In this article:
- Psoriasis is a chronic condition wherein the development of skin cells speeds up.
- A common skin disorder, psoriasis causes red and scaly skin that is accompanied by discomfort, itching, and pain.
- Psoriasis is generally due to genetic factors or an overactive immune system.
- Different body parts are affected by psoriasis depending on its type.
- The management of psoriasis requires proper diagnosis, followed by clinical and home treatments.
- Various factors predispose you to psoriasis or worsen the condition.
What Is Psoriasis?
Psoriasis is caused by an autoimmune disorder that accelerates the growth of skin cells, resulting in their buildup. As a result, dry red patches and silvery scales develop on the skin and cause itching.
This chronic condition can affect both genders at any age, though adults more frequently.
Psoriasis primarily affects the surface of the skin, but it can also increase the tendency for other health complications, such as psoriatic arthritis, heart complications, and depression to name a few.
The condition may be mild or severe and usually affects the knees, elbows, scalp, lower back, palms, soles of the feet, and face. However, it may also spread to the toenails, fingernails, and mouth.
Prevalence of Psoriasis
Psoriasis is a widespread disease that can occur in people of any age or gender, irrespective of their ethnic origin. It is a global problem with incidence rates varying from 0.09% to 11.4% among different countries, according to published data. (1)
The disease is highly prevalent in the polar regions. However, it is also common in tropical/subtropical countries such as India due to the dense population.
Studies report that the rate of occurrence of psoriasis may increase in the near future. (2)
What Causes Psoriasis?
Psoriasis can occur due to problems in the immune system and certain genetic factors.
- Immune System: An overactive immune system may cause an increase in the activity of T-helper lymphocytes, a type of white blood cells.
This results in an abundance of cytokine molecules that are responsible for signaling between cells during an immune response. Cytokines direct immune cells toward the site of action and cause inflammation.
When the immune response targets the skin, it causes the widening of blood vessels, accumulation of white blood cells, and an increase in the division of keratinocytes (cells that produce keratin and make up a major part of the outer epidermal layer of the skin).
Normally, the life cycle of keratinocytes is 1 month long, which includes their division, maturation, migration to the surface, death, and removal. However, in psoriasis, the life cycle is completed in 3-5 days due to the overproduction of cytokines.
Thus, an increase in the rate of production of keratinocytes is observed. As a result, the skin turns red, thickens, and swells up. Consequently, the keratinocytes that matured early shed in the form of silvery scales.
- Genetics: Inheritance of some specific genes increases the likelihood of developing psoriasis. You are at a greater risk of developing psoriasis if any of your immediate family members have a diagnosis of psoriasis.
However, psoriasis has a low genetic predisposition as only 2%-3% of people having the gene develop the condition, according to the National Psoriasis Foundation (NPF).
Many additional factors contribute to the development of psoriasis besides genetic predisposition, such as infection, medications, trauma or injury to the skin (referred to as Koebnerization), stress, smoking, excessive alcohol consumption, and vitamin D deficiency.
Symptoms of Psoriasis
Psoriasis can affect any area of the skin, but the most commonly affected areas are the elbows, knees, and scalp. It may produce the following symptoms:
- Red patches on the skin
- Rough, flaky, and scaly skin
- Dry skin that may bleed from cracks
- Burning or stinging sensation in the skin
- Small bumps
- Peeling of the skin, itchiness
- Stiffness, pain, and swelling of the joints
- Patches on the scalp
- Discolored, thickened, and pitted nails
Types of Psoriasis
Psoriasis is of various types, each of which affects different body parts and also differs in symptoms. The common types of psoriasis include the following:
- Plaque psoriasis: Plaque psoriasis is the most prevalent kind of psoriasis. It usually affects the elbows, knees, lower back, and/or scalp region but can affect any area of the skin. The formed plaques are painful and itchy and can bleed due to the cracking.
Plaque psoriasis is a chronic, but manageable condition. However, it can be hard to manage as response rates to treatment vary largely and the condition is chronic with flare-ups and periods of well-controlled disease.
- Guttate psoriasis: Guttate psoriasis is characterized by the formation of multiple small plaques on the trunk and proximal limbs (usually the thigh and upper arm region) and scaly skin.
