Small Psoriasis Spots on Legs

Because the immune system is overactive in psoriasis, it starts to recognize healthy cells in the body as foreign and begins to attack itself. This overactivity of the immune system results in widespread inflammation and an increase in the number of skin cells that are being made. The number of skin cells being created and then shed is drastically higher than in those without psoriasis. A patient with psoriasis can grow and shed skin cells within four days compared to nearly a month, which is regularly observed in those without the disease.

As a result, small psoriasis spots begin to develop across the body, including the legs. These spots can grow larger and thicker as the disease progresses.

"Psoriasis is a chronic, auto-immune skin condition where you have red, scaly patches on the skin," Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, previously told SurvivorNet. "It is a chronic condition, which can ebb and flow. You can have good days and bad days."

What Does Psoriasis Look Like on Your Legs?

There are several subtypes of psoriasis. Each type has its own unique rash-like appearance. Knowing which type of psoriasis you have will impact what the psoriasis looks like on your legs. While each type is unique, they all share the common characteristics of inflamed, reddish spots/patches.

Types of psoriasis that do not commonly occur on the legs include the following:

• Inverse psoriasis
• Pustular psoriasis
• Nail psoriasis
• Scalp psoriasis

Plaque Psoriasis

Plaque psoriasis is the most diagnosed form of psoriasis. According to the American Academy of Dermatology, roughly 80-90% of all cases are considered this subtype. While the psoriasis itself is red, it is often covered up by plaques that tend to be silver or white in appearance.

The plaques that form with this subtype of psoriasis are generally thick and can look scaly, like a fish. They are generally round or oval shaped and can be found as individual patches or several may be close together and cover a wide portion of the body. Plaque psoriasis is commonly found on the knees, although it can be found in other areas of the legs as well.

Guttate Psoriasis

Patients who are diagnosed with guttate psoriasis will notice little red bumps on the leg that are generally <1 centimeter (cm). The word 'guttate' means 'drop' and the shape of the rash will generally resemble a tear drop-like pattern.  This subclassification presents as red bumps that are itchy but do not always have the silver-scale like appearance that is traditionally seen with plaque psoriasis. There is a strong association between recent streptococcal pharyngitis, and guttate psoriasis.

Psoriatic Arthritis

Psoriatic Arthritis (PsA) is a type of arthritis that develops in patients that also suffer from psoriasis. It is a condition that impacts the joints while also having silver-like scales. Patients with severe psoriasis may develop psoriatic arthritis overtime. Although plaque psoriasis commonly precedes psoriatic arthritis, approximately 10-15% of cases occur without a long-standing history of psoriasis.

It is important to note, the location of scales that are seen or develop is independent of the location of any inflamed joints. So, while the wrist may be inflamed, the scales could develop on the legs.

Patients with psoriatic arthritis would have the same clinical presentation as plaque psoriasis. In addition to the hallmark signs of plaque psoriasis, patients may also have swelling in the knees or behind the heel on the lower part of the leg, if those joints are affected.

“Half of the patients with psoriatic arthritis are not being treated with a systemic medicine,” Dr. George Han, a dermatologist at Northwell Health/Lenox Hill Hospital, said in a previous interview with SurvivorNet. “That is just not okay in this day and age when we have so many treatments that can really stop the joint damage in its drugs.”

Erythrodermic Psoriasis

Erythrodermic psoriasis is a severe form of psoriasis that produces a rash across large parts of the body, including the legs. According to the Cleveland Clinic, the rash appears as a severe sunburn and can affect up to 90% of your body.

Erythrodermic psoriasis can occur in patients that already have a diagnosis of psoriasis or can newly develop. Common causes of erythrodermic psoriasis include the following:

• Allergic reactions (most commonly to medications)
• Sunburn
• Discontinuing certain medications to0 quickly (e.g., steroids)
• Stress

Some medications, such as coal tar or topical steroids, can make erythrodermic psoriasis even worse. If you experience a large rash that develops quickly across your body, be sure to call your healthcare right away, as it is considered a medical emergency and can be life threatening if not properly treated.

Managing Psoriasis that Occurs on the Legs

While small psoriatic spots on your legs can be irritating or even embarrassing to some, understanding how to manage them can help to reduce outbreaks and irritation.

Clothing Choices

The types of pants that patients wear can directly impact the amount of irritation that occurs from psoriasis. Tight clothing can cause the skin to rub closely together with the fabric, which may result in increased irritation. Opting for pants that have a looser fit can help to increase comfort.

It is also important to choose breathable fabric for pants. Breathable fabrics allow moisture to go from inside the skin-clothing barrier into the air, preventing the pooling of sweat which may irritate the skin. Fabrics that are considered breathable include, but are not limited to, the following:

• Cotton
• Linen
• Satin

Laundry

Being aware of which laundry detergents to use can also help to manage psoriasis spots on your legs. Using fragrance-free products can help to reduce skin irritation. The National Psoriasis Foundation houses a directory of products that carry the National Psoriasis Foundation Seal of Recognition. Products listed within the directory are considered safe and non-irritating for patients with this condition. This directory includes many household and personal products, including a listing of laundry products that hold the Seal of Recognition.

Keeping Skin Moisturized

Moisturizing your skin is an important part of psoriasis maintenance. Because of the high cell turnover, the skin can begin flaking and become dry or itchy. Applying a moisturizer to your legs will help to keep the skin hydrated and reduce symptoms and irritation. Regular application of moisturizers can also help to prevent future flare ups.

Medication & Other Treatments

Your physician may recommend medications as an adjunct to lifestyle changes to manage your psoriasis. Mild cases can typically be treated with topical treatments. If the psoriasis does not respond well to topical treatment, your doctor may recommend UV light therapy (also known as phototherapy) or a systemic medication instead.

Systemic therapies used for the treatment of psoriasis can be either oral or injectable treatments and aim to reduce the underlying cause of inflammation.  While topical treatments can be used on an as needed basis to treat psoriasis flare ups, systemic therapies are typically used routinely to treat active psoriasis and reduce the recurrence of future flares.

Moving Forward -Questions to Ask Your Doctor

• What type of psoriasis do I suffer from?
• Will my small psoriasis spots on my legs become bigger?
• What can I do to manage my disease?
• Do I need medication to treat the psoriasis spots on my legs?

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