1. Moderate to Severe Psoriasis Slideshow
2. Psoriasis Quiz: Test Your Medical IQ
3. How Much Is Psoriasis Affecting Your Life?

Medical Author:

Gary W. Cole, MD, FAAD

Gary W. Cole, MD, FAAD

Dr. Cole is board certified in dermatology. He obtained his BA degree in bacteriology, his MA degree in microbiology, and his MD at the University of California, Los Angeles. He trained in dermatology at the University of Oregon, where he completed his residency.

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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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In the generalized type, the skin is initially fiery red and tender. You may have symptoms such as headache, fever, chills, joint pain, a feeling of general discomfort or uneasiness, decreased appetite, and nausea. Within hours, you may see clusters of pustules.

The most common places these pustules appear are the anal and genital areas and bends and folds in your skin. Pustules may appear on the face, but this is unusual. Pustules can appear on the tongue, which may make it difficult to swallow. They can also occur under your nails and cause your nails to come off.

Within a day, the pustules fuse together and form "lakes" of pus that dry and peel off in sheets. The skin underneath is a smooth reddish surface, on which new pustules can appear. These episodes of pustules appearing, fusing and peeling, and reappearing can last for days to weeks. They can make you uncomfortable and exhausted. In two to three months, a phase involving hair loss can occur.

Once the pustules improve, most of your other symptoms (such as headache and fever) will usually disappear. However, in some people, the skin may remain bright red, and skin symptoms of classical psoriasis may continue.

The ring-shaped type is more common in young children. This type tends to be subacute or chronic, and the symptoms are less severe than in the generalized type. Ring-shaped plaques (elevated areas) appear and are often recurrent. Pustules may appear at the edges of the ring. These areas of skin symptoms appear mostly on the trunk but also on the arms and legs. The edges expand, and the center heals. Other symptoms are either absent or mild.

The juvenile, or infantile, type of pustular psoriasis is usually mild. Other symptoms besides skin symptoms are seldom present. The condition often resolves on its own.

Pustular psoriasis of the palms and soles is usually chronic and may be associated with bone or joint inflammation. The palms or soles are red with white or yellow pustules.

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