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Your top 10 questions about psoriasis

Woman on bed looking at her skin

This complicated autoimmune condition has no cure. But there are steps you can take to ease psoriasis symptoms — and even achieve remission. 

Kim Robinson

By Kim Robinson

Psoriasis is a condition that causes red, scaly, sore or itchy patches to form on the skin. It can show up anywhere on the body, especially the elbows, knees, scalp, back, palms and feet. But the impact of psoriasis is anything but skin-deep.

Psoriasis causes the body to make skin cells too quickly, says the National Psoriasis Foundation. The condition affects more than 8 million Americans and can show up at any age. Not only can these flare-ups ding confidence, but they can cause major discomfort, including joint pain.

To top it off, there is no cure for psoriasis. Still, that doesn’t mean you can’t do anything about it. Here are 10 common questions about psoriasis and how the answers can help you manage the condition.

Q: What causes psoriasis?

Psoriasis is an autoimmune disease. “It’s caused by an abnormal response to the body’s immune system in people who are genetically predisposed,” says Jason Miller, MD. He’s a dermatologist with Schweiger Dermatology Group in Freehold, New Jersey.

In other words, psoriasis tends to run in families. And the symptoms usually show up when something triggers the disease.

“There are certain triggers that have been identified, including strep infections and some medications,” Dr. Miller says. “In most patients, we can’t identify the specific trigger for their psoriasis.”

Other common psoriasis triggers include:

  • Cold, dry weather
  • Skin injuries such as sunburn or scratches (even shaving)
  • Stress
  • Smoking
  • Heavy alcohol use

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Q: Is psoriasis contagious?

No. Neither psoriasis itself nor the rash it causes is contagious. But because the rash is sometimes very noticeable, it can cause a lot of stigma, according to a 2019 study from the University of Pennsylvania. The researchers surveyed people about their attitudes toward someone with psoriasis. They found that 54% would not date a person with psoriasis, 40% would not shake that person’s hand and 27% thought the person was contagious.

Q: What are the symptoms of psoriasis?

Psoriasis often goes through cycles. Symptoms may come and go at different times of the year or even disappear for long stretches.

Some common symptoms are:

  • Red patches of skin covered in thick scales
  • Dry, cracked skin that sometimes itches or bleeds
  • Itching, burning or soreness
  • Thickened, pitted or ridged nails
  • Swollen and stiff joints

Q: Is there more than one type of psoriasis?

Yes, there are several types of psoriasis depending on what part of the body is affected, according to the American Academy of Dermatology (AAD).

They include:

  • Plaque psoriasis: This is the most common type, and it causes red, scaly patches that might be itchy and sore. It usually affects the knees, lower back and scalp.
  • Nail psoriasis: This causes pitting and discoloration of the nails and toenails.
  • Guttate psoriasis: With this type, tiny bumps appear suddenly on the skin. They typically clear within a few weeks — and may never return. This is mainly seen in young adults and children. It’s thought to be triggered by a bacterial infection such as strep throat.
  • Inverse psoriasis: This one is mainly found in the skin folds of the breast, groin or buttocks. It can sometimes be triggered by fungal infections.
  • Pustular psoriasis: This form results in pus-filled bumps that usually appear only on the hands and feet.
  • Erythrodermic psoriasis: This rare (and dangerous) type can result in a red, peeling rash that covers the entire body and is highly itchy. It can also be accompanied by muscle weakness, chills and fever.
  • Psoriatic arthritis: Signs can be subtle at first, including swollen and tender joints or stiffness that’s hard to shake in the morning. Most people notice that they have psoriasis well before they develop psoriatic arthritis.

(Rheumatoid arthritis is another autoimmune condition that causes joint pain. Learn more about it here.)

Q: How is psoriasis diagnosed?

Even a highly trained dermatologist can find it challenging to tell psoriasis apart from other skin diseases such as eczema. Its symptoms can also look different on people with different skin colors, according to the AAD.

If anyone in your family has psoriasis or a skin rash, that can be a good indicator. A doctor will then examine your skin and check your nails for divots or a yellowish appearance. You’ll also probably be asked about any recent illnesses, injuries and stressful situations, and whether you’re experiencing a lot of stiffness.

