Psoriasis – Diagnosis and Treatment
Diagnosis
Doctors usually begin by examining the skin, scalp, and nails for classic signs of psoriasis, such as red patches covered with silvery-white scales, thickened or ridged nails, and nail pitting.
They will also ask about symptoms, including itching, pain, or joint stiffness, and gather a family history of skin or autoimmune conditions, since genetics can play a role.
In most cases, a physical exam and symptom history are enough to diagnose psoriasis. However, if the diagnosis is unclear or another skin condition is suspected, doctors may perform a skin biopsy.
A small skin sample is examined under a microscope to confirm psoriasis and identify its typeâplaque, guttate, inverse, pustular, or erythrodermicâwhile excluding other conditions like eczema, fungal infections, or skin cancer.
In some situations, especially if joint pain is reported, doctors may order blood tests or imaging studies to check for psoriatic arthritis, an inflammatory joint disease associated with psoriasis.
Treatment
Medicines Used on the Skin
Most people with psoriasis start with creams, ointments, or lotions to ease redness and scales.
These are usually the go-to for mild cases, either alone or with other treatments. Corticosteroids are the top choice for many. They quickly calm swelling and itching.
Youâll find them in oils, creams, gels, foams, and even shampoos. Doctors suggest milder types for the face and skin folds, while stronger ones work better on thick spots like elbows, knees, or the scalp.
They usually recommend using these only during flare-ups, since overuse can thin the skin or make it less responsive.
| Treatment Type | Main Use | Common Forms | Precautions |
|---|---|---|---|
| Corticosteroids | Reduces swelling and itching | Cream, ointment, gel, etc. | Avoid long-term use of strong types |
| Vitamin D analogues | Slows skin cell growth | Cream, ointment | Costlier; may irritate less on sensitive skin |
| Retinoids | Reduces growth, clears scales | Gel, cream | UV sensitivity; not for pregnancy |
| Calcineurin inhibitors | Calms rash and scaling | Ointment | Not for long-term use or in pregnancy |
| Salicylic acid | Softens, loosens scalp scales | Shampoo, lotion | May be combined with other products |
| Coal tar | Itch and scale relief | Shampoo, cream, oil | Messy, stains, strong odor |
| Anthralin | Slows cell growth | Cream | Stains, not for face/genitals |
Vitamin D-based creams slow down the rapid skin cell growth that comes with psoriasis. You can use them alone or with corticosteroids, and they often cause less irritation in sensitive areas.
However, they can be pricier than regular steroid creams. Retinoid gels or creams also target skin cell growth. These usually work best once or twice daily, but they can make your skin more sensitive to sunlight.
Pregnant, nursing, or planning a pregnancy? Retinoids arenât for you.
Calcineurin inhibitors help reduce redness and scaling on sensitive areas, especially around the eyes or fragile skin where steroids arenât safe.
Thereâs a possible long-term risk of skin cancer and lymphoma, so doctors donât recommend them for long-term use.
Salicylic acid shampoos or solutions soften and loosen scalp scales, making it easier for other products to work. Coal tar products help with itching, scaling, and swelling.
They come as shampoos, creams, or oils. These can be messy, stain, and have a strong smell, but you can get them over-the-counter or by prescription.
If youâre pregnant or breastfeeding, itâs best to avoid them. Anthralin is a tar-based cream for tough spots, but not for sensitive areas like your face.
It slows skin cell growth and smooths the skinâs surface. It stains almost everything it touches and is usually applied for short periods before washing off.
Controlled Light Exposure
Phototherapy, or light-based treatments, help many people with moderate to severe psoriasis.
These treatments use natural or artificial light to slow down skin cell growth and clear up patches. You can use them alone or combine them with other medicines.
Brief sun exposure each day helps some individuals, but you have to be careful to avoid burns or other problems. A health professional can guide you on safe sunlight habits.
Broadband UVB treatments use artificial light for stubborn patches or big areas. Doctors often try these after creams havenât worked well.
Short-term issues like irritation or dryness sometimes pop up. Narrowband UVB treatments can work better than broadband therapy.
Youâll usually need several sessions a week at first, then fewer to keep your skin clear. These can cause stronger side effects than broadband UVB, though. PUVA therapy combines a medicine called psoralen with UVA light.
It reaches deeper skin layers and works for tougher cases. PUVA can cause nausea, headaches, itching, dry skin, and increases the long-term risk of skin cancer and early aging.
Excimer laser therapy pinpoints a strong UVB beam right on psoriasis spots. This often brings faster improvement with fewer visits, but sometimes causes redness or blisters.
