Psoriasis is a common, immune-mediated, chronic inflammation of the skin. It can sometimes affect the joints as well (psoriatic arthritis). The red scaly plaques of psoriasis can affect the scalp, face, and body. Psoriasis treatment may include topical or oral medications, as well as injectables or laser and phototherapy devices that will give you significant improvement and hopefully long-term clearance.
Of note, psoriasis affects more than 7.5 million people in the United States. Psoriasis can develop at any age and affects both men and women. We know that both family history and environment can stimulate the development of psoriasis. At Mittal Dermatology we understand that psoriasis is much more than a cosmetic disorder- it has an emotional and physical impact. We will work with you to help develop a treatment plan that addresses all of your needs.
How do Excimer Lasers work?
Psoriasis laser or phototherapy treatments are painless and take only a few minutes, twice to three times a week. The excimer laser creates a concentrated, but painless, beam of ultraviolet light that is delivered to psoriatic lesions through a handpiece. By targeting only active lesions and limiting exposure to healthy skin, the laser delivers high-dose treatment for fast clearing and long remission.
Who is a candidate for psoriasis treatment?
The laser is ideal for treating mild to moderate psoriasis. Traditionally hard-to-treat areas such as knees, elbows, and scalp are easily treated, thanks to the laser’s aiming beam and adjustable spot size handpiece. The targeted high-dose therapy can treat stubborn plaques, even those that have not responded to other treatments. Ask if laser treatment is right for you.
How does treatment compare with other psoriasis treatments?
Unlike topical creams and gels, treatment with the laser does not require any daily maintenance. Each patient is unique, but some patients enjoy several months of treatment-free remission.
How safe is the treatment?
The laser may have fewer shortcomings than many common psoriasis treatments. Due to the targeted nature of laser therapy, healthy skin exposure is limited.
What can I expect during treatment?
Treatment will take place in your doctor’s office. First, Dr. Mittal will determine the best dosage level for you. Then, we will apply laser therapy. Most treatments take only a few minutes.
Does psoriasis treatment hurt?
Most patients experience no pain or discomfort. A few patients may feel slight warmth shortly after treatment. This warmth is mild and short-lived. No anesthesia is needed.
How many treatment sessions will I need?
Dr. Mittal will create a customized course of therapy for you based upon the extent, thickness, and location of the lesions.
How do I prepare for psoriasis treatment?
No extensive preparation is required for laser therapy. Just ensure that the skin to be treated is clean, dry, and free of any make-up, lotion, or creams containing SPF protection.
Are there side effects?
The side effects of laser therapy are minimal. Most patients report no side effects. A few patients have reported a mild and short-lived redness at the lesion site. More serious side effects such as blistering and hyper-pigmentation are rare and short-lived.
Psoriasis
A common and chronic condition, psoriasis typically causes patches of itchy, scaly and sometimes inflamed skin. Although they can appear anywhere, these patches, called plaques, are most likely to crop up on your knees, elbows, hands, feet, scalp or back. In some cases, the fingernails and toenails are also affected.
The symptoms of psoriasis can vary a great deal depending on its severity, ranging from mildly annoying to truly debilitating.
While the itchiness and pain can be unpleasant to say the least, some of the worst effects can be emotional. People with severe psoriasis sometimes are so overwhelmed by their condition and self-conscious of their appearance that they feel isolated and depressed.
Researchers estimate that up to seven million people in the U.S. have psoriasis, about 1% to 2% of the population. Unfortunately, there isn’t a cure for this condition, but there are a number of effective treatments that can help keep it under control.
What Causes Psoriasis?
Normally, skin cells are constantly being formed, then pushed up to the surface where they eventually die and flake off, revealing new skin cells. In people with psoriasis, however, the skin cells grow too quickly, causing layers of skin to build up, forming a whitish, flaky crust. Blood vessels increase flow in an attempt to nourish this skin, causing reddened inflammation. Thus the hallmark symptoms are reddened, inflamed skin with a whitish, flaky layer of dead cells on top.
Although psoriasis usually appears as a skin condition, recent discoveries show that its real cause is a problem with the immune system.
Your body naturally fights infections and heals injuries with special cells — called white blood cells — that are designed to battle viruses or bacteria. Normally these cells go to the site of infection or injury and release antibodies and other chemicals to repair wounds, clot blood and prevent infection. One byproduct of this normal process is inflammation (redness and swelling).
