Inflammatory
Psoriasis
Psoriasis is a long-term skin condition in which the immune system speeds up skin growth, causing thick, scaly patches. It is common, it is not contagious, and it can usually be controlled with the right care, though it tends to come and go over time.
Reviewed by Raashid Haque, MD, board-certified dermatologist
For education only. This guide does not diagnose or treat any condition.
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Ointments soften thick scale and ease itch and cracking in plaques.
Look for
- Fragrance-free and dye-free
- Ointment or thick cream in a tub or tube
- Petrolatum, mineral oil, dimethicone, or shea butter
Full details, cautions and sourcesAvoid
- Thin lotions in pump bottles for very dry areas
- Added fragrance, essential oils, or botanical extracts
- Dipping fingers into a tub repeatedly; use a clean spoon or scoop
These are products Dr. Haque has reviewed and recommends for different reasons. Unless a product is clearly marked 'Affiliate link,' it is not one. Most are not.
Food and lifestyle may play a part in Psoriasis too
Anti-inflammatory eating and lifestyleLearn about Psoriasis
Psoriasis is a chronic condition in which the immune system is overactive and tells the skin to make new cells much faster than normal. The extra cells pile up and form patches called plaques. Genes play a role, and so do outside factors. It can begin at any age.
Plaque psoriasis is the most common type. Plaques are usually well-defined, raised, dry, and itchy or sore. They often show up on the elbows, knees, lower back, and scalp. On lighter skin they tend to look pink or red with silvery-white scale. On brown and Black skin they may look violet, dark brown, or gray, and the scale may look gray. Because the color can blend in with the surrounding skin, it can be easier to miss. After plaques clear, lighter or darker patches can remain for months before fading.
Some people also have:
- Scalp psoriasis, with flaking and thick scale that can extend past the hairline.
- Nail changes, such as tiny pits, ridges, or the nail lifting from the nail bed.
- Skin fold (inverse) psoriasis, which looks smooth, red or dark, and shiny, and is often sore rather than scaly.
Psoriasis follows a pattern of flares and quieter periods. It is not contagious, it is not caused by poor hygiene, and it is not the same as eczema or a fungal infection, though they can look alike. Psoriasis can also be linked to joint problems and to heart and metabolic health, which are covered below.
Self-care
What it is
Thick, fragrance-free moisturizers (creams or ointments) and lukewarm, short baths help soften scale and calm dryness and itch.
Often considered when
Often considered for nearly everyone with psoriasis, alone for mild disease or alongside other treatments.
Less suitable or needs caution when
Less suitable as the only approach when plaques are thick, widespread, or painful. Some people react to fragrance or other additives.
What to watch for
Stinging, new redness, or rash after a product. Avoid picking or scrubbing scale, which can injure skin and trigger new plaques.
How long to judge it
Comfort often improves within days to a couple of weeks, but moisturizers do not stop the underlying immune activity.
Questions to ask
- Which moisturizers suit my skin and budget?
- Is my bathing routine helping or drying me out?
- What should I do when scale is thick?
Over the counter
What it is
Products with salicylic acid or coal tar help loosen scale, and are sold as shampoos, creams, and washes. Low-strength hydrocortisone is also sold without a prescription.
Often considered when
Often considered for mild scaling, scalp flaking, or when someone wants a starting point before seeing a clinician.
Less suitable or needs caution when
Less suitable on broken or very irritated skin, or near the eyes. Coal tar can stain and has a strong smell, and some people are sensitive to it. Ask a clinician about use in pregnancy or for children.
What to watch for
Dryness, burning, or irritation. Coal tar can make skin more sun-sensitive. Salicylic acid used over large areas is a concern, so ask first.
How long to judge it
Many people judge scalp products over several weeks of regular use.
Questions to ask
- Is an over-the-counter option reasonable for my scalp?
- Could these products interfere with a prescription?
- When should I move on to something stronger?
Prescription creams and gels
What it is
Steroid creams, ointments, foams, and solutions calm inflammation. Vitamin D-based topicals (such as calcipotriene) slow skin cell growth. They are sometimes combined in one product.
