Definition
What is Psoriasis?
Psoriasis is a chronic, inflammatory disease in which faulty signals from the immune system make skin cells multiply much faster than normal. In healthy skin, cells renew about once a month; in psoriasis, this drops to a few days, and cells pile up on the surface before they have a chance to shed. The result is sharply bordered, red, thick patches covered with silvery-white scales. The most commonly affected areas are the elbows, knees, scalp, lower back and behind the ears; the nails, palms, soles and genital area can also be involved.
Psoriasis is not contagious and has nothing to do with dirt or hygiene. In people with a genetic predisposition, it appears or flares up with triggers like stress, infection, skin injury, smoking, alcohol, excess weight and certain medications. How common it is varies by region around the world; in Western and Central Europe, about 2% of the population is affected. There's also a finding that stands out for men: in a Swedish study of 5,438 patients, psoriasis severity scores were significantly higher in men than in women, and this difference held across all age groups.
Psoriasis shouldn't be seen as just a skin disease. About one in five people with psoriasis develops joint inflammation (psoriatic arthritis); morning stiffness, sausage-like swelling of the fingers and heel pain can be signs of this. Meta-analyses show that severe psoriasis is associated with an increased risk of heart attack, stroke and cardiovascular death. Psoriasis also often occurs together with smoking, excess weight, diabetes and depression. That's why managing psoriasis isn't just about creams: regular follow-up with your dermatologist, keeping an eye on joint and heart health, and lifestyle changes should all be addressed together. The good news is that today there are very effective treatments for psoriasis, and many patients' skin can be largely cleared.
Check yourself
How do you spot it?
- ✓Sharply bordered, red, thick patches on the elbows, knees, lower back and scalp
- ✓Silvery-white scales on the patches that flake off easily
- ✓Thick scaling on the scalp that's mistaken for dandruff and extends past the hairline
- ✓Itching, burning or a feeling of tightness
- ✓Small pits, yellowing, thickening and lifting of the nails from the nail bed
- ✓Shiny red patches without scales in skin folds like the groin and armpits
- ✓New patches appearing at the site of a scratch, tattoo or wound
- ✓Thick, cracking patches on the palms and soles
- ✓Joint pain, morning stiffness and sausage-like swelling of the fingers
Why it happens
Main causes
01
Genetic predisposition
Psoriasis runs in families. The risk is higher if your mother or father has psoriasis; however, not everyone with a genetic predisposition develops the disease, and triggers play a decisive role.
02
The immune system
Psoriasis is a disease in which the immune system launches a mistaken, excessive inflammatory response against the body's own skin. This response speeds up the multiplication of skin cells.
03
Smoking
A meta-analysis showed that the likelihood of psoriasis is significantly higher in smokers and that smoking is an independent risk factor for developing psoriasis. The risk rises the longer and the more you smoke.
04
Alcohol
Alcohol consumption has been linked to psoriasis appearing and getting worse; it can also increase the risk of side effects from some psoriasis medications.
05
Excess weight
Fat tissue produces inflammatory signals and can feed psoriasis. In a randomized study of overweight psoriasis patients, weight loss achieved through a low-calorie diet led to a significant improvement in quality of life and a trend toward reduced psoriasis severity.
06
Stress, infection and skin injury
Intense stress, throat infections, skin cuts, tattoos and friction can trigger psoriasis flares. A patch appearing at the same spot after a skin injury is a typical feature of psoriasis.
In daily life
Triggers that cause flare-ups
Medical approach
Treatment options
01
Topical treatments
For mild to moderate psoriasis, your dermatologist may recommend corticosteroid creams, vitamin D-derived creams or a combination of both. For the scalp, there are solutions, foams and shampoos. Your doctor decides which area to use them on, at what strength and for how long.
02
Phototherapy
For widespread psoriasis, controlled narrowband ultraviolet light therapy can be given in dermatology clinics. It requires several sessions a week and leads to noticeable improvement in many patients.
03
Systemic treatments
For moderate to severe psoriasis, when the nails and joints are involved, or when quality of life is seriously affected, your dermatologist may consider oral immune-modulating medications. These medications require regular blood tests and medical follow-up.
04
Biologic treatments
Biologic drugs that target specific inflammatory signals in psoriasis have fundamentally changed treatment for severe psoriasis. Current reviews show that with these treatments, the skin of a large share of patients can be largely cleared. Eligibility is determined through your doctor's screening and evaluation.