For reasons that doctors don’t yet understand, the immune systems of people with psoriasis malfunction. One type of white blood cell – the B-cell – begins creating antibodies that destroy normal skin cells. Another type of white blood cell – the T-cell – begins overproducing a substance called cytokines. This overproduction turns off a signal that regulates skin cell growth.
That’s why this condition is considered an immune-mediated disease.
Psoriasis of the skin or nails may look like a rash or fungus, but you can’t catch it from another person and you can’t give it to anyone else. You also can’t spread it from one part of your body to another by touch. Experts now know that a susceptibility to getting psoriasis can be inherited. If it runs in your family, your chances of developing psoriasis are higher.
Types of Psoriasis
There are several different types of psoriasis. About 90% of all cases of psoriasis are plaque psoriasis, but other varieties include:
Guttate psoriasis. This form of psoriasis usually affects children, teenagers, and young adults. It often appears after a bacterial infection, such as strep throat. Its typical symptoms are the appearance of red, scaly, raindrop-shaped spots on the skin, usually over the abdomen, arms, legs and scalp. It can often clear up on its own without treatment.
Pustular psoriasis. The typical symptoms of pustular psoriasis are pus-filled blisters on the skin. The blisters usually dry up, turn brown, become scaly and peel off. The lesions usually occur on the hands and feet.
Erythrodermic psoriasis. Symptoms include red and scaly skin over large areas of the body. This condition can evolve from other forms of psoriasis or be triggered by psoriasis treatment. It can also be triggered by withdrawal from drugs such as corticosteroids (often taken for diseases such as asthma).
Inverse psoriasis. In people with this condition, dry and bright red patches appear in folds of skin, for instance under the breasts, in the armpits, or on the genitals. This type of psoriasis can be exacerbated by obesity.
Progression of Psoriasis
Psoriasis doesn’t have any set way of progressing — it develops differently depending on the person. While some people may only have occasional and minor symptoms for their entire lives, others may have to cope with severe symptoms on a regular basis.
In most people, the symptoms come and go. Flare-ups might be brought on by some of the conditions mentioned above, such as dry weather or stress.
Untreated, extremely severe psoriasis can be dangerous. Although it happens very rarely, if lesions cover enough of the body, it’s possible for the immune system to become overwhelmed trying to fight off infections. This increases your risk of developing serious bacterial infections. Be sure to see your doctor immediately if your psoriasis spreads to cover large parts of your body or if you show signs of infection, such as fever.
Your board-certified dermatologist or advanced practitioner will tailor your psoriasis treatment based on your skin’s condition, which can include topical therapies, XTRAC, Narrow Band UVB phototherapy, oral systemic medications and biologics.
Treatments for Psoriasis
Topical Therapies
Oral Medication
Biologics
Psoriasis (suh-rye-ah-sis) is a condition that causes the body to make new skin cells in days rather than weeks. As these cells pile up on the surface of the skin, you may see thick, scaly patches.
Plaque psoriasis is the most common type of psoriasis
Those thick, scaly patches that develop on the skin are called plaques (placks). About 80% to 90% of people living with psoriasis get plaques, so they have plaque (plack) psoriasis1.
Plaque psoriasis on an elbow
When someone has plaque psoriasis, you’ll often see raised patches coated with a silvery-white scale.
Plaques can appear anywhere on the skin, but you’re most likely to find them on the:
Knees
Elbows
Lower back
Scalp
Plaques tend to vary in size. They may appear on the skin as a single patch or join together to cover a large area of skin. No matter the size, plaques tend to be itchy. Without treatment, the itch can become intense. Some people notice that their skin stings, burns, or feels painful and tight.
Psoriasis is often a life-long disease
Most people who get psoriasis have it for life. That’s true no matter what type of psoriasis you have, with one exception. Some children who have guttate (gut-tate) psoriasis see their psoriasis go away. Because psoriasis tends to be a life-long disease, it helps to learn about it and see a board-certified dermatologist. A bit of knowledge and help from a board-certified dermatologist can give you some control over the psoriasis. By gaining control, you can see clearer (or clear) skin. Gaining control can also help you to feel better, improve your overall health, and prevent the psoriasis from worsening.
