Psoriasis

Psoriasis symptoms: what does psoriasis look and feel like?

We asked 18 young people about the look and feel of their psoriasis. The main things they described were:
  • patches and plaques
  • inflamed and red skin
  • itchiness
  • soreness and pain
  • skin flaking
  • scars and lasting changes to the skin
Some symptoms, like dry skin and itchiness, became worse with a ‘flare-up’. Sometimes flare-ups happened unexpectedly; but other times people knew of specific triggers like stress or fragranced bath and shower products. Adam’s psoriasis could flare-up rapidly (e.g. over the course of an evening) when he was age 19/20.
Patches of psoriasis

Psoriasis was often described as different to ‘normal’ skin. People talked about patches or plaques, which varied in size, shape and appearance (see also type of psoriasis). For some, their psoriasis was like a rash: red, often raised or with scabs. Jack says he didn’t mind the look of his psoriasis at first as it was only “small red dots” on his torso.
Patches/plaques could feel very dry and ‘crispy’. Dry skin was often itchy and prone to cracking, which could cause bleeding and scabs as well as risk infections. Some found their skin was especially dry in winter. Russell’s dry skin looked “a bit silvery or white”. A few people talked about the difficulties of wearing make-up; while some said it was a confidence boost, it could also highlight the dryness of the skin. Lisa doesn’t tend to wear make-up products like foundation because it will ‘congeal’.

To help with the dryness, people used medical emollients, shop-bought cosmetic moisturisers or found their steroid creams helped - but these topical treatments could be unpleasant to use. Some people said they became better at keeping the skin moisturised as they got older.

A characteristic of psoriasis is built-up skin, where the layers grow on top of one another (see causes). The patches can be raised and flaky, which adds to the itchiness. Lucy described her psoriasis as having “scales”. Steven could feel the return of his “real skin” with topical treatment because “it’s not flaky and it’s flat”.
Inflamed skin

Lots of people said their psoriasis looked redder than the rest of their skin. For Steven treatments, such as dithranol, add to this by tinting the skin. Ella finds some areas of the psoriasis on her body are red (such as on her chest) but others are not (such as on her hairline). Sometimes the person’s skin was also very sore and sensitive to touch.

Flare-ups could make the skin more intensely red. Inflamed psoriasis can look “angry” and “red raw”. Louie and Jack talked about activities, like doing sports and being in a warm room, which make their skin more ‘flush’. Louis and Lisa had strategies to settle their skins down when inflamed, such as keeping the room cool or wearing a t-shirt (rather than a jumper/coat) outside.

Inflamed and red skin could be mistaken by other people for another injury, such as an insect bite, a burn or a cut. It could be difficult for doctors to diagnose the symptoms of psoriasis and sometimes they thought it was another condition, such as ringworm (a fungal infection). Simon sometimes used excuses for his symptoms, like he had accidentally knocked his forehead, because it was easier than explaining about psoriasis to other people. Damini felt self-conscious when the redness of her skin attracted attention and questions. Ella and Carys have been told by strangers that their skins looked ‘sore’.
Some people talked about having ‘sores’ and ‘cuts’, caused by scratching when the skin was itchy. Simon described having “welts” as part of his psoriasis. A few people had blisters, a feature often associated with pustular psoriasis (see types). Russell had blisters on his feet with his first flare-up, but says it’s not been like this since.

Itching and scratching

Most people said psoriasis made their skin very itchy and many felt it was the worst part of having psoriasis for them. It could become especially bad because of triggers and irritants, like certain fabrics or perfumes. A few said they didn’t have much itching or it only happened when their psoriasis was bad. Others spoke about intense itchiness and how distracting it could be. Megan described it as a “weird itch”, Louis sometimes had “a burning itching sensation” and Lola felt like her scalp was “on fire”. Megan, Abbie and Damini all found their psoriasis itchiest at night and some people had woken up, having scratched while asleep, to find their skin sore and bleeding.

Although many said it was best not to scratch, it can be difficult to avoid. Lucy thinks it “comes across as rude” to scratch in public, but says it’s hard not to when it’s so itchy. Zara sometimes digs her nails in as she finds the pain preferable over itchiness. Sofia says, “Occasionally it is very hard not to” scratch her psoriasis, so she tries to do it only gently to limit damaging her skin. Other strategies for coping with itching include:
  • sitting on the hands
  • cooling the skin down, such as having a cold shower 
  • cutting their nails short
  • finding distractions, like talking to someone
  • putting on emollients, moisturisers and/or steroid creams
  • taking antihistamine tablets
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People tried to avoid scratching because it could be painful and make the psoriasis worse or “spread”. Some appreciated being told by other people not to scratch their skin as they saw it as caring. Others disliked these comments and found them annoying.
Soreness and pain

Scratching the skin often made it sore, but psoriasis can be painful in other ways too. Sometimes the skin cracks on its own which makes it difficult to move, as for Carys who has a physically active job. Simon’s psoriasis is especially sore in hot weather and he finds sweating makes his skin sting. Louis took painkillers to get to sleep. Avoiding triggers and irritants which might aggravate the skin usually helped.
Particular parts of the body can be especially painful. Zara has psoriasis on her feet – it makes walking, running and standing difficult, with sharp painful sensations “like tingles up your body”. Zara’s toenails fell out when she was younger and it hurts when doctors spread her toes apart to examine the psoriasis. Megan finds it painful when her psoriasis plaques get caught on her tights.

A few people saw some kinds of pain as a ‘good’ sign for their psoriasis. Megan doesn’t like the sting of swimming in chlorine or salty water, but she thinks it helps by “cleaning” her psoriasis.
Skin flaking

Skin flaking or peeling was a major part of psoriasis for most people we talked to. Steven says “you learn to brush skin off quite quickly”. An exception was Louis who was grateful that his hadn’t been flaky. Skin flaking was often a source of feeling self-conscious and embarrassed. Louie found skin flaking from his scalp and across the eyebrows most difficult. Steven gels his hair up to keep it in place and finds this helps reduces flakes which “flick” off. Some people had been teased about skin flaking, often in school

Lots of people said skin flaking had impacts, such as:
  • worrying about other people (and family pets) seeing or touching the skin flakes
  • concerns about cooking or working in a job with food
  • skin flakes showing up on dark coloured clothes and hair  
  • getting distracted and picking at skin flakes
  • doing more cleaning, such as hoovering and changing bedding
  • finding ‘symptom relief’ products to gently remove flakes, such as exfoliating gloves for Lucy
  • difficulties shaving – Damini and Lisa found their skin cut more than usual, though Simon found his psoriasis skin was less prone to bleeding
Lucy and Lola had close friends who would subtly brush skin flakes from their shoulders. Others had strategies, such as using a lint roller, to remove the flakes from their clothes before going out. Louie also uses a hairdryer to blow away skin flakes from his bedding.
Scars and lasting marks

Some people had lasting impacts on their skin, even when their psoriasis had cleared. Lola, Carys and Abbie had some ‘scars’ different to the surrounding skin, showing where psoriasis had been. Most people felt okay about the scarring though and preferred it over active psoriasis.

Hyper-pigmentation is when the colour of the skin changes, becoming lighter or darker. Sofia had some white patches after using steroid creams. Hannah says the scarring from her guttate psoriasis made her look “a bit like a leopard”.

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