Expert reviewer, Dr Joanna Gach, Consultant Dermatologist, and Melanie Hill, Bupa Clinics GP
Next review due May 2023

Psoriasis is a skin condition that typically causes raised patches of red, scaly skin. Although there’s no cure for psoriasis, symptoms tend to come and go over time, and there are lots of treatments that can help.

A woman's hand on her bare arm

What is psoriasis?

If you have psoriasis, your skin sheds cells and replaces them more quickly than normal. New skin cells build up on your skin in thick, red, crusty patches called plaques. Dead skin cells may build up on the plaques, causing a silvery scale. Your skin may also become inflamed.

It's estimated that psoriasis affects around three in every 100 people in the UK. You can develop it at any age, but it’s more likely to begin between the ages of 20 and 30 or later when you’re over 50. Psoriasis affects men and women equally. It isn’t contagious so you can’t catch it or pass it on to anyone else.

Symptoms of psoriasis

Psoriasis typically causes thickened, red patches of skin, which may be covered with silver-white scales. This is the most common form of psoriasis, called plaque psoriasis. The plaques can appear anywhere on your body – often your on back, scalp, knees and elbows. The patches may be different sizes and will look different from your surrounding skin. They may itch, and sometimes bleed. Some people have lots of plaques and others only have a few.

Plaques on your scalp can be very thick and can look like dandruff. You may notice some hair loss. It can also affect your fingernails and toenails, causing them to become pitted, thickened, discoloured or loosened from the nail bed.

There are some less common types of psoriasis too, which may look a bit different.

  • Guttate psoriasis is where small, scaly, inflamed spots appear all over your body, arms and legs. This type tends to affect children and young adults, often after they’ve had a throat infection, and usually disappears after three to four months.
  • Pustular psoriasis causes small, pus-filled spots (pustules) on your skin. These may be only on the palms of your hands or soles of your feet. More rarely, it can affect your whole body (generalised pustular psoriasis), which can be life-threatening and needs hospital treatment.
  • Flexural psoriasis (inverse psoriasis) causes patches of smooth, red, shiny skin in areas where your skin folds, such as your armpits and groin.
  • Erythrodermic psoriasis is a rare form of psoriasis where your skin becomes red and inflamed all over. This can cause serious complications and you’ll usually need to go to hospital for treatment. Erythrodermic psoriasis usually affects people who already have another type of psoriasis.

Some people with psoriasis have pain, swelling and stiffness in their joints too. This is known as psoriatic arthritis and it tends to affect the joints in your hands, feet, knees and ankles.

If you have any of these symptoms, make an appointment to see your GP. If you have erythrodermic psoriasis or generalised pustular psoriasis, you may feel very unwell with a high temperature and fast heart rate. Seek urgent medical attention if you have symptoms of these types of psoriasis.

Diagnosis of psoriasis

Your GP will usually be able to diagnose psoriasis by asking about your symptoms, your medical history and examining your skin. They’ll be able to tell what type of psoriasis you have from how the affected areas of skin look, how big they are and where they are on your body. Your doctor will want to know if your symptoms are affecting your normal activities and how it’s making you feel.

Your GP may refer you to a dermatologist if:

  • there’s any uncertainty about what’s causing your symptoms
  • your symptoms are particularly severe
  • a large area of skin is affected

A dermatologist is a doctor who specialises in identifying and treating skin conditions.

If you have signs of psoriatic arthritis such as painful joints, your GP may refer you to see a rheumatologist. This is a doctor who specialises in identifying and treating conditions that affect your joints and muscles.

If you have symptoms of generalised pustular psoriasis or erythrodermic psoriasis, your GP will refer you to a specialist straight away for further assessment and treatment.

Self-help for psoriasis

There are certain things that can make psoriasis flare up – for example, feeling stressed, drinking alcohol, smoking, and being overweight. You may be able to ease your symptoms if you avoid these triggers. So, try to manage your stress levels, don’t drink too much alcohol, quit smoking if you smoke, and try to lose weight if you need to.

