Psoriasis

Overview

Psoriasis happens when the body makes new skin cells much faster than normal. The extra cells build up into thick, raised patches (plaques) covered with silvery-white scales. On white skin the patches look pink or red. On brown or black skin they can look grey and may leave dark marks after they heal. The exact cause is not known, but the immune system (the body's defence system) is thought to play a main part, and it often runs in families.

Psoriasis can start at any age. It most often begins in the late teens or early twenties, or between about 50 and 60. It comes and goes: there are times when it is mild or clear, and times when it flares up. Common triggers include stress, infections, skin injury, alcohol, smoking and some medicines. Psoriasis is not an infection and cannot spread from one person to another.

The World Health Organization describes psoriasis as a long-term, painful and disabling disease that also affects the nails and joints. Some people get psoriatic arthritis (painful, swollen joints). People with psoriasis also have a higher risk of heart disease, diabetes and depression. Treatment does not cure psoriasis, but it can clear or greatly reduce the patches and help people live normally.

Symptoms

• Raised, dry, scaly patches (plaques) with clear edges, often on the elbows, knees, scalp, lower back and lower legs
• Itching, soreness or a burning feeling in the patches
• Patches that look pink or red on white skin, and grey on brown or black skin
• Thick scale on the scalp and behind the ears
• Smooth red patches without much scale in skin folds, such as the armpits, groin, under the breasts and around the genitals
• Nail changes: small dents (pits), yellow-brown spots, thickening, or the nail lifting off the skin
• Many small, drop-shaped spots over the body, often after a throat infection (guttate psoriasis), mainly in children and young people
• Painful, stiff or swollen joints, fingers or toes (signs of psoriatic arthritis)

Causes and risk factors

Causes

• The immune system becomes overactive and speeds up the growth of skin cells, so they pile up into scaly patches
• Genes: psoriasis often runs in families
• Infections, especially a strep throat infection, which can set off guttate psoriasis
• Injury to the skin, such as cuts, scratches or grazes, where new patches can appear (the Koebner effect)
• Some medicines, such as lithium, beta blockers (heart and blood pressure medicines), chloroquine and anti-inflammatory painkillers (NSAIDs), which can make it worse
• Stopping steroid tablets suddenly, which can cause a severe, widespread flare

What makes it more likely

• A parent, brother or sister with psoriasis
• Stress
• Smoking
• Drinking alcohol
• Being overweight
• Infections, including strep throat and HIV
• Winter weather, which often makes it worse (summer often helps)

Complications

Psoriasis is more than a skin problem. Up to about a third of people develop psoriatic arthritis, which causes painful, swollen joints and, if not treated, can damage them. People with psoriasis, especially severe psoriasis, have a higher risk of heart disease, high blood pressure, diabetes, blood clots and inflammatory bowel disease (Crohn's disease). Many people face stigma and feel isolated, and depression is more common. Rarely, psoriasis turns into a severe form where the skin goes red all over (erythrodermic psoriasis) or breaks out in widespread pus spots (pustular psoriasis); these can make a person very ill and need hospital care. Some treatments, such as strong steroid creams used for too long, can thin the skin.

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Diagnosis

A doctor can usually diagnose psoriasis by looking at the skin, scalp and nails and asking about the history and family history. Tests are not usually needed. If the diagnosis is unclear, a small piece of skin may be taken for testing (a skin biopsy). If only the hands or feet are affected, skin scrapings may be checked for a fungal infection, which can look similar.

The doctor also judges how severe the psoriasis is, how much of the body is affected, and how it affects daily life and mood. Skin specialists use scoring tools for this. People with psoriasis should be asked about joint pain every year, using a short questionnaire, and checked for heart disease risk factors. Before tablets or injections that calm the immune system are started, blood tests are usually done, such as a blood count, liver and kidney tests and hepatitis tests, along with a test for tuberculosis (TB) and, for women, a pregnancy test.