It has a sudden onset and in a few days, covers large areas with small red scaly plaques and some scattered lesions.
Guttate psoriasis may also form on the scalp, ears, and face, but the lesions that develop in these areas are light and disappear quickly. This is commonly triggered by an infection, most commonly strep throat.
- Pustular psoriasis: The formation of pus spots on reddened areas of the skin is characteristic of pustular psoriasis. The pus spots may look infectious, but they are only due to the accumulation of white blood cells and are not infectious nor contagious.
The coexistence of pustular psoriasis and plaque psoriasis is common. Pustular psoriasis can be triggered by medications in a patient with a history of plaque psoriasis. This condition requires more aggressive treatment and hospitalization.
- Inverse psoriasis: The formation of scaly plaques in skin folds is known as inverse psoriasis. This condition usually affects the groin, buttock creases, axillae, and folds under the breasts.
As the scales fall off due to skin-on-skin friction and heat, the affected areas appear smooth, shiny, and red, similar to scalded skin.
- Erythrodermic psoriasis: The development of a red rash and inflammation all over the body is symptomatic of erythrodermic psoriasis. This condition may occur due to stress conditions caused by fever, infection, or any illness that affects the whole body.
The redness in the skin may be accompanied by extreme itching, fast heartbeat, pain, and incapability to maintain the temperature of the body.
We generally have 5 types of psoriasis. Nail psoriasis is a complication of psoriasis.
- Nail psoriasis: Defects in the nail, such as pitted surface, crumbling, ridges, thickening, and lifting indicate nail psoriasis.
Nail psoriasis can be the only manifestation of psoriasis with no involvement of the skin. The prevalence of nail psoriasis is higher in those with psoriatic arthritis, which causes joint pain, swelling, and stiffness.
A few topical and systemic therapies used to treat skin psoriasis can be used for nail psoriasis as well. Other options include the injection of medications directly into the nail bed. However, the treatments may not be successful.
Any primary care doctor can diagnose psoriasis by analyzing its signs and symptoms. However, psoriasis can resemble other skin problems such as eczema, in which case a dermatologist can provide a proper diagnosis.
The diagnosis can be confirmed using the medical history of the patient and a skin biopsy. A skin biopsy involves removing a small piece of affected skin to be observed under a microscope. The results also help in determining the kind of treatment to be given.
Medical Treatment for Psoriasis
Several treatment methods are available for psoriasis. The treatment option is selected according to the surface area covered, the body part affected, and the severity of the disease.
The treatments may have varying effects on different people and are broadly classified into the following three categories:
- Topical treatment includes ointments, lotions, and creams that are directly applied to the skin. The medications may be available in the form of moisturizers, vitamin D creams, prescription corticosteroids, retinoids, or shampoos containing coal tar or salicylic acid.
The application of topical treatments may be messy but is useful for treating mild and moderate cases of psoriasis.
- Light therapy (phototherapy) involves the use of ultraviolet (UV) light to effectively treat skin conditions such as psoriasis. The affected skin is exposed to controlled doses of UV light (under medical supervision), which helps in slowing down cell growth.
In severe cases, light therapy may include laser therapy (excimer laser) or a combination of UV light and topical or medicinal treatments.
- Oral or injected medications may be required along with topical treatment to manage moderate to severe psoriasis and to treat and prevent joint damage with psoriatic arthritis.
The medications that are administered orally or through injection affect the whole body. Therefore, it is recommended to consider all the possible benefits, risks, and side effects before employing these medications.
Preventive Self-Care to Avoid Flare-Ups
Taking a few precautionary steps can help to manage the symptoms of psoriasis and improve the cosmetic look of the skin. The following tips may be helpful:
- Shower daily and avoid scrubbing your skin to prevent irritation.
- Cleanse private areas daily, shower every other day or take a very quick shower only using cleanser on the private areas.
- Prefer using a mild soap or body wash over a harsh bar soap to avoid drying of the skin.
- Do not use hot water for bathing as it can aggravate the condition. Use lukewarm water in the shower or bath and limit bathing to 20 minutes or less.
- Practice relaxation techniques to manage stress.
- Use humidifiers to maintain the moisture level indoors.