Gaining control often involves:
Learning (and avoiding) what triggers your psoriasis
Sticking to a good psoriasis skin care routine
Living a healthy lifestyle
Using medication when necessary
Seeing a board-certified dermatologist has another benefit. Psoriasis can increase your risk of developing certain diseases, such as psoriatic arthritis or diabetes. Your dermatologist can watch for early signs of disease. If you do develop another disease, early treatment helps to prevent the disease from worsening. When you see a board-certified dermatologist about psoriasis, your dermatologist may talk about the type(s) of psoriasis you have. It’s possible to have more than one type.
What are the signs and symptoms of psoriasis?
Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.
While patches of thickened, dry skin are common, psoriasis can cause many signs and symptoms. What you see and feel tends to vary with the:
Type of psoriasis you have
Places psoriasis appears on your body
Amount of psoriasis you have
Types of psoriasis
The following pictures show what each type psoriasis can look like on the skin. You’ll also see how psoriasis can affect your nails and joints.
Plaque (plack) psoriasis
Plaque psoriasis
About 80% to 90% of people who have psoriasis develop this type1. When plaque psoriasis appears, you may see:
Patches of thick, raised skin called plaques
Scale (a dry, thin, and silvery-white coating) covers some plaques
Plaques of different sizes
Smaller plaques joining together to form larger plaques
Plaques usually form on the scalp, elbows, knees, or lower back, but they can develop anywhere on the skin. It’s common for plaques to itch, but try not to scratch. Scratching can cause the patches to thicken. To stop the itch, dermatologists recommend treating the psoriasis.
Guttate (gut-tate) psoriasis
Guttate psoriasis
When someone gets this type of psoriasis, you often see tiny bumps appear on the skin quite suddenly. The bumps tend to cover much of the torso, legs, and arms. Sometimes, the bumps also develop on the face, scalp, and ears. No matter where they appear, the bumps tend to be:
Small and scaly
Salmon-colored to pink
Temporary, clearing in a few weeks or months without treatment
When guttate psoriasis clears, it may never return. Why this happens is still a bit of a mystery. Guttate psoriasis tends to develop in children and young adults who’ve had an infection, such as strep throat. It’s possible that when the infection clears so does guttate psoriasis.
It’s also possible to have:
Guttate psoriasis for life
See the guttate psoriasis clear and plaque psoriasis develop later in life
Plaque psoriasis when you develop guttate psoriasis
There’s no way to predict what will happen after the first flare-up of guttate psoriasis clears.
Inverse psoriasis
Inverse psoriasis
This type of psoriasis develops in areas where skin touches skin, such as the armpits, genitals, and crease of the buttocks. Where the inverse psoriasis appears, you’re likely to notice:
Smooth, red patches of skin that look raw
Little, if any, silvery-white coating
Sore or painful skin
Other names for this type of psoriasis are intertriginous psoriasis or flexural psoriasis.
Pustular psoriasis
Pustular psoriasis
This type of psoriasis causes pus-filled bumps that usually appear only on the feet and hands. While the pus-filled bumps may look like an infection, the skin is not infected. The bumps don’t contain bacteria or anything else that could cause an infection. Where pustular psoriasis appears, you tend to notice:
Red, swollen skin that is dotted with pus-filled bumps
Extremely sore or painful skin
Brown dots (and sometimes scale) appear as the pus-filled bumps dry
Pustular psoriasis can make just about any activity that requires your hands or feet, such as typing or walking, unbearably painful.
Pustular psoriasis (generalized)
Pustular psoriasis (generalized)
Serious and life-threatening, this rare type of psoriasis causes pus-filled bumps to develop on much of the skin. Also called von Zumbusch psoriasis, a flare-up causes this sequence of events:
Skin on most of the body suddenly turns dry, red, and tender.
Within hours, pus-filled bumps cover most of the skin.
Often within a day, the pus-filled bumps break open and pools of pus leak onto the skin.
As the pus dries (usually within 24 to 48 hours), the skin dries out and peels (as shown in this picture).
When the dried skin peels off, you see a smooth, glazed surface.
In a few days or weeks, you may see a new crop of pus-filled bumps covering most of the skin, as the cycle repeats itself.
Anyone with pustular psoriasis also feels very sick, and may develop a fever, headache, muscle weakness, and other symptoms. Medical care is often necessary to save the person’s life.
