Complete Guide to Psoriasis

Psoriasis is a chronic condition, which means you’ll always have it, but your symptoms may come and go. Tell your doctor about all your symptoms and how often you have flare-ups. What you say today will help shape your treatment plan.

Ask Your Doctor . . .

Newly diagnosed:

What type of psoriasis do I have?

What are my treatment options?

Can you recommend over-the-counter products to help my skin?

Do I need to change my bathing and skincare routines?

How quickly will my symptoms get better?

Living with psoriasis:

I’m having side effects. What do you recommend?

If my first treatment doesn’t work, what else can I try?

Are there any lifestyle changes I can make to help prevent flare-ups?

Am I at risk for complications or other health problems because of my psoriasis?

TIP: Always share with your doctor any updates since your last visit—from new medicines to major life changes. These can impact your health. And be honest about how you’re feeling and whether you’re following your treatment plan. Your doctor can’t help you if he doesn’t know what’s really going on.

Psoriasis is a skin condition that makes your skin inflamed, dry and scaly. It’s caused by skin cells that grow too quickly and build up on the surface of your skin.

Normally, your skin cells start growing deep in your skin and work their way to the surface slowly. Then, new skin cells replace old skin cells that have died and flaked off. But if you have psoriasis, your immune system tells your body to grow new skin cells too fast and old skin cells don’t die quickly enough. This causes thick, reddish patches of skin that can itch and feel sore.

Psoriasis is a chronic disease of your immune system, which means you’ll always have it, but your symptoms may come and go. With treatment and lifestyle changes, psoriasis doesn’t have to interrupt your life or keep you from doing the things you enjoy.

Types of Psoriasis

There are 5 main types of psoriasis:

• Plaque psoriasis: This is the most common form of psoriasis and causes raised patches of skin covered with white scales.
• Guttate psoriasis: This looks like small, red or dark scaly spots, and may be caused by the same bacteria that leads to strep throat.
• Pustular psoriasis: This form of psoriasis causes pus-filled bumps that can be painful.
• Inverse psoriasis: This form causes redness and scaling in skin folds (under arms, around the groin area, under breasts, etc.)
• Erythrodermic psoriasis: This form is the least common and causes redness and skin shedding over the entire body.

TIP: Psoriasis is not contagious, meaning you can’t give it to another person. And it won’t spread by touching one part of your body to another (like a poison ivy rash spreads).

Psoriasis can develop at any age, but it usually starts between ages 15 and 35. It can affect your elbows, knees, scalp, lower back, face, hands, nails and soles of your feet.

Symptoms vary from person to person, but you’ll probably have these common symptoms:

• raised patches of thick skin that is red (on light skin) or gray or violet (on dark skin), covered with silvery scales.
• dry, cracked skin (that may bleed)
• skin that itches, burns or is sore
• thick or ridged nails

In severe cases, you might also have blisters full of pus on top of the red patches of skin.

Flare-ups of psoriasis symptoms usually happen in cycles. You may have symptoms for a while and then they go away, until they flare up again. Psoriasis flare-ups are usually triggered by:

• infections
• stress
• changes in the weather
• certain medicines
• alcohol
• smoking

Psoriasis and Joint Pain

If you are diagnosed with psoriasis, you are also at risk for a painful joint condition called psoriatic arthritis. In fact, 30% of people who are diagnosed with psoriasis, develop psoriatic arthritis. Like other kinds of arthritis, it causes joint stiffness, pain and inflammation. If you ignore these symptoms, your joints can become damaged over time. 

Other symptoms of psoriatic arthritis include:

• stiffness when you wake up in the morning
• changes to your fingernails and toenails, including pits in your nails or separating from the skin underneath
• redness and pain in your eyes
• feeling more tired than usual

The main goals of treatment are to:

• stop your immune system’s reaction that causes new skin growth
• reduce the raised patches of dry skin.

Common Treatments

Topical treatments—Creams and ointments that are applied directly to your skin can help treat mild to moderate psoriasis. They are available over-the-counter or by prescription depending on their strength and active ingredients.

Phototherapy treatments—These use special lights to treat your skin and may be combined with a light-sensitizing medicine to make them work better. Some kinds of phototherapy can increase your risk for skin cancer. Your doctor will explain all the risks and benefits to help you choose a treatment that is right for you.

Systemic medicines—These work by interfering with how your body makes new skin cells. (Systemic means the medicine works through your whole body rather than just in one place like local and topical medicines do.) They are taken as a pill or given by injection or IV infusion.

Biologic treatments—These medicines are given by injection or IV infusion and help block immune cells that are overreacting and causing psoriasis flare-ups.

PDE4 Inhibitors—This medicine is taken as a pill. It works by blocking a specific enzyme (a type of protein in your cells) to reduce inflammation.

There are other medicines your doctor might recommend to treat specific types of psoriasis. Your doctor will consider how severe your psoriasis is and what symptoms you have to choose a treatment that will work best for you.

Always follow your treatment plan as prescribed. Don’t stop using your medicine without talking to your doctor first, even if your symptoms go away or you have side effects. Your doctor will work with you to find a medicine, or combination of medicines, that works for you.

For Treatment Success!

If you know how your medicine works, you’ll know why it’s important not to miss a dose. 

Ask your doctor or pharmacist these questions:

What is the name of my medicine?

How much will I take or use? For how long?

If it’s a topical, should I apply it before sunscreen or other cosmetics?

How does it work to improve symptoms? When will it start working?

What do I do if I miss a dose or application?

What are possible side effects? And what do I do if they occur?

Are there any foods, drinks or activities to avoid while taking this medicine?

And follow these tips to help you remember to take your medicine:

• Set an alarm on your watch or cellphone.
• Use an app, pillbox or medicine tracker.

To improve symptoms, you can take small steps to replace old habits with new and healthy ones. Find out what you need to do, why you need to do it, and a few simple ideas on how to start to make the change.

Limit alcohol

WHY: Alcohol can trigger flare-ups and may interfere with some psoriasis medicines.

HOW TO START: Ask your doctor how much, if any, alcohol is safe for you. Most doctors recommend people with psoriasis drink in moderation, which means up to one drink a day for women and two for men. If you take methotrexate to treat your psoriasis, don’t drink any alcohol to prevent serious side effects.

Stop smoking and vaping

WHY: Tobacco smoke and e-cigarette vapor may trigger psoriasis flare-ups.

HOW TO START: Talk to your doctor about stop-smoking products like gum, a patch or medicine. And visit Smokefree.gov to learn about apps, texting programs and other digital tools to help you quit.

Reduce stress

WHY: Stress is a common psoriasis trigger.

HOW TO START: Just having psoriasis can be stressful. Work with your doctor to develop a plan for healthy stress relief. Your plan might include things like adding moderate exercise to your day, joining a psoriasis support group or talking to a psychologist or counselor.

Have regular medical screenings

WHY: Having psoriasis increases your risk for other serious medical conditions. Doctors think this might happen because of inflammation in your body, but they aren’t sure whether psoriasis causes other conditions or is caused by them.

HOW TO START: Ask your doctor how often you should be screened for heart disease, diabetes and stroke.

Spend time in the sun

WHY: Small amounts of sunlight can help your psoriasis.

HOW TO START: Ask you doctor how much natural sunlight is safe for your skin. Keep careful track of any time you spend outdoors and protect your other skin with sunscreen.

Shower every day

WHY: Showering helps to remove the scales from your skin.

HOW TO START: Use lukewarm water and only shower for about 10 minutes. Don't rub yourself dry. Pat your skin gently with a soft towel.