Medicines Taken by Mouth or by Shot
Doctors use systemic treatmentsâtaken by mouth or injectionâfor people with moderate to severe symptoms or if other options havenât worked.
These medicines can have strong side effects, so doctors usually keep them short-term. Steroid injections quickly improve small, stubborn patches.
Doctors use them rarely and only for problem areas. Oral retinoids slow down how fast skin cells multiply.
They can cause dry skin and muscle aches, and arenât safe for pregnant or breastfeeding people. Biologics are special drugs given by injection that change how the immune system reacts.
They block the body processes that trigger psoriasis symptoms. Biologics can also lower your ability to fight infections, so doctors keep a close eye on things.
Immunosuppressant is taken weekly as a pill. It reduces scaling and swelling by slowing cell growth and suppressing inflammation.
Side effects may include stomach upset, fatigue, or liver issues, so doctors monitor with regular blood tests. Women should discontinue use at least three months before trying to conceive.
Calcineurin inhibitor also suppresses immune system activity to reduce flare-ups. It works quickly but may increase blood pressure and harm the kidneys with long-term use. Doctors usually recommend short-term treatment with this medication.
Phosphodiesterase-4 inhibitor is a newer oral medication that blocks inflammatory signals to improve symptoms, though it may cause diarrhea or nausea in some people.
Systemic Treatment Considerations:
- Immunosuppressant: Requires liver function monitoring; not recommended for women who are pregnant or planning pregnancy.
- Calcineurin Inhibitor: Monitor for kidney problems and high blood pressure.
- Biologic Therapies: May increase risk of infections; tuberculosis screening is recommended before starting.
- Oral Retinoids: Not safe for women who are or may become pregnant.
- Phosphodiesterase-4 Inhibitor: May cause stomach upset, such as nausea or diarrhea.
Things to Think About When Choosing Care
Choosing a treatment plan depends on a lot of things. Doctors look at the type and severity of psoriasis, where patches are, whether someone is pregnant or planning to be, age, and how well previous treatments have worked.
For mild cases, doctors usually start with topical products. If those donât do enough, or if large areas are affected, they might suggest light therapy or systemic medicines.
Other things to keep in mind:
- Safety: Not all treatments are safe for long-term use, kids, or during pregnancy.
- Side Effects: Every therapy has risks, like thinning skin from steroids or immune suppression from biologics.
- Cost: Newer meds, especially biologics, can be pricey.
- Insurance: Not every drug is covered. Always check with your health insurer.
- Convenience: Some therapies need frequent clinic visits, while others you can use at home.
A doctor or dermatologist can help figure out a plan that fits your needs and health.
Other Non-Traditional Approaches
Some individuals try different or complementary ways to manage psoriasis.
- Aloe vera cream might help ease some redness.
- Fish oil supplements could reduce swelling, though results are hit-or-miss.
- Oatmeal baths may soothe itching and help calm the skin.
- Mind-body practices like stress reduction, meditation, and yoga sometimes reduce symptom triggers for people.
- Acupuncture or herbal products get tried too, but thereâs not much proof they work for most.
Before starting any alternative approach, always check with a healthcare provider to make sure itâs safe and wonât interfere with other treatments.
Everyday Tips and Home Strategies
You can manage psoriasis at home to keep symptoms in check and make life a bit easier.
A few self-care habits might help with itching, dry patches, or flare-upsâespecially on tricky spots like the scalp, elbows, knees, genitals, buttocks, and other extensor areas.
| Strategy | Benefit | Best For |
|---|---|---|
| Warm baths with mild soap | Reduces irritation, soothes skin | General use, especially scalp |
| Thick moisturizers/emollients | Long-lasting moisture | Elbows, knees, buttocks, genitals |
| Medicated scalp shampoo | Controls scaling, calms itch | Scalp |
| Sunlight (brief, protected) | May improve patches | Localized areas |
| Avoid scratching | Lowers risk of skin injury | All skin, especially delicate areas |
Gentle Bathing Habits
Try using lukewarm water for your daily bath or shower. Mild soaps that have added oils or fats usually work best, since harsh cleansers just dry things out more.
You might want to add bath oil, Epsom salts, or even oatmeal to your bath and soak for at least 15 minutes. It can really soothe irritated skin. Skip the scrubbing, thoughâit tends to make symptoms worse.
Moisturize Regularly
Slather on moisturizer or emollient right after bathing to lock in moisture. Heavy ointments or skin oils stick around longer and protect really dry spots.
Using these regularly on knees, elbows, scalp, and buttocks can soften up scaly, rough patches. If the air in your house feels dry, using a humidifier might help keep your skin from drying out.