- Ask your doctor about the foods you need to avoid to prevent a flare-up. High-glycemic foods, excess sugar, and processed foods can contribute to insulin resistance and inflammation in the body, which may worsen psoriasis.
- Do not scratch or pick at the lesions.
- Wear soft cotton and linen materials.
- Avoid the use of possible irritants such as perfumes and dyes.
- Decrease alcohol intake as it can render your treatment ineffective.
- Apply the medications as directed by your dermatologist until the symptoms improve.
Home Remedies for Psoriasis
Note: Home remedies help prevent flare-ups and manage symptoms by providing relief from dry skin and inhibiting lesion formation and bleeding. These remedies cannot be used as a cure for psoriasis.
Use herbal remedies only after consulting your doctor. Avoid using herbal or home remedies if you are breastfeeding, pregnant, diabetic, have high blood pressure or are on medications. Discontinue the treatment if you experience any side effects and seek immediate medical consultation.
1. Apply a cold compress
A cold compress can provide temporary relief from itching and can decrease swelling. These occur due to the numbing and distraction effect of the cold temperature.
If performed carefully, a cold compress can be a safe and effective treatment for skin problems that cause itching, such as psoriasis.
How to use:
- Wrap ice cubes in a clean washcloth and lightly press the compress against the affected areas for 10 minutes. Repeat this method several times a day.
Note: Avoid direct application of ice to the skin as it can cause frostbite. Discontinue the compress if stinging or burning occurs.
2. Take an oatmeal bath
Soaking your skin in colloidal oatmeal is helpful in treating various skin conditions, including eczema, psoriasis, and dry skin. Colloidal oatmeal is made by suspending powdered oats in liquids such as milk, water, or gel.
Colloidal oatmeal has been used in dermatological treatments for a long time. It is a safe and natural product that showed to be highly efficient for the treatment of drug-induced rash, psoriasis, and other skin problems. Therefore, the use of oatmeal should be included in therapies. (3)
A study was conducted in 2018 to compare the effect of products with natural ingredients with that of a colloidal oatmeal-based product for dry-skin care. (4)
It was demonstrated that the natural products had benefits similar to those of the colloidal oatmeal-based products. Both the creams showed high efficacy in hydrating the skin and improving its appearance and emerged to be good options for treating dry skin conditions. (4)
How to use:
- Fill the bathtub with warm water and add in 1 cup of finely ground oatmeal.
- Stay in the colloidal bath for about 20 minutes, and then wash with lukewarm water.
- Pat your skin dry and apply a moisturizer.
- Repeat daily during flare-ups.
Note: Oatmeal baths should not be used as the only treatment. It is advised to seek medical help, especially if the symptoms worsen or do not subside.
3. Use glycerin
Glycerin helps in healing the skin by stimulating cell growth. It also manages dry skin conditions by improving skin hydration similar to hyaluronic acid (HA).
A study conducted in 2017 found that the daily application of a single dose of Jaluronius CS fluid (a hydrating fluid containing HA, Centella asiatica extract, and glycerin) provided effective hydration for up to 24 hours and also helped in enhancing the function of the skin barrier in healthy women. (5)
A study conducted in 2011 revealed the effectiveness of a new formulation of cream containing glycerin for the treatment of erythema, lichenification, and flaking. It also helped in improving skin hydration in people with psoriasis. (6)
How to use:
- Apply generous amounts of glycerin to the affected areas and allow it to be absorbed by the skin.
Note: Aloe vera gel or natural plant-derived aloe vera can be used in place of glycerin.
4. Apply turmeric gel
Several scientific studies demonstrated that turmeric acts as an anti-inflammatory agent, inhibits several enzymes involved in inflammation, and therefore can be used to treat psoriasis.
A study performed in 2015 suggested the use of turmeric gel as an alternative therapy for treating plaque psoriasis. (7)
Another study conducted in 2018 stated that curcumin is a safe and effective treatment agent for psoriasis. It also suggested the use of the turmeric derivative in the form of oral curcumin after conducting more studies. (8)
How to use:
- Apply turmeric gel to the affected areas. You can also mix turmeric powder and water to form a paste for application. Leave the gel or paste overnight and wash it off with warm water the morning after.
- Turmeric or curcumin supplementation may also be beneficial for psoriasis involving both the skin and joints.
