Psoriasis symptoms most commonly include a rash characterized by patches of raised red skin covered by white scales. It can also have a pimple-like or burned appearance, and is often accompanied by severe itching and burning. These patches are found over the knees, elbows, scalp, hands, feet, lower back, face or skin folds. Some patients develop small lesions on the palms and soles. Nail lesions and nail pitting, ridging, and cracking can occur as well as separation of the nail from the nail bed in both the fingernails and toenails.
The relationship between psoriasis and psoriatic arthritis depends on the nature of the both the skin and joint disease. Patients can have a combination of psoriasis and psoriatic arthritis, including the presence or absence of either condition and varying severity of either condition.
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In 85% of cases, the skin condition psoriasis will first occur, often years before joint symptoms appear. In approximately 15% of patients, the skin and joint symptoms will appear at the same time.
Given the high occurrence of arthritis in combination with the skin condition, it is important to talk about any aches and pains with your dermatologist to get appropriate and early detection and treatment for psoriatic arthritis.
Characteristic signs and symptoms of psoriasis and psoriatic arthritis may include:
- Stiffness. This generally follows periods of immobility and is worse in the morning and improves during the day.
- Soreness. This can occur in the low back or neck as well as over the tendons.
- Itchy or patchy skin. This can occur commonly in patches on the elbows, knees, and scalp.
- Fatigue. This is a common symptom and can include feelings of being tired in the morning and feeling overwhelmed.
- Dactylitis. Swelling of the fingers and toes to resemble sausages.
- Joint pain. Mostly at the ends of the fingertips and toes, joint pain can also occur in one or more joints.
- Fingernail and toe problems. Symptoms in the nails begin with the formation of small holes in the nail surface (pitting), and are followed by transverse ridging, cracking, discoloration, and separation of the nail from the nail bed.
- Red eye. Both pain and redness caused by inflammation, such as conjunctivitis.
- Spondylitis. This form of psoriatic arthritis usually involves the sacroiliac (SI) joints of the lower back.
Inflammation is also commonly found at the attachment sites for ligaments and tendons, especially the Achilles tendon, located on the back of the leg near the ankle as well as the plantar fascia, located on the sole of the foot.