Often considered when
Often considered as a first step for limited plaque psoriasis, including scalp and some other areas.
Less suitable or needs caution when
Less suitable on the face or skin folds for stronger steroids unless a clinician advises, on large areas for long periods, or during pregnancy without guidance. Vitamin D-based products can irritate.
What to watch for
Skin thinning, stretch marks, or lightening or darkening of the skin with steroids. Irritation with vitamin D-based products. Plaques returning after stopping.
How long to judge it
Often judged over about 2 to 4 weeks, with the clinician reviewing how it is going.
Questions to ask
- How strong a topical is right for each area of my body?
- How do I avoid side effects with long-term use?
- What happens if the plaques come back?
What it is
Several steroid-free creams and foams exist, including newer medicines that block inflammatory signals in the skin (for example roflumilast cream) and topical retinoids. Some are designed for folds and the face.
Often considered when
Often considered for skin folds, the face, long-term use, or when steroid side effects are a concern.
Less suitable or needs caution when
Less suitable if you have had a reaction to an ingredient. Retinoids are generally avoided in pregnancy. Cost and insurance coverage can be a barrier.
What to watch for
Burning, stinging, or dryness at first. Rarely, diarrhea, headache, or nausea with some newer products. Ask what to watch for with your specific product.
How long to judge it
Often judged over several weeks, with some people noticing change sooner.
Questions to ask
- Would a steroid-free option make sense for my skin folds?
- Is this covered by my insurance?
- Can I use it together with my other treatments?
Procedures
What it is
Controlled doses of ultraviolet light, given in a clinic or sometimes with a prescribed home unit, slow skin cell growth and calm inflammation.
Often considered when
Often considered when psoriasis covers a larger area or topicals alone are not enough.
Less suitable or needs caution when
Less suitable with a history of skin cancer, very light-sensitive skin, or certain light-sensitizing medicines. Visits several times a week can be hard to fit into work and family life.
What to watch for
Sunburn-like redness, itching, and dryness. On medium to darker skin, light therapy can deepen dark spots. Long-term skin cancer risk is something to discuss. Eye protection is needed.
How long to judge it
Often judged after about 1 to 2 months of regular visits.
Questions to ask
- Is phototherapy practical for my schedule and location?
- How could it affect my skin tone and dark spots?
- Is a home unit an option for me?
Pills
What it is
Several pills are used for moderate to severe psoriasis. They include methotrexate, oral retinoids, apremilast, and newer targeted pills such as TYK2 inhibitors (for example deucravacitinib).
Often considered when
Often considered when psoriasis is widespread, affects daily life, involves hard-to-treat areas such as nails or palms, or does not respond enough to topicals or light.
Less suitable or needs caution when
Suitability varies a lot by medicine. Methotrexate and oral retinoids are generally not used in pregnancy or when planning pregnancy. Liver disease, heavy alcohol use, and certain infections affect the choice.
What to watch for
Each pill has its own monitoring needs. Some need regular blood tests. Others can cause stomach upset, headache, or mood changes. Ask for a clear list for any medicine you are offered.
How long to judge it
Often judged after about 2 to 4 months, depending on the medicine.
Questions to ask
- Which oral option fits my health history and any pregnancy plans?
- What blood tests or check-ups would I need?
- How do these compare with injectable medicines for me?
Injections and biologics
What it is
Biologics are made from living cells and block specific immune signals that drive psoriasis. Major classes target TNF, IL-17, IL-23, or IL-12/23. They are given by injection or infusion.
Often considered when
Often considered for moderate to severe psoriasis, psoriatic arthritis, or when other treatments have not worked well enough or are not a good fit.
Less suitable or needs caution when
Suitability depends on infection history, tuberculosis or hepatitis exposure, pregnancy plans, and some other conditions. Different classes suit different situations, for example when joints are involved.
What to watch for
Higher chance of infections. Clinicians usually check for tuberculosis and other infections before starting. Injection-site reactions and upper respiratory infections are common. Tell your care team about fevers or infections.