Erythrodermic psoriasis
Erythrodermic psoriasis
Serious and life-threatening, this type of psoriasis requires immediate medical care. When someone develops erythrodermic psoriasis, you may notice:
Skin on most of the body looks burnt
Chills, fever, and the person looks extremely ill
Muscle weakness, a rapid pulse, and severe itch
Most people who develop erythrodermic psoriasis already have another type of psoriasis. Before developing erythrodermic psoriasis, they often notice that their psoriasis is worsening or not improving with treatment. If you notice either of these happening, see a board-certified dermatologist. People who develop erythrodermic psoriasis should seek immediate medical attention. Among other dangers, the person may be unable to keep warm, so hypothermia can set in quickly.
Nail psoriasis
Nail psoriasis
While many people think of psoriasis as a skin disease, you can see signs of it elsewhere on the body. Many people who have psoriasis see signs of the disease on their nails. With any type of psoriasis, you may see changes to your fingernails or toenails. About half of the people who have plaque psoriasis see signs of psoriasis on their fingernails at some point2.
When psoriasis affects the nails, you may notice:
Tiny dents in your nails (called “nail pits”)
White, yellow, or brown discoloration under one or more nails
Crumbling, rough nails
A nail lifting up so that it’s no longer attached
Buildup of skin cells beneath one or more nails, which lifts up the nail
Treatment and proper nail care can help you control nail psoriasis.
Psoriatic arthritis
Psoriatic arthritis
When psoriasis affects the joints, it causes a disease known as psoriatic arthritis. If you have psoriasis, it’s important to pay attention to your joints. Some people who have psoriasis develop a type of arthritis calledpsoriatic arthritis. This is more likely to occur if you have severe psoriasis. Most people notice psoriasis on their skin years before they develop psoriatic arthritis. It’s also possible to get psoriatic arthritis before psoriasis, but this is less common.
When psoriatic arthritis develops, the signs can be subtle. At first, you may notice:
A swollen and tender joint, especially in a finger or toe
Heel pain
Swelling on the back of your leg, just above your heel
Stiffness in the morning that fades during the day
Like psoriasis, psoriatic arthritis cannot be cured. Treatment can prevent psoriatic arthritis from worsening, which is important. Allowed to progress, psoriatic arthritis can become disabling.
You’ve just seen how psoriasis can affect your skin, nails, and joints. Psoriasis can also affect other parts of your body. To find out how, go to: Can psoriasis affect more than my skin?
Psoriasis is common. About 2% of people living in the United States have this condition.1
Most people who get psoriasis have white skin, but the condition develops in people of all races. Findings from studies indicate that psoriasis may be more common in skin of color than previously thought. In one US study, researchers found that 3.6% of whites, nearly 2% of African Americans, and 1.6% of Hispanics had psoriasis.2
PSORIASIS RUNS IN FAMILIES
If a parent, grandparent, brother, or sister has psoriasis, you have a higher risk of getting it.
What causes psoriasis?
Psoriasis runs in families: If a parent, grandparent, brother, or sister has psoriasis, you have a higher risk of getting it.
Psoriasis is not contagious. Unlike chickenpox or a cold, you cannot catch psoriasis from someone.
You also CANNOT get psoriasis by:
Swimming in a pool with someone who has psoriasis
Touching someone who has psoriasis
Having sex with someone who has psoriasis
While we know that psoriasis isn’t contagious, scientists are still trying to determine exactly how psoriasis develops.
Scientists have learned that a person’s immune system and genes play a role in causing psoriasis. Here’s what studies have revealed about each of these.
Immune system: White blood cells, also called T-cells, are part of the body’s immune system. These cells help prevent us from getting sick by attacking things that can harm us, such as bacteria and viruses.
When a person has psoriasis, something goes wrong in the immune system, so T-cells also attack the body’s skin cells. This attack causes the body to make new skin cells more often. The extra skin cells pile up on the surface of the skin, and you see psoriasis.
Once T-cells start to attack skin cells, this usually continues for the rest of a person’s life. There is one exception. Some children who get a type of psoriasis called guttate (gut-tate) psoriasis never have it again.
Genes: We know that psoriasis runs in families. Scientists have found that people who have certain genes are more likely to get psoriasis.
