Symptoms — Skin Lesions

Psoriatic arthritis (PsA) generally occurs in people with existing psoriasis, a chronic inflammatory disease affecting the skin. In most people with PsA, psoriasis precedes the joint disease by several years. However, in about 10-15% of cases, PsA will develop before psoriasis.1 The skin lesions that affect people with PsA are actually due to psoriasis.

Characteristics of psoriasis skin lesions

Psoriasis is an autoimmune disease that causes red, scaly, raised patches to appear on the skin. The skin lesions, or plaques, most often appear on the scalp, knees, elbows, lower back and feet. They are often itchy and painful, and they can crack and bleed. The plaques may vary in size and can appear as distinct patches or join together to cover a large area of the skin.2,3

There are several varieties of psoriasis, with the most common being plaque psoriasis, which affects 80-90% of all psoriasis patients. Plaque psoriasis is characterized by a gradual appearance of lesions, and the disease remits and recurs with triggers. Common triggers include stress, infections, and cold temperatures. 2,3

Psoriasis is a persistent, long-lasting condition. It cannot be cured, although people with PsA may experience periods of remission with no symptoms of the disease.2

How is psoriasis diagnosed?

A dermatologist or other physician diagnoses psoriasis by examining the affected skin. Occasionally, a biopsy or sample of the skin is taken for microscopic examination. Physicians also will inquire about the patient’s family history, as approximately one-third of people with psoriasis have a family member with the disease.2

How is psoriasis treated?

Treatment of psoriasis is based on the severity of the disease, which is determined by both the surface area of the skin affected and the level of impairment on the patient’s quality of life. Treatment options include topical medications, oral medications, biologics, and phototherapy. Some of the treatment options for psoriasis, such as several of the biologics, are also used to treat psoriatic arthritis.2

Topical treatments are applied directly to the skin and are generally the first treatment option for psoriasis. Phototherapy uses ultraviolet light on the skin and is performed either at a doctor’s office or at home with a specific phototherapy unit. 2


Oral medications for psoriasis include methotrexate, systemic retinoids (acitretin and isotretinoin), and immunosuppressants. The biologics are usually prescribed for moderate to severe disease and are given by injection or intravenously (IV). Biologics used for psoriasis include Cimzia (certolizumab pegol), Enbrel (etanercept), Humira (adalimumab), Remicade (infliximab), Simponi (golimumab), Stelara (ustekinumab), Cosentyx (secukinumab) and Taltz (ixekizumab).2

In addition to medications, topicals and light therapy, stress reduction is important for people with psoriasis as stress is a common trigger. Many people with PsA also benefit from dietary changes, which can have benefits for weight loss, heart health and reducing inflammation.2

Written by: Emily Downward | Last reviewed: October 2016.
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