Verrucous Psoriasis: What You Need to Know
Verrucous psoriasis is a very rare form of psoriasis that often mimics other skin conditions, such as warts and squamous cell carcinoma. Common treatment options include topical creams and phototherapy.
Psoriasis is an autoimmune skin condition that manifests in various forms. The most common type is plaque psoriasis, characterized by raised patches of skin covered in scales. A much less common variant is verrucous psoriasis, which involves the development of thickened plaques covered by wart-like papules.
Due to its rarity, verrucous psoriasis can be difficult to identify. Here’s what you need to know about this unusual condition.
What Are the Symptoms?
Verrucous psoriasis can appear in several areas of the body, including the torso, legs, arms, and backs of the hands. Symptoms may include:
- Thickened and raised papules
- Plaques clustered on top of the skin
- A ring around the papules and plaques
- A foul odor
Verrucous psoriasis is often mistaken for other skin conditions like squamous cell carcinoma, common warts, or epidermal nevus—a benign overgrowth of skin cells in the top layer of the skin. This resemblance can make verrucous psoriasis challenging to diagnose and treat effectively.
What Are the Causes of Verrucous Psoriasis?
Verrucous psoriasis is extremely rare, with only about 40 documented cases as of 2022. Experts have not yet identified the exact cause of verrucous psoriasis. However, many speculate that it could result from repeated injury or trauma to areas already affected by psoriasis.
What Are the Risk Factors for Verrucous Psoriasis?
Typically, individuals who develop verrucous psoriasis already have a background of psoriasis, though it can occur independently in very rare instances. The condition is indeed scarce, with only a handful of cases reported in medical literature.
It is far more common for individuals with psoriasis to develop psoriatic arthritis, affecting approximately 30% of psoriasis patients.
Treatment Options for Verrucous Psoriasis
Typically, doctors start treating plaque psoriasis with topical treatments, which may include one or more of the following:
- Topical corticosteroids
- Salicylic acid
- Synthetic vitamin D
- Topical calcineurin inhibitors
- A retinoid, such as tazarotene
If topical treatments prove ineffective, a doctor may recommend additional options, such as:
- Phototherapy
- Disease-modifying antirheumatic drugs (DMARDs), like apremilast (Otezla)
- Biologics, such as ustekinumab (Stelara)
- TYK2 inhibitors, like deucravacitinib (Sotyktu)
In general, treatment options for verrucous psoriasis are limited, and experts continue to search for other potential treatments. A recent study published in 2024 highlighted that adalimumab was effective in treating some cases of verrucous psoriasis. The study noted a case where verrucous psoriasis did not respond to other treatments, including oral methotrexate, phototherapy, and topical corticosteroids. However, the condition showed an excellent response to adalimumab, boasting an efficacy rate of 90%.
If you develop unusual-looking papules or plaques on your skin, consult a doctor for an evaluation. Even if it’s not verrucous psoriasis, you may have another skin condition that requires treatment and management.
Frequently Asked Questions
What is annular verrucous psoriasis?
Annular verrucous psoriasis involves the growth of wart-like protrusions away from the skin. Some people describe these warts as “finger-like projections.”
Does psoriasis look like warts?
Certain types of psoriasis, such as verrucous psoriasis, may cause papules to appear on the skin that resemble warts.
What is inverse psoriasis?
Inverse psoriasis is a skin condition that causes a shiny and smooth rash. It may appear red on light skin tones and purple or brown on dark skin tones.