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Psoriasis on the Knees and Elbows: How to Treat Flares
Psoriasis most frequently appears on the extensor surfaces — the front — of the knees and the elbows, says Jeffrey Cohen, MD, MPH, a board-certified medical dermatologist and director of the psoriasis treatment program at Yale Medicine in New Haven, Connecticut.
What Knee and Elbow Psoriasis Looks Like
Plaque psoriasis is the most common type of the psoriasis in general, affecting about 80 to 90 percent of people who have the condition.
Plaque psoriasis is also the most common type of psoriasis to appear on the knees and elbows. “You’ll usually see a well-circumscribed plaque, bigger than a centimeter, with thickened skin and overlying white scales,” says Elisabeth Richard, MD, an assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore. Plaques tend to appear red or salmon pink on white skin, whereas they tend to be purple or brown on black or brown skin.
The prevalence of psoriasis in these areas is no accident. “We lean on our knees and elbows frequently, or they are apt to rub against clothing. This can result in a process called Koebnerization, in which microtraumas like rubbing or banging skin potentially lead to flare-ups,” Dr. Cohen says.
Typically, psoriasis on the knees and elbows isn’t itchy or painful, says Dr. Richard, “unless the skin becomes very thick. Then small cuts, known as fissures, can develop.”
Rarely, other types of psoriasis, such as guttate psoriasis and pustular psoriasis, can appear on the knees and elbows. Signs of guttate psoriasis include small, round, red, or discolored spots. Symptoms of pustular psoriasis include pustules (white, pus-filled, painful bumps) that may be surrounded by reddened or discolored skin.
Knee and Elbow Joint Issues Due to Psoriasis
About 1 in 3 people with plaque psoriasis also have psoriatic arthritis. Typically, psoriasis develops before psoriatic arthritis, which causes swelling, pain, and stiffness in the joints and entheses, places where tendons and ligaments connect to bones. Psoriatic arthritis can occur regardless of whether the psoriasis is mild, moderate, or severe.
Having knee or elbow psoriasis doesn’t necessarily mean you will have arthritis in those joints. However, the knees and elbows are commonly affected by both conditions.
One study found that older people with psoriasis were more likely to end up having total knee replacement surgery than people of the same age without psoriasis.
The Psychological Impact of Knee and Elbow Psoriasis
People living with psoriasis often struggle with depression, anxiety, and being stigmatized. One study found that while up to 98 percent of psoriasis patients felt that their skin disease had affected their emotional or psychological well-being, only 18 percent sought help.
“I see a lot of patients who don’t feel comfortable wearing shorts or short sleeves, even in summer, because they’re embarrassed,” Cohen says.
The National Psoriasis Foundation’s Support & Community page can connect people with psoriatic disease with peer and other types of support services.
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