Note: Avoid the ingestion of turmeric if you have gallbladder problems. If you have any blood clotting issues or take medicines for diabetes, get your doctor’s permission before using this herbal remedy.
5. Apply oils
1. Olive oil
Oleic acid (a monounsaturated fatty acid), oleuropein, and vitamin E provide physiological functions to olive oil, making it an important anti-inflammatory and antioxidant agent. (9)
A 2018 study demonstrated the use of olive oil for the treatment of psoriasis. It was found out that the polyphenols present in extra-virgin olive oil act as anti-inflammatory and antioxidant agents, which help in managing immune disorders such as psoriasis. (10)
The use of a cream formulated with plant-based extracts, black cumin oil, and olive oil on skin lesions for 12 weeks helped in alleviating psoriasis. (10)
How to use:
- Heat olive oil to lukewarm temperature and apply it to the affected areas to provide hydration.
- Alternatively, combine 1 teaspoon each of olive oil, honey, and beeswax, and use this lotion.
2. Jojoba oil
A study conducted in 2017 evaluated the efficacy of a jojoba oil microemulsion as a carrier and demonstrated its effectiveness in alleviating the irritation caused by tazarotene (a topical cream used for the treatment of acne and psoriasis). (18)
It also helped in improving the deposition of tazarotene into the skin and thus enhancing the therapeutic outcome. The patients using tazarotene alone experienced swelling and redness, whereas those utilizing the microemulsion did not experience any irritation. (18)
How to use:
- Apply a jojoba oil-based gel to the affected portions of the skin.
3. Aloe vera oil and coconut oil
Aloe vera oil can be applied to skin lesions, while coconut oil can be used for scalp psoriasis. These oils work by hydrating the skin. However, no scientific studies have been conducted to test their efficacy in treating psoriasis.
It is advised to do a patch test before applying these oils to identify possible adverse effects.
6. Consider licorice root
Licorice is commonly used for the treatment of psoriasis in the Chinese medicine system. Licorice root contains an active compound known as glycyrrhizin, which helps in subsiding irritation, redness, and inflammation caused by psoriasis.
An animal study conducted in 2018 evaluated the effect of glabridin isoflavone found in licorice root for psoriasis treatment. It was shown that glabridin helped in downregulating the production of pro-inflammatory cytokines and increasing the amount of antioxidants. (19)
Some General Queries
Can psoriasis be cured?
Psoriasis cannot be cured. However, many treatments can help in subsiding the symptoms and skin patches, thus managing the condition.
Is psoriasis contagious?
Because psoriasis does not develop due to an infection, it is not contagious.
Does psoriasis increase the risk of cancer?
Having psoriasis can predispose you to cancer due to the chronic inflammation associated with the disease. The risk of developing cancer also increases with the use of UV light and immune-suppressive medications for therapy.
An increase in the prevalence of factors such as obesity and smoking that are well-known factors for carcinogenesis also contributes to the development of cancer in patients who have psoriasis. (11)
How does diet affect psoriasis?
Psoriasis is a chronic problem that causes prolonged inflammation. Therefore, it is essential to lead a healthy lifestyle and include anti-inflammatory foods in a well-balanced diet. It is recommended to avoid the ingestion of dairy, red meat, gluten, refined sugar, and processed foods, which may trigger inflammation.
A review paper published in 2019 concluded that though dietary modifications may not help in treating psoriasis, they are required as an adjunct to first-line treatments. (17)
Does pregnancy affect psoriasis?
Psoriasis does not have any effect on fertility or pregnancy. However, some women find improvement in their psoriasis during pregnancy, while some others feel that the condition worsens.
Psoriasis treatment may harm the baby; thus, consultation with a doctor is recommended.
Does psoriasis cause the belly button to smell?
The increased cytokine production and the death of normal cells during psoriasis make the skin scaly and patchy. In such conditions, the belly button may smell due to the growth of germs in its moist and dark environment.
It is important to maintain hygiene by taking regular baths and cleaning the belly button once a week to get rid of the smell.
Are psoriasis and eczema similar?
Psoriasis and eczema have a similar appearance, due to which a general physician may not be able to distinguish between the two. Both these skin problems cause a rash (patches of inflamed, red, and itchy skin) on the same body parts such as the scalp and the hands.