05
Monitoring joint and heart health
If you have joint pain, morning stiffness or finger swelling, your dermatologist may ask for a rheumatology evaluation. Men with psoriasis should also have their blood pressure, blood sugar, cholesterol and weight checked regularly.
06
Lifestyle is part of treatment
Quitting smoking, cutting back on alcohol, losing excess weight and managing stress can support the effect of medical treatment. These steps matter not only for your skin but also for the cardiovascular risks linked to psoriasis.
Did you know? · Psoriasis
19.7% · In a meta-analysis combining observational and clinical studies, psoriatic arthritis (joint inflammation linked to psoriasis) was found in 19.7% of people with psoriasis.
Step by step
Care routine for Psoriasis
5 steps
- 01
A lukewarm, short shower
Keep your shower short and the water lukewarm; hot water increases dryness and itching.
- 02
Soap-free cleanser
Use a low-pH, fragrance-free body cleanser; don't scrub the patches or force the scales off.
- 03
Moisturize
Apply a fragrance-free, rich cream with prebiotic ingredients to slightly damp skin; give the patches extra attention.
- 04
Your doctor's treatment
If your dermatologist recommended a cream for the morning, apply it only to the patches, in the recommended amount.
- 05
Gentle shaving
If you have patches on your face and neck, use a sharp razor and avoid nicks and irritation; remember that new patches can appear where you cut yourself.
Caution
What to avoid, and when to see a doctor?
Avoid these
- ✕Scraping patches with an exfoliating mitt or picking them off with your nails
- ✕Very hot, long showers
- ✕Using prescription steroid creams for long periods without asking your doctor
- ✕Starting and stopping oral steroids on your own
- ✕Remedies and mixtures that promise a 'guaranteed cure'
- ✕Smoking and heavy drinking
- ✕Seeing psoriasis as just a skin problem and ignoring joint pain
- ✕Stopping treatment once the patches fade without asking your doctor
See a dermatologist
- →Whenever scaly patches appear for the first time (for a diagnosis)
- →If patches are spreading quickly or redness covers your whole body
- →If redness comes with fever, chills and pus-filled bumps (emergency)
- →If you have joint pain, morning stiffness or sausage-like swelling of your fingers
- →If your nails have started pitting, thickening and lifting
- →If your current treatment isn't working or is causing side effects
- →If psoriasis is negatively affecting your work, relationships or mood
Common misconceptions
Myth or fact?
✕Common belief
Psoriasis is contagious and spreads through touch.
✓Fact
Psoriasis is not contagious. It's a disease driven by the immune system; it doesn't spread through touch, sharing towels, going in a pool or sharing a bed.
✕Common belief
Psoriasis is just a skin problem.
✓Fact
Psoriasis is a systemic inflammatory disease that can affect the joints and is linked to cardiovascular disease, diabetes and depression. That's why its follow-up shouldn't be limited to creams.
✕Common belief
There's no treatment for psoriasis; you just have to live with it.
✓Fact
Although psoriasis is a chronic disease, today there are very effective treatments. With the right treatment, many patients' skin can be largely cleared and their quality of life can improve significantly.
Popular searches
Most asked about Psoriasis
Your questions
Frequently asked questions
01Is psoriasis contagious?+
No. Psoriasis is not an infection but a chronic disease driven by the immune system. It doesn't pass to others through touch, sharing towels or items, or at the pool or gym.
02Does psoriasis go away completely?+
Psoriasis is a chronic disease that can come in flares, so it wouldn't be accurate to say it disappears completely. But with current treatments, patches can largely clear up in many patients, and they can have long calm periods. Continuing treatment with your doctor and managing your triggers makes these periods last longer.
03Do smoking and alcohol really affect psoriasis?+
Yes. A meta-analysis showed that the likelihood of psoriasis is significantly higher in smokers, and alcohol has also been linked to psoriasis getting worse. Both also further raise the cardiovascular risk that is already increased with psoriasis. Quitting smoking and cutting back on alcohol are an important part of managing psoriasis.
04Could thick dandruff on my scalp be psoriasis?+
It could. Scalp psoriasis shows up as thick, silvery-scaled patches with sharp borders, and it often extends beyond the hairline to the forehead, the nape of the neck and behind the ears. Ordinary dandruff, on the other hand, has finer, oily, yellowish flakes. It's important to have a dermatologist tell them apart, because the treatments are different.