How long to judge it
Many people see change within about 3 to 4 months, and some sooner.
Questions to ask
- Which class of biologic might suit my skin and joints?
- What screening tests do I need first, and how often afterward?
- What should I do if I get sick while on treatment?
Lifestyle and holistic
What it is
Reaching a healthier weight, cutting back on alcohol, and quitting smoking are linked with less active psoriasis and may help treatments work better.
Often considered when
Often considered for anyone with psoriasis who smokes, drinks regularly, or carries extra weight, alongside medical treatment.
Less suitable or needs caution when
Not a substitute for medical treatment. Weight goals should be realistic and safe, and crash diets can backfire. Support matters, because these changes are hard.
What to watch for
Rapid weight loss or very restrictive plans. Mood changes when quitting smoking. Ask your clinician about support programs.
How long to judge it
Skin changes from lifestyle shifts are gradual, often over months.
Questions to ask
- How much could weight or smoking be affecting my psoriasis?
- Can you connect me with a program that supports these changes?
- Could my medicines be affected by alcohol?
Triggers differ from person to person, and many flares have no clear cause. Factors that are commonly linked to flares include:
- Skin injury, such as scratches, sunburn, tattoos, or friction. Psoriasis can appear in the injured spot.
- Infections, especially strep throat.
- Stress, which many people notice before a flare.
- Smoking and alcohol.
- Certain medicines. Never stop a prescribed medicine on your own; ask your clinician.
- Cold, dry weather, which can dry out the skin.
- Excess body weight, which is linked to more active psoriasis.
Moderate sunlight helps some people, but sunburn can trigger a flare. Keeping a simple diary of flares can help you and your clinician spot patterns.
| Topic | Evidence | What it means |
|---|---|---|
| Weight | Established | Carrying extra weight is linked with more active psoriasis, and losing weight may help skin and make treatments work better. Aim for gradual, sustainable steps rather than crash diets. |
| Alcohol and smoking | Established | Smoking and heavy alcohol use are linked with more psoriasis and worse flares. Cutting back or quitting is good for skin, heart, and overall health. |
| Eating pattern | Promising | A Mediterranean-style pattern (vegetables, fruit, whole grains, fish, olive oil) is often suggested and may help, partly through weight and heart health. No single food or diet is proven to clear psoriasis, and very restrictive diets can cause nutrition problems, so talk with your clinician first. |
| Stress and mood | Promising | Stress can set off flares, and living with visible psoriasis can affect mood and sleep. Stress-reducing habits and mental health support may help you cope and may ease flares, though the skin benefit is less certain. |
| Heart and metabolic check-ups | Established | Psoriasis is linked with higher risk of heart disease, high blood pressure, high cholesterol, and type 2 diabetes. Regular check-ups and treating psoriasis well may help lower those risks. |
Read: Anti-inflammatory eating
Avoid very restrictive diets, especially for children, unless a clinician is guiding you.
Psoriasis ·
When to get care soon
- Joint pain, swelling, or stiffness, especially stiff joints in the morning, a finger or toe that looks like a swollen sausage, or heel or lower back pain. These can be signs of psoriatic arthritis, where early care helps protect joints.
- Redness spreading over most of the body, especially with pain, burning, or feeling chilled, or pus-filled bumps that spread quickly. Seek urgent care.
- Fever, fast heartbeat, or feeling very unwell along with a skin flare.
- Signs of skin infection, such as warmth, increasing pain, swelling, oozing, or crusting.
- Eye pain, redness, or changes in vision.
- Sudden small, drop-shaped spots over the body after a sore throat.
- Not improving despite your current plan, or flares that disrupt sleep, work, or mood.
- Unsure of the diagnosis, since several conditions look like psoriasis, especially on brown and Black skin.
About the reviewer
Raashid Haque, MD
Board Certified Dermatologist · Charlotte, NC
- 25+ years of clinical experience
- Dermatology at University of Oklahoma - Chief Resident
- Internship at Baylor College of Medicine
- LSU School of Medicine Shreveport - Valedictorian, AOA