What complicates matters is what else scientists have learned. It’s seems that some people who get psoriasis don’t have genes that increase their risk of getting psoriasis.
It’s also possible to have genes that increase the risk of getting psoriasis and never develop psoriasis. It’s this discovery that led scientists to believe that the person must be exposed to a trigger before psoriasis appears.
What can trigger psoriasis?
Plenty of everyday things can act as a trigger, causing psoriasis to appear for the first time. Common psoriasis triggers include:
Stress
Skin injury, such as a cut or bad sunburn
Infection, such as strep throat
Some medications, including lithium, prednisone, and hydroxychloroquine
Weather, especially cold, dry weather
Tobacco
Alcohol (heavy drinking)
These triggers can also cause psoriasis flare-ups. Different people have different triggers. For example, periods of intense stress may trigger your psoriasis but cold weather may not.
That’s why it’s so important for people who have psoriasis to know what triggers their psoriasis. Avoiding triggers can reduce psoriasis flares.
You’ll find common triggers and what you can do to avoid them at: Are triggers causing your psoriasis flare-ups?
You’ll find many products to treat psoriasis that you can buy without a prescription. Your dermatologist may refer to these products as “over-the-counter” (OTC) treatments. No matter what you call them, these products work best for people who have very mild psoriasis, with one exception. Moisturizers can benefit anyone who has psoriasis.
Some OTC treatments contain an active ingredient (what treats the psoriasis) like coal tar or hydrocortisone. People have used these for years to treat psoriasis. Other active ingredients are so new that we know little about how well they work or whether they’re safe.
Here’s what we know about OTC psoriasis treatment:
Coal tar
This active ingredient is found in many psoriasis treatments—both prescription and OTC products. Coal tar has been used for years to treat psoriasis because it can:
Lessen the itching and flaking
Reduce redness, swelling, and scaling
Slow the rapidly growing skin cells
You’ll find coal tar in OTC shampoos, creams, ointments, and bath solutions for psoriasis.
COAL TAR CAN IRRITATE SKIN
Coal tar may irritate your skin, so it’s best to test the product on a small area before applying it to all of your psoriasis.
Hydrocortisone creams and ointments
You can buy a mild corticosteroid like hydrocortisone without a prescription. For a few small patches of psoriasis, a mild hydrocortisone works well. If you have more than a few small patches, you’ll likely need a prescription corticosteroid to see results.
Whether OTC or prescription, this medicine works quickly to:
Reduce the itch
Decrease inflammation
If you have cracked or bleeding skin, an ointment will likely feel better than a cream. Ointments tend to be more soothing and less irritating than creams.
Moisturizer
This may help anyone who has psoriasis because psoriasis makes the skin dry and scaly. Moisturizer helps to seal water in the skin, which can:
Relieve dryness
Help your skin heal
Dermatologists recommend applying moisturizer once a day, and more often when your skin is really dry. When shopping for a moisturizer, you want to select a:
Heavy cream, ointment, or oil rather than a lotion
Fragrance-free product
Product that you like and will use
Oil can be especially healing, but it’s also messy. To reap the benefits of oil, try applying it before bedtime.
MOISTURIZE BEFORE WASHING
For best results, you want to apply your moisturizer within 3 minutes of bathing and after washing your hands.
Scale softeners
You’ll find OTC products and prescription medicines that contain salicylic acid. This active ingredient helps to:
Remove and soften scale
Reduce swelling
Because it can effectively remove scale, salicylic acid is often found in products for scalp psoriasis. Your dermatologist may also include salicylic acid in your treatment plan if you have thick plaque-type psoriasis anywhere on your body.
Removing the scale helps other medicine that you apply to your skin to work better.
It is important to use products containing salicylic acid as indicated in the instructions. Too much can worsen psoriasis, causing dry, red, itchy skin where you applied it. Other active ingredients that can soften and remove scale are:
Lactic acid
Urea
SCALE SOFTENERS
To get the best results from a scale softener, it helps to take a warm (NOT hot) 15-minute bath before you apply this product.
Anti-itch products
Some people say that the itch is the worst thing about having psoriasis. The best way to get rid of the itch is to treat the psoriasis. Until you start seeing results from treatment, using an anti-itch product can help. Look for a product that contains calamine, camphor, hydrocortisone, or menthol. These ingredients tend to work best on itchy psoriasis.