Q: When should you see a doctor?

If you have a rash that bothers you or it doesn’t go away after a couple of days, tell your doctor. You should also see a doctor if your psoriasis:

  • Becomes more severe or widespread
  • Causes you pain
  • Gives you concern about your appearance
  • Causes stiff or swollen joints
  • Isn’t getting better with treatment

Q: What treatments are available for psoriasis?

“This is a very exciting time for psoriasis therapy,” Dr. Miller says. “We have a variety of treatments that can improve the symptoms dramatically.”

Treatments depend on your symptoms and the type of psoriasis you have. Often, more than 1 type of therapy is used at a time.

Topical therapy

This includes medicinal gels, creams and ointments. They are usually the first step in managing mild to moderate psoriasis. Prescription-strength topicals include:

According to the AAD, these therapies work to slow how quickly your skin cells grow, clearing psoriasis for most people. They can also be used together or in conjunction with other treatments.

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Systemic medications

For people with more severe psoriasis or psoriasis that impacts their joints, dermatologists may prescribe medications such as methotrexate (Trexall®), says Dr. Miller. It works to calm an overactive immune system and slow down skin cell production. That said, it can cause many side effects, including fatigue, loss of appetite or more severe damage to organs such as the liver. Your doctor will monitor your health closely to catch and halt any side effects early.

Biologics

These newer medications are more selective. They target only the part of your immune system that is driving the psoriasis. Biologics disrupt the cycle of the condition. So unlike older medications, biologics can have fewer side effects. Common ones include certolizumab pegol (Cimzia®), etanercept (Enbrel®), infliximab (Remicade®) and adalimumab (Humira®). Newer biologics, including ixekizumab (Taltz®) and guselkumab (Tremfya™), work very fast and can result in complete clearance over several months. The downside is they're very expensive.

Light therapy

Controlled doses of light can curb excess skin cell growth by targeting the cell’s DNA. And this makes it harder for skin cells to replicate. It can also reduce inflammation and calm the itch. This treatment is safe for most people. That includes children, women who are pregnant or breastfeeding and those with a weakened immune system.

There are different types of light therapy, so ask your doctor which one may be right for you. For some, you need to visit a hospital several times a week. Others you can do from the comfort of your home.

Q: Can lifestyle changes improve psoriasis?

Yes, there is much more you can do for your psoriasis — and your overall health — beyond medications. “Eating a diet rich in fruits, vegetables and healthy proteins, getting exercise, quitting smoking and stress management have also been shown to improve psoriasis,” Dr. Miller says.

Some healthy habits, such as movement, can help reduce stress — 1 possible trigger of flare-ups. Others, such as limiting alcohol use, can even make psoriasis treatments more effective, according to the AAD. Talk to your doctor about your lifestyle and what changes may help keep psoriasis at bay.

Q: What helps with itchiness?

Itchy skin can be super frustrating. The AAD recommends these simple solutions to help reduce or prevent the discomfort:

  • Follow your psoriasis treatment plan. (These 5 tips can help you stick with it.)
  • Limit showers to 5 minutes and baths to 15 minutes. Water can dry out your skin and make the itching worse.
  • Keep your skin moisturized. Aim for a heavy cream, an ointment or an oil rather than a lotion. And opt for one that’s fragrance-free.
  • Use an itch-relief product that contains menthol or camphor.
  • Avoid scratching your skin.
  • Apply a cool compress, such as a washcloth, to your skin.

Q: How soon can treatments bring relief?

Easing psoriasis symptoms doesn’t happen overnight, but it can happen quickly.

“There are some new biologics that, in some patients, can give complete remission of symptoms within weeks,” Dr. Miller says. Depending on the type of therapy or the severity of the disease, it can take some trial and error, so work with your doctor to find the best treatment for you.

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Additional sources
Overview of psoriasis:
American Academy of Dermatology
Psoriasis signs and symptoms: American Academy of Dermatology
How to find help for psoriasis: National Psoriasis Foundation
Psoriasis and stigma: Journal of the American Academy of Dermatology (2019). "Stigmatizing attitudes toward persons with psoriasis among laypersons and medical students"