While these skin conditions are noncontagious, they may lead to infections.
An experienced dermatologist can distinguish between the two using features such as the flakiness of the skin in eczema and the buildup of silvery scales in psoriasis.
Psoriasis occurs due to the overactivity of an individual’s immune system, speeding up the growth of cells. On the other hand, allergy, skin barrier dysfunction, environmental issues, bacterial infection, and many other factors contribute to the development of eczema.
What is the difference between psoriasis and ringworm?
Psoriasis and ringworm have similar symptoms, although ringworm has a higher resemblance to eczema.
Ringworm results in the formation of round lesions, surrounded by small scales, bumps, or blisters that may turn red. The lesions are well bordered, thus distinguishing the affected areas from healthy skin. The center of the lesion appears to be normal, and the lesions vary from being dime-sized to several inches in diameter.
Ringworm usually affects the limbs, trunk, or face. A multilobed appearance may be found due to the merging of lesions that are close together.
Psoriasis is the buildup of the skin due to the rapid growth of skin cells, which occurs as a result of problems in the immune system. However, ringworm is caused by an infection of dermatophytes (fungus) that feed on keratin.
Can sun exposure help with psoriasis?
People with psoriasis have reported an improvement in their skin condition on exposure to the sun. However, sun exposure should be spread over a prolonged period. Spending a couple of days under the sun may subside the symptoms mildly.
It is important to avoid staying under the sun for long at one single stretch as it can result in sunburn. This will injure the skin, and a new plaque of psoriasis may develop on the injured portion.
Is apple cider vinegar helpful in treating psoriasis?
Although not scientifically proven yet, the application of apple cider vinegar may help in subsiding the itchiness and irritation during a bout of psoriasis.
Make sure to use diluted apple cider vinegar. Otherwise, it can cause burning, stinging, or irritation due to its acidic pH.
Risk Factors for Psoriasis
Medical conditions and factors that may trigger psoriasis include the following:
- Infection: Sinusitis, strep throat, tonsillitis, and other respiratory tract infections may cause psoriasis flare-ups.
- HIV/AIDS: Psoriasis may become severe in people with HIV/AIDS.
- Stress/emotional disorders: The inflammation may increase due to the chemicals released during mental stress, causing flare-ups.
- Obesity: Some scientific studies associated obesity with the onset of psoriasis. It can also aggravate existing psoriasis, and losing weight may help in managing the skin condition. Excessive body fat may hinder the effect of medical treatment for psoriasis and increase the risk of cardiovascular problems. (15)
- Skin injuries: The site of an abrasion, burn, cut, or injection, where the skin is injured, may be affected by psoriasis. This delayed occurrence of psoriasis is called the Koebner phenomenon.
- Alcohol: There is no evidence on whether alcohol increases the risk of psoriasis or whether individuals with psoriasis increase their intake of alcohol due to the emotional burden. Nonetheless, alcohol intake should be avoided during psoriasis flare-ups.
Complications Associated with Psoriasis
Psoriasis, especially when left untreated, can lead to the following complications:
- Psoriatic arthritis: The inflammation of the joints (arthritis) accompanied by psoriasis is known as psoriatic arthritis. The symptoms include redness, stiffness, and pain in joints, and heat and swelling in the surrounding tissues.
The condition may affect the feet and hands, and it may give the toes and fingers a “sausage-like” appearance due to the redness and inflammation (dactylitis). Approximately 10%-30% of patients who have psoriasis develop psoriatic arthritis.
- Mental disorders: The unusual appearance of the skin due to psoriasis may negatively affect the patient’s quality of life and self-esteem, leading to mental disorders such as depression, anxiety, substance abuse, and sexual disorders. (12)
- Parkinson’s disease: Psoriasis may cause chronic inflammation of the neuronal tissue and may lead to the development of Parkinson’s disease. (13)
- Cardiovascular disease: Patients with psoriasis are prone to developing cardiovascular problems and stroke.
- Type 2 diabetes: Studies report that psoriasis may be associated with insulin resistance and an increased risk of diabetes mellitus (DM), which is a contributor to cardiovascular problems that occur with psoriasis. (20)
- Eye disease: Psoriasis increases the risk of inflammation in the eye’s middle layer and may cause uveitis.