Overnight Skin Care
At bedtime, put a thick moisturizer or ointment on the rough spots. Some individuals wrap the area in plastic wrap to help it soak in better.
In the morning, just take off the wrap and rinse away any loose scales.
Sunlight Exposure
Spending a short time in natural sunlight sometimes eases psoriasis. Itâs best to talk to your healthcare provider about how to do this safely.
Too much sun or getting sunburned can make things worse and increase risks. Always protect healthy skin with sunscreen (at least SPF 30), clothing, or a hat.
Itch Relief
If youâre itching, try a nonprescription anti-itch cream with hydrocortisone or salicylic acid. Keep your fingernails short so you donât break the skin if you scratch.
Soft, non-irritating clothes can also help, especially in sensitive spots like the genitals and buttocks.
Scalp Psoriasis Care: Medicated shampoos with coal tar can help with scalp scales and itching. Massage the shampoo in gently and avoid scratching or picking at the patches.
Preventing Triggers: Triggers can be different for everyone, but common ones include infections, skin injuries, smoking, and too much sun. If you keep track of your personal triggers, you can step in early or avoid them.
Staying Cool and Comfortable: Heat often makes itching or redness worse. Choose loose, light clothing and stay in cool places on hot days. Cold packs can calm itching, and storing your moisturizer in the fridge might give you a little extra cooling relief.
Healthy Habits: Healthy routines support your skin and overall well-being. Try to stay active, eat a balanced diet (the Mediterranean diet is a good place to start), limit alcohol, and keep a healthy weight. Some people notice fewer flare-ups if they avoid certain foods that seem to bother them.
Managing Day-to-Day and Getting Help
Psoriasis affects more than just your skin. It can make daily life tough and sometimes brings stress, low mood, or embarrassment.
If the patches are easy to see or the discomfort is bad, those feelings can get stronger. Some people find it harder to enjoy life because of itching, pain, trouble sleeping, or worrying about what others think.
Simple ways to stay in control:
Learn About the Condition: Figure out what triggers your psoriasisâmaybe stress, sunburn, strep throat, certain foods, or alcoholâso you can cut down on flare-ups.
Follow Treatment Plans: Stick to what your healthcare provider suggests. This might mean creams, ointments, or making lifestyle changes like keeping a healthy weight or avoiding things that irritate your skin.
Stress Management: Since stress can trigger flare-ups, try yoga, talking with friends, or relaxing hobbies to keep it in check.
Social Support: Connect with others who have psoriasis or talk to friends and family you trust. It can really help with emotional support and make you feel less alone.
Cover-Up Options: On days when youâre not feeling confident, loose clothing or gentle concealers (not on open skin) might help you feel more comfortable in public.
| Coping Tool | How It Can Help |
|---|---|
| Moisturizing | Eases irritation and helps plaques heal |
| Healthy Diet | Can reduce obesity, which may lessen symptoms |
| Support Groups | Reduces loneliness and provides shared advice |
| Avoiding Alcohol | May prevent some flare-ups |
| Regular Exercise | Reduces stress and improves mood |
Long-term skin problems can sometimes lead to depression or extra emotional stress. If things start to feel unmanageable, reach out to a healthcare professional.
Taking small steps every day to manage triggers and find support can make living with psoriasis a bit easier.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Getting organized before you visit your dermatologist or healthcare provider can make your appointment go more smoothly.
Here are a few ways to prepare:
- Write down all your symptomsâeven ones that donât seem related to your skin. They could matter.
- Make a list of every medicine, vitamin, and supplement you take. Include the doses.
- Jot down any questions you want to ask about your condition or care. For example:
- What could be causing my symptoms?
- Do I need any specific tests?
- What are my treatment options, and which one fits my situation?
- What side effects might treatments have?
- How soon could treatment help my symptoms?
- What if the main treatment isnât right for me?
- How do I manage more than one health problem at once?
- Any advice on daily skin care or products?
A simple table can help you keep your questions organized:
| Topic | Example Question |
|---|---|
| Diagnosis | What is causing my symptoms? |
| Testing | Are any tests needed? |
| Treatment | What options do I have? |
| Daily Care | Which skincare products do you recommend? |
What the Doctor Will Ask You
Your dermatologist or healthcare provider will probably ask about your health history and what symptoms youâre dealing with right now. They might want to know things like:
- When did your skin issues first show up?
- How often do you notice these problems?
- If your symptoms come and go, or if they stick around?
- What do you think makes things better or worse?
If you show up with this info on hand, it really helps the healthcare team figure out what to do next.