05My joints hurt. Could it be related to psoriasis?+
It could. About one in five people with psoriasis develops psoriatic arthritis. Long-lasting morning stiffness, sausage-like swelling of a finger or toe, and heel and lower back pain are warning signs. Early diagnosis is important to limit joint damage; be sure to tell your dermatologist about these symptoms.
06Do working out and losing weight help psoriasis?+
In overweight psoriasis patients, weight loss has been shown to significantly improve quality of life and lead to a trend toward reduced psoriasis severity. Regular exercise reduces stress and protects cardiovascular health. Not leaving sweat on your skin after working out and moisturizing areas that rub helps limit irritation of the patches.
Scientific basis
Sources
- 01Prevalence of psoriatic arthritis in patients with psoriasis: A systematic review and meta-analysis of observational and clinical studies.
Alinaghi F, Calov M, Kristensen LE, Gladman DD, Coates LC, et al. · J Am Acad Dermatol · 2019 · doi:10.1016/j.jaad.2018.06.027
In the meta-analysis, the prevalence of psoriatic arthritis in psoriasis patients was 19.7%; among European patients, it was 22.7%.
- 02Psoriasis.
Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN · Lancet · 2021 · doi:10.1016/S0140-6736(20)32549-6
A comprehensive review summarizing the immune-based mechanisms of psoriasis, its associated conditions and current treatment options, including biologic drugs.
- 03Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review.
Armstrong AW, Read C · JAMA · 2020 · doi:10.1001/jama.2020.4006
A review covering the clinical types of psoriasis, topical, light, systemic and biologic treatments, and monitoring of associated conditions.
- 04National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study.
Parisi R, Iskandar IYK, Kontopantelis E, Augustin M, Griffiths CEM, et al. · BMJ · 2020 · doi:10.1136/bmj.m1590
The prevalence of psoriasis was estimated to range from 0.14% in East Asia to 1.99% in Australasia, at 1.92% in Western Europe and 1.83% in Central Europe.
- 05Severity of Psoriasis Differs Between Men and Women: A Study of the Clinical Outcome Measure Psoriasis Area and Severity Index (PASI) in 5438 Swedish Register Patients.
Hägg D, Sundström A, Eriksson M, Schmitt-Egenolf M · Am J Clin Dermatol · 2017 · doi:10.1007/s40257-017-0274-0
In 5,438 patients, men's median psoriasis severity score (7.3) was significantly higher than women's (5.4), and the difference persisted across all age groups.
- 06Psoriasis and smoking: a systematic review and meta-analysis.
Armstrong AW, Harskamp CT, Dhillon JS, Armstrong EJ · Br J Dermatol · 2014 · doi:10.1111/bjd.12670
The likelihood of psoriasis was shown to be significantly higher in smokers, and smoking was shown to be an independent risk factor for developing psoriasis.
- 07Alcohol consumption and psoriasis: a systematic literature review.
Brenaut E, Horreau C, Pouplard C, Barnetche T, Paul C, et al. · J Eur Acad Dermatol Venereol · 2013 · doi:10.1111/jdv.12164
A systematic literature review assessed that there may be a link between alcohol consumption and psoriasis, and that alcohol may negatively affect psoriasis severity.
- 08Effect of weight loss on the severity of psoriasis: a randomized clinical study.
Jensen P, Zachariae C, Christensen R, Geiker NR, Schaadt BK, et al. · JAMA Dermatol · 2013 · doi:10.1001/jamadermatol.2013.722
In 60 overweight psoriasis patients, weight loss achieved through a low-calorie diet significantly improved quality of life and showed a trend toward reduced psoriasis severity.
- 09Psoriasis and major adverse cardiovascular events: a systematic review and meta-analysis of observational studies.
Armstrong EJ, Harskamp CT, Armstrong AW · J Am Heart Assoc · 2013 · doi:10.1161/JAHA.113.000062
The meta-analysis showed that severe psoriasis in particular is associated with an increased risk of heart attack, stroke and cardiovascular death.
- 10Community differentiation of the cutaneous microbiota in psoriasis.
Alekseyenko AV, Perez-Perez GI, De Souza A, Strober B, Gao Z, et al. · Microbiome · 2013 · doi:10.1186/2049-2618-1-31
In 51 patients and matched controls, bacterial diversity was shown to be lower in psoriasis patches and in patients' non-affected skin, with a markedly different microbiome structure.
