31(3):e12589. doi: 10.1111/dth.12589. Epub 2018 Mar 6.
3. National Psoriasis Foundation. Causes and Triggers. Accessed on June 14, 2022. Available at: www.psoriasis.org/causes.
4. Jiaravuthisan MM, Sasseville D, Vender RB et al. Psoriasis of the nail: anatomy, pathology, clinical presentation, and a review of the literature on therapy. J Am Acad Dermatol 2007; 57: 1–27.
5. Haneke, E., et al. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management. Psoriasis (Auckl). 2017;7:51-63. Published 2017 Oct 16. doi:10.2147/PTT.S126281.
6. National Psoriasis Foundation. Hands, Feet and Nails. Accessed on June 14, 2022. Available at: https://www.psoriasis.org/hands-feet-nails/.
7. NHS. Genital Psoriasis. Accessed on June 14, 2022. Available at: https://www.nhs.uk/ipgmedia/National/Psoriasis%20and%20Psoriatic%20Arthritis%20Alliance/assets/GenitalPsoriasis.pdf.
8. Hong, J., et al. Genital and Inverse/Intertriginous Psoriasis: An Updated Review of Therapies and Recommendations for Practical Management. Dermatol Ther (Heidelb). 2021;11(3):833-844. doi:10.1007/s13555-021-00536-6.

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