Treatment

1. Use a moisturiser (emollient) often, to soften scale and ease itching, alongside any other treatment
2. For patches on the body, arms and legs, the usual first treatment is a strong steroid cream or ointment together with a vitamin D-type cream (calcipotriol), either as two separate products or as one combined product. Your doctor decides how long to use it and reviews you
3. For the scalp, a steroid lotion or gel is used first; softening and removing thick scale helps the treatment work. A combined vitamin D and steroid product or coal tar may be added
4. For the face, skin folds and genitals, only a mild or moderate steroid is used for a short time, because the skin there thins easily; a non-steroid ointment may be used instead under a specialist's advice
5. If creams do not control it, your doctor may refer you to a skin specialist for light treatment (narrowband UVB phototherapy)
6. For extensive, severe or very distressing psoriasis, a specialist may start tablets that calm the immune system, usually methotrexate first, or ciclosporin or acitretin. Regular blood tests are needed
7. If these do not work or cannot be used, a specialist may start biological medicines (injections or drips that block parts of the immune system). Joint symptoms are managed together with a joint specialist (rheumatologist)

Medicines in Pakistan

Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.

Also used (not yet in our price list): Coal tar preparations (skin and scalp), Dithranol (short-contact treatment for stubborn plaques), Tacrolimus ointment (a calcineurin inhibitor for the face and skin folds, started by a specialist), Infliximab, ustekinumab, secukinumab and ixekizumab (biological medicines given by specialists)

Self-care and prevention

Self-care

• Use moisturiser every day, even when the skin looks clear; use a spoon or pump instead of putting fingers into the tub, and do not share it
• Keep away from naked flames and do not smoke while using moisturisers, because clothes and bedding soaked with them can catch fire easily
• Learn your own triggers, such as stress or alcohol, and try to avoid them
• Stop smoking and cut down on alcohol
• Aim for a healthy weight with a balanced diet and regular exercise
• Protect your skin from cuts and scratches, and try not to pick or scratch patches
• Tell every doctor and pharmacist that you have psoriasis before starting a new medicine, and do not stop steroid tablets suddenly
• Ask for support if psoriasis is affecting your mood, sleep, work or relationships

Prevention

• Flare-ups can often be reduced by learning and avoiding your own triggers, such as stress
• Not smoking, drinking less alcohol and keeping a healthy weight can help control psoriasis
• Protect the skin from injury, because new patches can appear where the skin is hurt
• Have regular check-ups for joint pain, blood pressure, blood sugar and cholesterol, because psoriasis raises the risk of these problems

Common questions

Is psoriasis contagious?

No. Psoriasis cannot spread from one person to another. It is linked to the person's own immune system, not to germs. Even so, many people with psoriasis face stigma, so understanding this matters.

Can psoriasis be cured?

There is no cure yet, and psoriasis usually comes and goes throughout life. But treatment can clear or greatly reduce the patches for long periods. Many people find a routine that keeps it under control.

Is it safe to use steroid creams for psoriasis?

Steroid creams work well and are safe when used as your doctor advises. Used too long or too strong, especially on the face or skin folds, they can thin the skin. Your doctor will choose the right strength for each part of the body and plan breaks between courses.

Can psoriasis affect the joints?

Yes. Some people develop psoriatic arthritis, which causes pain, stiffness and swelling in the joints, fingers, toes or back. Tell your doctor about any joint symptoms, because early treatment can prevent lasting damage.

Can I take psoriasis medicines if I want to get pregnant?

Some psoriasis medicines can be harmful in pregnancy, so treatment may need to change before or during pregnancy. Acitretin needs a strict pregnancy prevention programme. Talk to your doctor before trying for a baby and before stopping or changing any medicine.

Sources

1. NICE. Psoriasis: assessment and management (CG153) (2017).
2. World Health Organization. Global report on psoriasis (2016).
3. NHS 111 Wales. NHS 111 Wales - Health A-Z : Psoriasis (n.d.).
4. StatPearls (NCBI Bookshelf). Psoriasis - StatPearls - NCBI Bookshelf (2023).
5. Journal of Pakistan Association of Dermatologists. Psoriasis in Pakistani population: Associations, comorbidities, and hematological profile (2013).

Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.

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