What is psoriasis—and how can you treat it?

There are plenty of reasons your skin may become inflamed, dry, red, or flaky. It can be the result of cold weather, an allergic reaction, or even stress. But if your irritated skin persists, you may have a condition called plaque psoriasis, which is marked by scaly, swollen patches of skin. Like eczema, rosacea, or keratosis pilaris, psoriasis is generally a life-long, chronic skin condition, so it’s imperative that you know how to treat the symptoms. To learn more about the common skin disease, we tapped Dr. Alexis Parcells, a New Jersey-based, board-certified plastic surgeon and owner of Parcells Plastic Surgery.

What is psoriasis?

Psoriasis is an autoimmune disease that causes your skin to be in a constant or near-constant inflammatory state. Instead of your immune system only attacking outside aggressors, like bacteria or viruses, your T cells attack healthy skin cells, causing the skin to become inflamed. From there, your skin cells mature faster and turn over at a quicker rate than normal, explains Parcells. For perspective, your skin cells normally turn over every month, but the skin cells on someone with psoriasis can turn over every three to four days. Because the skin can’t shed fast enough to keep up, “the skin ends up piling up on itself and it starts to become thicker and causes itching, burning, and stinging sensations,” Parcells says. Both males and females of any race can have psoriasis, and the onset of symptoms most commonly begins between ages 15 and 25.

What causes psoriasis?

You will only experience psoriasis if you have the autoimmune disease. This differs from, say, eczema, which you can experience if you have a lack of protein in the skin or from environmental triggers only, like cold weather. However, there are triggers that cause psoriasis to flare up, such as stress, infections (such as an upper respiratory infection), or injuries to the skin, like a sunburn, bug bite, or scratch.

Psoriasis is not contagious and thought to be hereditary, as about a third of people with psoriasis also have a relative with the disease, according to the National Psoriasis Foundation.

How can you identify psoriasis on your skin?

To diagnose psoriasis, you’ll want to see a dermatologist, who will evaluate and possibly biopsy the skin to confirm the condition. But while it’s always wise to see a doctor when there are changes to your skin, you may not run to your dermatologist every time you experience flaky or red skin. To help you determine whether your skin irritation could be psoriasis, and therefore should be treated by a doctor, you can look for certain characteristics and take inventory of your routine.

Psoriasis most commonly appears as plaque, or raised red patches with white or silver-looking scales, around the knees, elbows, and scalp. The patches of irritated skin may burn or feel tender or thick to the touch. You’ll also want to take note of any pain, stiffness, or swelling in the joints, as about one in three people with plaque psoriasis also develop psoriatic arthritis, according to the National Psoriasis Foundation.

Skin irritation, psoriasis included, can come as a result of a change in routine, such exposing the skin to new products (think: skincare lotions and potions, laundry detergent, or clothing). If this happens, first try getting back to the basics and only using gentle, fragrance-free products on the skin. If it gets better, you may have only experienced a mild skin irritation. If it gets worse or doesn’t go away, it could be a sign of a psoriasis flare and you’ll want to see a doctor for treatment.

To help your dermatologist, take photos of the skin while it's irritated and consider keeping a log of possible triggers and any patterns you notice among the flare-ups (including things like whether they happen during the busiest times at work when you’re most stressed).

How do you treat plaque psoriasis?

The first step to treating psoriasis is consulting your doctor. “There are creams and lotions, depending on how severe the case is, so that's why it's important that, if it is psoriasis, you have a physician who is prescribing treatment for you,” Parcells says.

For a mild case, you may be able to treat it at home with colloidal oatmeal or unscented epsom salt baths, which will relieve itchy skin and soothe joint pain for psoriatic arthritis, respectively. For the former, try the Aveeno Soothing Bath Treatment, which claims to cleanse, moisturize, and relieve sensitive, itchy skin. For the latter, choose a soak that’s unscented, like the Solimo Epsom Salt Soak, to avoid further skin irritation while you soothe your joints. After a bath, Parcells recommends applying a thick cream while the pores are still dilated from the warm water. For this, go with the Cerave Moisturizing Cream that contains hyaluronic acid to hydrate the skin and ceramides to protect the skin barrier. For a more emollient ointment that seals in moisture and adds a protective layer over the skin, try the Eucerin Original Healing Cream.

For more moderate cases, your doctor may recommend you use a prescription topical steroid cream to control the irritation. And if you experience a heightened flare-up, Parcells says they may recommend applying the cream at night and covering it with a layer of plastic wrap to “keep the environment moist and allow the medication to penetrate properly.”

Severe cases may be treated with an oral “biologic” medication that suppresses the immune system to reduce the effects of the skin disease. Parcells says that patients won’t be on biologics for long periods of time, as the idea is to calm a severe flare-up and then, with a physician monitoring, taper the medication down to see how your body adjusts and responds.

Regardless of how severe your psoriasis is or the treatment you’re seeking, you should keep your skincare routine simple, with gentle, non-irritating formulas that are free of fragrance and acids. If you’re tempted to physically or chemically exfoliate away the thick or flaky skin, don’t, as this may only speed up the cell turnover process and worsen the problem.

How do you treat scalp psoriasis?

Given that the skin on your scalp is different from that on your body, you’ll want to take a different approach to treating psoriasis in this area. Your doctor may want to prescribe you a wash or ointment for the scalp or they may direct you toward an over-the-counter option, like the MG217 Psoriasis Medicated Conditioning 3% Coal Tar Shampoo, which claims to treat psoriasis and dandruff by softening and removing scales and slowing the turnover of skin cells with salicylic acid and coal tar, respectively.

Can you cure psoriasis?

There is no cure for psoriasis, but it is manageable with counsel from a doctor and treatment. Not treating the condition may only cause it to grow more uncomfortable. “You should be empowered to seek treatment and there are affordable ways to improve your symptoms,” Parcells says. “We’re all human, we’ve all got skin conditions, and don’t feel ashamed by it.”