Psoriasis is a chronic, immune-mediated inflammatory condition that causes red, thickened patches of skin with whitish or silvery scales.

It most commonly affects the scalp, elbows, knees, and lower back, but it can also involve other areas of the body, the nails, and sometimes the joints.

Psoriasis is not contagious. It cannot spread through touching, hugging, or sharing items.

Current treatments can help keep psoriasis under control for extended periods in many patients.

What Causes Psoriasis?

Genetic predisposition and an inflammatory immune response play important roles in psoriasis.

Skin cells normally renew in an orderly cycle. In psoriasis, immune activity speeds up this process, causing thick, scaly plaques to form on the skin’s surface.

Factors that may contribute to the development of psoriasis or trigger flare-ups include:

• Genetic predisposition
• Certain infections
• Emotional stress
• Skin irritation or injury
• Smoking and excessive alcohol consumption
• Obesity
• Certain medications

Triggers vary from person to person.

What Are the Symptoms of Psoriasis?

Common symptoms include:

• Well-defined, red, scaly plaques
• Whitish or silvery scales
• Itching and burning
• Dry, cracked skin
• Thick scale buildup on the scalp
• Small pits in the nails, nail thickening, or separation of the nail from its bed

Some patients also experience joint pain, swelling, and morning stiffness.

Types of Psoriasis

Plaque Psoriasis

This is the most common form of psoriasis. It causes scaly plaques on the elbows, knees, scalp, and trunk.

Scalp Psoriasis

Scalp psoriasis causes redness, heavy flaking, and thick scale buildup. It can sometimes extend beyond the hairline.

Guttate Psoriasis

This form causes numerous small, drop-shaped lesions, particularly on the trunk. It is more common in children and young adults and sometimes develops after a throat infection.

Inverse Psoriasis

Inverse psoriasis affects the underarms, groin, and other skin folds. Scaling may be less noticeable in these areas, while redness and irritation can be more prominent.

Pustular and Erythrodermic Psoriasis

These are less common forms of psoriasis that can sometimes be severe. Widespread redness, fever, fatigue, or numerous pustules may require urgent medical evaluation.

How Is Psoriasis Diagnosed?

Psoriasis is usually diagnosed through a dermatologic examination.

The assessment considers the appearance and distribution of lesions, nail changes, and the patient’s medical history.

When needed, additional tests or a skin biopsy may help distinguish psoriasis from fungal infections, eczema, and other scaly skin conditions.

Current Psoriasis Treatments

Treatment is planned based on the extent and location of psoriasis, the severity of itching, its effect on quality of life, and other health conditions.

1. Topical Treatments

Medications applied to the skin are usually the first choice for mild, localized psoriasis.

Corticosteroids: Help reduce redness, skin thickening, and inflammation.

Vitamin D analogs: Medications such as calcipotriene help regulate excessive skin cell growth. They may also be used in combination with corticosteroids.

Calcineurin inhibitors: A dermatologist may recommend these for suitable patients with psoriasis in sensitive areas, such as the face and skin folds.

Newer topical treatments: Nonsteroidal medications such as tapinarof and roflumilast are used to treat psoriasis in some countries. Their regulatory approval status and availability in Türkiye require separate assessment.

2. Treatment for Scalp Psoriasis

Medicated lotions, solutions, foams, or shampoos may be used for scalp psoriasis.

Appropriate keratolytic products, which help loosen scales, may be useful for thick buildup.

Preparations containing salicylic acid can help soften scales in some patients.

Picking off scales, vigorous combing, and irritating treatments are not recommended.

3. Phototherapy

Narrowband UVB (NB-UVB) phototherapy may be used, particularly for widespread psoriasis or disease that has not responded adequately to topical treatments.

Treatment is delivered at scheduled intervals using controlled doses.

Tanning beds are not a substitute for medical phototherapy.

4. Systemic Medications

Oral or injectable treatments may be needed for moderate to severe psoriasis or persistent lesions affecting certain sensitive or difficult-to-treat areas.

Options include methotrexate, cyclosporine, acitretin, and apremilast.

Medication selection depends on the patient’s age, other health conditions, pregnancy plans, and safety assessment.

5. Biologic Treatments

Biologic medications represent one of the major advances in psoriasis treatment in recent years.

They target specific immune signals involved in the condition.

Current biologic treatment groups include:

• TNF-alpha inhibitors
• IL-17 inhibitors
• IL-23 inhibitors
• IL-12/23 inhibitors

In suitable patients, biologic treatment can substantially improve skin lesions and may achieve clear or nearly clear skin.

However, these treatments are not appropriate for everyone. Infections and other risk factors are assessed before treatment, and regular monitoring is required throughout care.

6. Newer Targeted Oral Treatments

TYK2 inhibitors are a newer group of targeted medications developed for psoriasis.

Deucravacitinib is one option for suitable patients with moderate to severe plaque psoriasis.

A dermatologist should assess treatment suitability, safety, and availability in Türkiye.

Can Psoriasis Affect the Joints?

Some people with psoriasis develop an inflammatory joint condition called psoriatic arthritis.

Symptoms to watch for include:

• Joint pain and swelling
• Significant morning stiffness
• Swelling of an entire finger or toe
• Heel pain
• Persistent inflammatory lower back pain

These symptoms warrant coordinated evaluation by a dermatologist and a rheumatologist.

Early diagnosis is important for reducing the risk of permanent joint damage.

Is Psoriasis Associated With Other Health Conditions?

Psoriasis can affect more than the skin.

Assessment for conditions such as obesity, metabolic syndrome, high blood pressure, diabetes, and cardiovascular disease is particularly important in people with moderate to severe psoriasis.

Overall health should therefore be considered as part of psoriasis care.

Can Psoriasis Go Away Completely?

Psoriasis is a chronic condition. There is currently no treatment that provides a permanent cure for every patient.

However, current treatments can provide long-term control and, in some patients, clear or nearly clear skin.

The condition may flare up again after treatment is stopped.

Daily Care and Lifestyle Tips for Psoriasis

• Moisturize your skin regularly.
• Avoid long showers with very hot water.
• Do not pick off thick scales.
• Avoid irritating your skin with abrasive washcloths or brushes.
• If you smoke, try to quit.
• Limit alcohol consumption.
• Maintain a healthy weight and a balanced diet.
• Get regular physical activity.
• Do not stop medications without medical advice.
• Tell your physician about joint pain, morning stiffness, or similar symptoms.

No specific diet or herbal mixture has been proven to eliminate psoriasis.

Dermatologic Evaluation and Follow-Up

Psoriasis care aims to reduce scaling, provide long-term disease control, improve quality of life, and assess associated health concerns.

At Dr. Armin Müştak’s private dermatology practice, patients with psoriasis receive a dermatologic examination. A treatment and follow-up plan is developed based on the type, extent, and location of psoriasis, along with previous treatments.

Effective treatment options are available for psoriasis. Accurate diagnosis, appropriate treatment, and regular follow-up can help keep symptoms well controlled.