If you decide to use an anti-itch product, beware that it can irritate and dry your skin. You can prevent this by finding one that feels moisturizing and soothing or by using moisturizer along with your anti-itch product.
Complementary and alternative treatments
You’ll find plenty of these for treating psoriasis. The US Food and Drug Administration (FDA) doesn’t regulate these products. As such, few of these treatments have been studied. Those that have been studied were tested on small numbers of people, so we don’t know how well these treatments work. We also don’t know whether they’re safe.
How a dermatologist can help
With so many products, it can be difficult to know what to use. If you don’t see the results you like with OTC treatment for psoriasis, you may want to see dermatologist. Dermatologists are the skin disease experts. They know how to tailor psoriasis treatment to the type of psoriasis you have. Sometimes, this requires combining treatments. You may also need one treatment plan to gain control over your psoriasis and another to maintain the results.
If your psoriasis seems to flare for no reason, one or more triggers could be to blame. Everyday things like stress, a bug bite, and cold temperatures can trigger psoriasis.
Triggers vary from person to person. By finding your triggers and learning how to manage them, you can gain better control of your psoriasis and have fewer flares.
To find yours, you’ll have to do a bit of detective work. A good place to start is by looking at this chart of the common triggers, which also gives you signs that that it could be a trigger for you.
Common psoriasis triggers that can cause psoriasis flare-ups
Stress
Do you get flare-ups when you're feeling overwhelmed or stressed? Stress is a common trigger.
Reduce risk of flare-ups from stress
Find a way to manage your stress and practice it — even when you’re feeling okay. Common stress busters include yoga, meditation, and support groups.
Before going to sleep, write down 3 things that you’re grateful for. Do this daily.
When you start to feel stressed, take a deep breath, hold it, and exhale slowly.
Check out what board-certified dermatologist Alexa Boer Kimball, MD, MPH, FAAD, tells her patients to help them cope with stress.
Stress is a common trigger
Do you get flare-ups when you're feeling overwhelmed or stressed? Stress is a common trigger of a psoriasis flare-up.
Skin injury
If this triggers your psoriasis, you’ll get a flare-up near (or in the same spot as) the injury or bite. This happens about 10 to 14 days after you injure your skin.
Flare-ups happen after getting a cut, scrape, sunburn, scratch, outbreak of poison ivy, bruise, or bug bite.
Reduce the risk of flare-ups from a skin injury
If you injure your skin, treat it quickly.
If your skin itches, calm the itch.
Avoid scratching, which can trigger a flare.
Try to avoid getting bug bites by using insect repellent and staying indoors when bugs are most active. Bugs are most active at dusk and dawn.
Skin injury
Flare-ups happen after getting a cut, scrape, sunburn, scratch, outbreak of poison ivy, bruise, or bug bite.
Drinking frequently or in excess
If you drink daily or have more than 2 drinks in a day frequently, your treatment for psoriasis may have little or no effect. Even treatment that could be effective for you may not work and you’ll continue to have flare-ups.
Reduce the risk of flare-ups from drinking
Quit drinking.
If you continue to drink, limit how much you drink in a day. Women should stop after 1 drink. Men should limit themselves to 2 drinks per day.
Be sure to tell your dermatologist if you drink alcohol. Drinking can make it risky to take some psoriasis medications like methotrexate.
Drinking frequently or in excess
If you drink daily or have more than 2 drinks in a day frequently, your treatment for psoriasis may have little or no effect.
Smoking
Does your psoriasis flare unexpectedly? If you smoke or spend time with people who smoke, this could be the cause.
Reduce the risk of flare-ups from drinking
Stop smoking. Because this can be difficult, ask your dermatologist or primary care doctor for help.
Before trying a nicotine patch, ask your dermatologist whether using it could trigger your psoriasis.
Avoid being around people who are smoking.
Smoking
Does your psoriasis flare unexpectedly? If you smoke or spend time with people who smoke, this could be the cause.
Dry, cold weather
If your psoriasis worsens when the humidity or temperature drops, such as in the winter or fall, this is likely a trigger for you.
Reduce the risk of flare-ups from dry, cold weather
Treat your psoriasis.
Limit showers and baths to 10 minutes and use warm rather than hot water.