Some people may find that sunlight makes their psoriasis better, but for others it can trigger a flare up. You shouldn’t expose your skin to the sun if you’re using some psoriasis medicines – for example, tazarotene. It’s also important to stay safe in the sun – too much sunlight can also increase your risk of developing skin cancer.

Treatment of psoriasis

There’s no cure for psoriasis. But there are lots of treatments that may help to relieve your symptoms. Some may work better for you than others, so you may need to switch treatments after a while or try a combination. Your GP may be able to prescribe some treatments, but others are only available through referral to a specialist.

Emollients (moisturisers)

Emollients are creams, lotions or ointments that moisten, soften and soothe your skin. They can help to reduce scaling and itching, and sometimes might be the only treatment you need – especially if your symptoms are mild. They may also help other psoriasis skin treatments work better. Your doctor can prescribe emollients, but you can also buy some types over the counter from a pharmacy.

You should apply emollients to your skin regularly and generously, even when your skin appears to be clear. You may find you’re using them three or four times a day or more often if you’ve got very dry skin or are having a flare-up. Emollients work best after a bath or shower, when your skin is still damp. Use a combination of an emollient bath oil, soap substitute and emollient cream, lotion or ointment.

Medicated creams and ointments

Your GP may prescribe you one of the following medicated creams or ointments.

  • Corticosteroid creams. These can be used on your body, limbs, face and scalp. You should only use steroid creams under the supervision of a doctor, particularly when applying it to your face. Your doctor will usually prescribe them for a set amount of time and you stop using them once your skin is clear or nearly clear.
  • Vitamins D ointments and lotions. You’ll usually be prescribed these alongside corticosteroid creams initially, for psoriasis on your body or limbs. You can also use these preparations on their own, and for longer periods of time than corticosteroids creams.
  • Vitamin A analogues (retinoids) such as tazarotene. These can be useful to treat patches of mild-to-moderate plaque psoriasis. You shouldn’t use these medicines if you’re pregnant, breastfeeding or planning to get pregnant because they could harm your baby.
  • Creams containing dithranol. You might be prescribed this if other treatments haven’t worked. It’s usually only used on tougher skin, for instance on your elbows and knees, and you only leave it on for a short time before washing it off. The treatment can stain – wear disposable gloves when you’re using it and wash your hands afterwards.
  • Coal tar creams and shampoos. These may be an option for psoriasis on your scalp, body or limbs that hasn’t cleared up with other treatments. But these products can be smelly and messy, and can stain skin and clothing, so they aren’t very popular these days.

If topical treatments don’t completely control your symptoms or your psoriasis covers a lot of your body, your GP may refer you to a dermatologist to discuss the additional treatment options described below.

Light therapy

Ultraviolet (UV) light therapy is one option for psoriasis when creams and ointments aren’t enough. It’s also called phototherapy. Light therapy involves standing in a specially-designed cubicle that contains ultraviolet fluorescent lights. It’s important to note this is very different from using high-street sunbeds, which aren’t beneficial for psoriasis. For more information, see our FAQ: Will using a sunbed help my psoriasis?

There are two types of light therapy.

  • Ultraviolet B (UVB) light therapy. This uses a small part of the UVB light naturally found in sunlight to treat your psoriasis.
  • UVA light therapy with psoralen (PUVA). Psoralen is a medicine that makes your skin more sensitive to UVA light. PUVA is a more intensive treatment, only available from specialist centres in the UK.

Light therapy usually involves having two or three sessions a week, for around three to four months.

Medicines for psoriasis

Tablets and capsules

Several medicines for psoriasis (for example, methotrexate, ciclosporin, acitretin and apremilast) are available in tablet form to be taken by mouth. Which your doctor prescribes will depend on things such as the type of psoriasis you have, whether or not you’re trying to conceive, and if you have arthritis.

These medicines work by dampening down your immune system or slowing down your production of skin cells. They can cause severe side-effects so your doctor will want you to have regular check-ups. Some of these medicines can be harmful during pregnancy, so you’ll need to take precautions not to get pregnant (or to get your partner pregnant). Ask your doctor for more details and read our FAQ: What psoriasis medicines should I avoid during pregnancy?

