Psoriasis is a chronic autoimmune skin condition affecting approximately 2–3% of the UK population — around 1.8 million people. It causes skin cells to grow too quickly, building up in red, scaly patches that can be itchy, sore, and psychologically distressing. While there is currently no cure, psoriasis can be effectively managed with a range of treatments, from topical creams to advanced biological therapies available on the NHS.
What Is Psoriasis?
In healthy skin, cells grow and shed in a cycle of about 3–4 weeks. In psoriasis, an overactive immune system triggers skin cells to replace themselves in just 3–7 days — far faster than they can shed. This rapid cell turnover causes cells to pile up on the skin’s surface, forming the characteristic thick, scaly plaques. Psoriasis is not contagious — it cannot be passed from person to person.
Types of Psoriasis
| Type | Frequency | Description |
|---|---|---|
| Plaque psoriasis (psoriasis vulgaris) | ~80–90% | Red, raised patches covered with silvery-white scales; typically on elbows, knees, scalp, and lower back |
| Guttate psoriasis | ~10% | Small, drop-shaped red lesions; often triggered by streptococcal throat infection; common in children and young adults |
| Inverse (flexural) psoriasis | Common | Smooth, red patches in skin folds (armpits, groin, under breasts); no scales |
| Pustular psoriasis | Less common | White pus-filled blisters surrounded by red skin; can be localised (hands/feet) or generalised (rare, serious) |
| Erythrodermic psoriasis | Rare | Widespread redness and shedding across the whole body; medical emergency — can affect temperature regulation and heart function |
| Scalp psoriasis | ~50% of cases | Extends beyond the hairline; causes flaking mistaken for dandruff; can cause temporary hair loss |
| Nail psoriasis | ~50% of cases | Pitting, thickening, discolouration, and separation of the nail from the nail bed |
Psoriasis Symptoms
- Red, inflamed patches of skin covered with silvery-white scales (plaques)
- Dry, cracked skin that may bleed
- Itching, burning, or soreness — can range from mild to severely debilitating
- Thickened, pitted, or ridged nails
- Swollen and stiff joints — psoriatic arthritis (see below)
- Skin in affected areas may flare and clear in cycles, with periods of remission
Psoriatic Arthritis
Around 30% of people with psoriasis develop psoriatic arthritis — painful joint inflammation that can cause permanent joint damage if untreated. It can affect any joint and may develop before, after, or at the same time as skin symptoms. See your GP promptly if you have psoriasis and develop joint pain, swelling, or stiffness — early treatment prevents damage.
Psoriasis Triggers
- Stress — one of the most common triggers; creates a vicious cycle as psoriasis itself causes stress
- Infections — streptococcal throat infection (especially for guttate psoriasis); HIV can worsen psoriasis
- Medications — beta-blockers, lithium, antimalarials (chloroquine), NSAIDs, and some antibiotics can trigger or worsen psoriasis
- Skin injury — cuts, scrapes, sunburn, tattoos (Koebner phenomenon — psoriasis appearing at the site of injury)
- Smoking — increases severity and reduces treatment response
- Alcohol — excess alcohol reduces treatment effectiveness and increases severity
- Hormonal changes — puberty, pregnancy, and menopause can trigger flares
- Cold, dry weather — many people improve in summer and flare in winter
NHS Treatment for Psoriasis
Step 1: Topical Treatments (First Line)
- Emollients (moisturisers) — essential for all psoriasis; reduce itching, scaling, and cracking; applied liberally and frequently; available on NHS prescription
- Topical corticosteroids — reduce inflammation and scaling; most effective treatment for mild-moderate psoriasis; must be used correctly to avoid skin thinning; potency chosen based on body area
- Vitamin D analogues — calcipotriol (Dovonex), calcitriol; slow cell growth; often used in combination with steroids (Dovobet = calcipotriol + betamethasone)