Immediately after bathing, slather on moisturizer, using a fragrance-free ointment or cream rather than a lotion.
Use a gentle, moisturizing cleanser instead of soap.
Apply moisturizer throughout the day when your skin feels dry.
Plug in a humidifier when the air in your home feels dry.
Stay warm and protect your skin from extreme weather when outside by wearing a hat, gloves, waterproof boots, and a winter jacket.
Sit far enough away from a fireplace, radiator, or other heat source so that you cannot feel the heat on your skin.
Remove wet clothes and footwear when you come in from the cold.
If your psoriasis continues to flare, see your dermatologist. Ask if phototherapy may be a treatment option for you in the winter.
Dry, cold weather
If your psoriasis worsens when the humidity or temperature drops, such as in the winter or fall, this is likely a trigger for you.
Sunshine, warm weather
During warm weather, psoriasis can flare if you:
Sunburn
Spend time in air conditioning
Reduce the risk of flare-ups during warm weather
If you spend time in air conditioning, apply moisturizer immediately after showering or getting out of a bath.
If your skin still feels dry from spending time in air conditioning, apply moisturizer throughout the day.
Avoid sunburn by wearing sunscreen. You want to apply sunscreen to skin that clothing doesn’t cover and is free of psoriasis. To get the protection you need, use sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance.
Sunshine, warm weather
During warm weather, psoriasis can flare if you get a sunburn or spend time in the air conditioning.
Infection
Psoriasis can flare 2 to 6 weeks after strep throat, an earache, bronchitis, or another infection. This is especially common in kids.
Reduce the risk of flare-ups due to infection
Treat the infection. This can lessen or clear the psoriasis.
Tell your dermatologist if you have an HIV (human immunodeficiency virus) infection, which can make some psoriasis treatments risky.
Infection
Psoriasis can flare 2 to 6 weeks after strep throat, an earache, bronchitis, or another infection. This is especially common in kids.
Medication
Some medications can cause a flare-up. If a medication is a trigger for you, you’ll flare 2 to 3 weeks after beginning a medication.
Reduce the risk of flare-ups from medication
If you think a medication is causing your psoriasis to flare, DON’T stop taking it. Ask the doctor who prescribed it whether the medicine could be causing your psoriasis to flare. If it could, ask if you could take another medication.
Before taking a medicine for the first time, ask the doctor prescribing it if the medicine could cause psoriasis to flare. Medicines that commonly trigger psoriasis include lithium, drugs taken to prevent malaria, strong corticosteroids like prednisone (if you quit taking it rapidly instead of stepping down), medicine that treats high blood pressure and problems with your heartbeat, some arthritis medications.
Medication
Some medications can cause a flare-up. If a medication is a trigger for you, you’ll flare 2 to 3 weeks after beginning a medication.
Tattoos and piercings
When you get a tattoo or piercing, you injure your skin. Any time you injure your skin, psoriasis can flare.
Reduce the risk of flare-ups from tattoos and piercings
Avoid tattoos and other types of body art if you have psoriasis.
If you want to get any type of body art, talk with your dermatologist first. Your dermatologist may be able to offer some tips that can reduce flare-ups.
Tattoos and piercings
When you get a tattoo or piercing, you injure your skin. Any time you injure your skin, psoriasis can flare.
Shaving
If you cut yourself while shaving, you may notice new psoriasis about 10 to 14 days later where you cut yourself.
Reduce your risk of flare-ups from shaving
Take care to avoid cutting yourself while shaving.
Dermatologists’ tip: To reduce cuts and nicks, try applying moisturizer and then shaving gel before you shave.
Shaving
If you cut yourself while shaving, you may notice new psoriasis about 10 to 14 days later where you cut yourself.
Biologics are newer, stronger medicines. A biologic can target, or quiet, only the part of the immune system that is overactive because of psoriasis. This means that biologics have less risk of causing problems with the liver, kidneys, and other organs than do other strong psoriasis medicines.
Why do dermatologists prescribe a biologic to treat psoriasis?
A biologic is an important treatment option for people with moderate-to-severe psoriasis, psoriatic arthritis, or both. For many people, taking a biologic was life changing because it helped control their symptoms when other treatments failed.
BENEFITS OF BIOLOGICS
Using a biologic to treat psoriasis (or psoriatic arthritis) is life changing for some people.