- High blood pressure: Psoriasis is found to induce conditions of high blood pressure in patients. The blood pressure may increase with the severity of the skin condition. (14)
- Autoimmune diseases: An overactive immune response associated with psoriasis increases the risk of developing other autoimmune disorders such as sclerosis, celiac disease, and Crohn’s disease (inflammatory bowel disease). (16)
When to See a Doctor
It is recommended to make an appointment with a dermatologist at the earliest upon recognizing the signs and symptoms associated with psoriasis for proper treatment. If you have already been diagnosed with psoriasis, you may need to seek further medical help in the following cases:
- You have a flare-up.
- You want to conceive or are pregnant.
- The treatment is not having any effect.
- You experience pain or discomfort in the joints (symptoms of psoriatic arthritis).
What your doctor may ask you:
- What are your symptoms and when did they develop?
- Does anyone in your family have this condition?
- Are you under stress?
- Have you tried any treatment before?
- Do you have any joint pain, swelling, or stiffness?
- Do you have other health problems?
What you may ask your doctor:
- What is the reason behind my psoriasis?
- What type of psoriasis do I have?
- What treatment should I undergo?
- Would the treatment cause any side effects?
- What measures can I take at home to manage the condition?
- Should I avoid any food or factors that may trigger flare-ups?
- Am I at risk of developing other health problems?
While psoriasis cannot be completely cured, it can be managed with the help of the recommended treatments. Flare-ups can be prevented by taking measures to avoid triggers.
Additionally, you can take the help of natural home remedies to alleviate the symptoms. It is vital to moisturize your skin to prevent irritation and discomfort.
Expert Answers (Q&A)
Answered by Dr. Michelle Levy, MD (Dermatology)
No, unfortunately there is no cure for psoriasis at this time. However, there are many new and effective treatments that can adequately control the disease in most people.
There is no scientific proof that avoiding dairy will improve or prevent psoriasis.
We do not know of a way to prevent psoriasis. Psoriasis is a chronic inflammatory skin condition. We know that genetic factors play an important role and that these are not changeable.
A minority of the time psoriasis may be triggered or worsened by streptococcal infections or by certain medications. Reducing the risk of streptococcal infections may reduce the risk of a form of psoriasis known as guttate psoriasis.
Other factors that may aggravate psoriasis include trauma (psoriasis can develop at sites of previous injuries), smoking, obesity and excessive alcohol consumption.
For those with psoriasis it is probably best to avoid smoking, limit alcohol consumption and to make lifestyle choices that may reduce the risk of obesity.
That depends on both the nature of someone’s psoriasis and the treatment being used. People using topical medications for their psoriasis may start to see a benefit within 1-2 weeks. However, thick plaques of psoriasis may take significantly longer to clear (or require different treatments).
Systemic medications (those taken internally) vary significantly in how quickly they work and how effective they are. Some newer injectable medications for psoriasis will result in significant improvement in as little as two weeks, while other medications or light treatments may take up to 2-3 months.
During the day we are kept busy with our jobs and activities. These often serve to distract us from symptoms such as pruritus (itch). At night, people are no longer distracted and more likely to notice symptoms, which is why many people find that itch gets worse in the evenings.
Symptoms of psoriasis are unpredictable and may worsen or improve at any time. The worsening of symptoms is not specifically a result of aging but is due to the disease process itself.
Psoriasis is in no way contagious and does not ‘spread’ in the traditional sense of the word. Psoriasis may flare or worsen and involve more of a person’s skin at some points in their lives but this increased degree of involvement is not a result of contagion.
Some areas of the body are more likely to develop psoriasis plaques. These include the scalp, elbows, knees and tailbone area. That being said, psoriasis can affect virtually any part of the skin.
The past 20 years have seen remarkable advances in the treatment of psoriasis. We now have highly-effective treatments for this problem that can treat even the most severe cases of psoriasis. If you have psoriasis, speak with a board-certified dermatologist to learn about your options.
About Dr. Michelle Levy, MD: Dr. Levy is a board-certified dermatologist with 15 years of experience. She is privately practicing medical and cosmetic dermatology in Toronto, Canada.