Biological medicines

If your psoriasis is severe and other treatments haven’t helped or aren’t suitable for you, your doctor may suggest a biological medicine. Biological medicines block chemicals in your body that cause inflammation. Examples include etanercept, adalimumab, infliximab and ustekinumab. You’ll need to see a specialist to have these treatments. They’re given as injections under your skin or into a vein. If one biological medicine doesn’t help your psoriasis, you may be able to try another one.

Causes of psoriasis

It’s not known exactly what makes some people develop psoriasis. Genetics is thought to play a part – you’re more likely to get it if other people in your family have the condition. Your immune system also seems to play a role in its development.

There are also certain factors that seem to trigger a flare-up of the condition in people who are already susceptible. These include throat infections, an injury to your skin, certain medicines, hormonal changes and stress. Smoking and drinking too much alcohol may also trigger a flare-up.

Living with psoriasis

Some people with psoriasis may feel anxious, depressed or self-conscious about how their skin looks; this might limit their activities. If you’re feeling like this, speak to your doctor, as they may be able to offer further advice and support. You may also find charities and support groups, such as the Psoriasis Association, offer useful advice. For more information, see our section: Other helpful websites.

You can’t pass psoriasis onto others, so there’s no reason why you shouldn’t go swimming, have sex or take part in any of your usual activities. If sex is uncomfortable due to psoriasis in your groin or genital area, using a condom and lubrication may help. Be aware that some creams and lotions can reduce how well latex condoms work – ask your pharmacist for advice on what’s safe to use.

Having psoriasis can increase your risk of heart disease and stroke. Try to reduce your risk by following a healthy diet, getting as much exercise as you can, stopping smoking if you smoke and losing weight if you need to. You can also ask your GP about checking for other risk factors, such as high blood pressure and high cholesterol.

Frequently asked questions

  • Some medicines used to treat psoriasis – including acitretin, methotrexate and tazarotene – could potentially harm your baby during pregnancy. So, don’t take them if you’re pregnant or trying for a baby. You shouldn’t take them if you’re breastfeeding either.

    Ideally, it’s best not to take ciclosporin when you’re pregnant. However, this medicine isn’t thought to cause developmental problems with your baby, so your doctor may recommend it if they think the benefits outweigh the potential risks.

    PUVA therapy (psoralen tablets with ultraviolet A light therapy) isn’t recommended during pregnancy, but you should be able to have UVB light therapy.

    Some of these medicines can stay in your body for a long time after you stop taking them. So, you’ll need to make sure the medicines are completely out of your system before you get pregnant. For instance, you’ll need to use an effective type of contraception for three years after taking acitretin, and for at least three months after taking methotrexate.

    Some medicines, such as methotrexate, can also affect a man’s sperm production. Men shouldn’t get their partner pregnant while taking methotrexate or for three months afterwards. If you and your partner are considering having a baby, talk to your doctor about your psoriasis treatments. Also talk to your doctor about the best forms of contraception.

  • No, tanning sunbeds are not helpful for psoriasis. Your dermatologist may prescribe ultraviolet (UV) light therapy (phototherapy) for your psoriasis. Using a sunbed isn’t a safe alternative. If you have phototherapy, the dose and strength of the ultraviolet light are carefully controlled. This makes sure you get the best treatment in the safest way.

    Commercial sunbeds don’t have any control over the exact type and dose of ultraviolet light you receive. Most commercial sunbeds use UVA light, which isn’t much benefit to psoriasis on its own.

    If you have too much exposure to UVA and UVB rays, this can cause skin ageing and increase your risk of skin cancer. So, using a sunbed may mean you’re exposed to the risks of too much sun, without any of the benefits to your psoriasis.

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Related information

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  • Reviewed by Pippa Coulter, Freelance Health Editor, May 2020
    Expert reviewer, Dr Joanna Gach, Consultant Dermatologist, and Melanie Hill, Bupa Clinics GP
    Next review due May 2023