Biologics work by blocking reactions in your body that cause psoriasis and its symptoms. If you have psoriatic arthritis, a biologic can stop the pain, stiffness, and swelling in your joints. It can prevent the arthritis from worsening and causing more damage to your joints. The US Food and Drug Administration (FDA) has approved the following biologics to treat adults with psoriasis or psoriatic arthritis. In many cases, these biologics have been approved to treat both diseases.
DrugFDA approved to treat psoriasisFDA approved to treat psoriatic arthritisCimzia® (certolizumab pegol) XXCosentyx® (secukinumab) XXEnbrel® (etanercept) XXHumira® (adalimumab) XXIlumya™ (tildrakizumab) XRemicade® (infliximab)X XSiliq1™ (brodalumab)XSimponi® (golimumab)XSkyrizi™ (risankizumab)XStelara® (ustekinumab)XXTaltz® (ixekizumab)XXTremfya™ (guselkumab)XX
1Approved to treat adults when other psoriasis treatments fail to work or stop working.
Sometimes, a biologic is prescribed to treat a child who has psoriasis. This can be very effective for a child who has moderate or severe psoriasis. The FDA has approved the following biologics for children who have moderate or severe psoriasis:
Etanercept: Approved for people 4 years of age and older
Ustekinumab: Approved for people 12 years of age and older
Secukinumab: Approved for people 6 years of age and older
Safety and effectiveness
Safety: Overall, the biologics have a good safety record.
A patient’s risk of developing a serious infection remains the biggest concern. For this reason, dermatologists carefully screen each patient before prescribing a biologic.
You’ll need to have some medical tests before your dermatologist can tell whether a biologic can be prescribed to treat your psoriasis. Blood tests and tuberculosis (TB) testing are typically required. Some patients need additional medical tests.
Effectiveness: Studies show that the biologics approved to treat psoriasis and psoriatic arthritis can be very effective. For many people with moderate-to-severe psoriasis or psoriatic arthritis, a biologic may offer the most effective treatment available.
If you take a biologic continuously, it tends to be more effective. Stopping and starting can cause a biologic to lose its effectiveness and may cause certain side effects.
It’s also possible for a biologic to stop working after a person takes it for some time. If this happens, another biologic may work.
While a biologic can lose its effectiveness over time, studies show that for many people a biologic remains an effective and safe treatment for years.
NOT EVERY BIOLOGIC WORKS FOR EVERYONE
It is important to know that no one biologic works for everyone. One biologic could fail to help you, but another could work very well.
How to use
This varies with the type of biologic. You’ll either get a shot or an infusion (through an IV). Some shots you can give yourself at home, after learning how to give yourself the shot. Infliximab requires an infusion (through an IV), so you’ll need to go to your doctor’s office or an infusion center for treatment.
How often you take the biologic varies from twice a week to once every three months. Your dermatologist will tell you how often you should take it.
TELL YOUR DERMATOLOGIST ABOUT CURRENT MEDICATIONS
Be sure your dermatologist knows all of the medicines you take, including ones that you can buy without a prescription.
Possible side effects
Each biologic has its own list of possible side effects. Most are mild and do not cause patients to stop taking the biologic. Some of the more common side effects include:
Upper respiratory tract infection
Skin reaction where the biologic is injected
Flu-like symptoms
Urinary tract infection
Headache
Because the biologics work by calming down part of your immune system, anyone taking a biologic has an increased risk of developing a serious infection. The risk is higher in patients who have diabetes, smoke or chew tobacco, or have a history of infections. Older patients also have a higher risk.
BIOLOGICS AND PREGNANCY
Pregnant? Breastfeeding? Planning to become pregnant? Be sure your dermatologist knows.
Dermatologists watch their patients for signs of problems. You will need to get some tests while taking a biologic; however, you will need fewer tests than when taking another strong psoriasis medicine like cyclosporine or methotrexate.
What to discuss with your dermatologist
You should tell your dermatologist if you:
Have any side effects while taking the biologic
Stop taking the biologic
Have questions, including how to take the biologic
Become pregnant
BIOLOGICS AND VACCINES
Before you get a flu shot or vaccinated against any disease, call your dermatologist. You should NOT get some vaccines while taking a biologic.