- Coal tar — reduces inflammation and scaling; old-fashioned but effective, especially for scalp psoriasis; messy and smelly but works
- Dithranol — very effective for thick plaques; stains skin and clothing; usually used in day treatment centres
- Calcineurin inhibitors (tacrolimus/pimecrolimus) — for sensitive areas like face and skin folds; steroid-sparing
Step 2: Phototherapy
For moderate-severe psoriasis not controlled by topicals, the NHS offers phototherapy in hospital outpatient settings:
- Narrowband UVB (NB-UVB) — 2–3 sessions per week for 6–12 weeks; very effective with minimal side effects; preferred over PUVA
- PUVA (psoralen + UVA) — psoralen (oral or topical) sensitises skin to UVA light; requires eye protection on treatment day; slight increased skin cancer risk with long-term use
Step 3: Systemic Medications
- Methotrexate — weekly tablets or injection; reduces immune cell activity; requires regular blood tests; avoid alcohol; effective for psoriasis and psoriatic arthritis
- Ciclosporin — rapid response; used for flares; limits 1–2 years due to kidney side effects; blood pressure monitoring required
- Acitretin — retinoid (vitamin A derivative); oral tablet; very effective for pustular psoriasis; cannot be used in pregnancy (teratogenic)
- Dimethyl fumarate (Skilarence) — newer oral option; taken 3 times daily; flushing and GI side effects common initially
Step 4: Biological Therapies (Severe Psoriasis)
Biologic drugs have transformed treatment of severe psoriasis. NICE has approved numerous biologics for psoriasis that hasn’t responded to conventional treatments. These are injected (usually fortnightly or monthly at home with a pre-filled pen):
- IL-17 inhibitors: secukinumab (Cosentyx), ixekizumab (Taltz), bimekizumab (Bimzelx) — fastest and most effective for skin clearance; 80–90% achieve PASI 90 response
- IL-23 inhibitors: guselkumab (Tremfya), risankizumab (Skyrizi), tildrakizumab (Ilumetri) — dosed less frequently (every 2–3 months after loading); excellent long-term response rates
- TNF inhibitors: adalimumab (Humira and biosimilars), etanercept (Enbrel and biosimilars) — established biologics; also treat psoriatic arthritis
- IL-12/23 inhibitor: ustekinumab (Stelara) — dosed every 12 weeks after loading
Skin Confidence and Psychological Impact
Psoriasis significantly impacts quality of life — studies show its psychological impact is comparable to heart disease and diabetes. Depression, anxiety, and social withdrawal are common. The NHS IAPT (Talking Therapies) service can provide CBT for the psychological impact of chronic skin conditions. Dermatology clinics often have access to clinical psychologists.
Psoriasis and Associated Health Risks
People with moderate-severe psoriasis have increased risk of cardiovascular disease (due to systemic inflammation), type 2 diabetes, obesity, depression, inflammatory bowel disease, and kidney disease. Treating psoriasis effectively may reduce these systemic risks. Regular GP health checks are important.
Support and Resources
- The Psoriasis Association (psoriasis-association.org.uk) — helpline: 01604 251 620; excellent patient information
- Changing Faces — charity supporting people with visible skin differences
- NICE guidelines NG35 — psoriasis assessment and management; freely available online
This article is for informational purposes only and does not constitute medical advice. See your GP or dermatologist for diagnosis and treatment recommendations.
Related Health Guides on YourHealthXpert
Explore these related NHS-aligned health guides:
- Eczema (Atopic Dermatitis) — psoriasis and eczema are both inflammatory skin conditions; they can coexist and share some treatments
- Rheumatoid Arthritis — psoriatic arthritis affects up to 30% of people with psoriasis; biologic treatments overlap
- Anxiety and Depression — psoriasis significantly impacts mental health; depression is very common
- High Cholesterol — psoriasis is associated with increased cardiovascular risk; cholesterol monitoring recommended
- High Blood Pressure — hypertension is more common in people with psoriasis; part of the metabolic syndrome link