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The immune system mistakenly attacks healthy skin cells, causing them to build up and form thick, scaly patches.

By: Mercura Wang

Psoriasis is the second most common autoimmune condition in the United States.

Far from being just a “skin problem,” psoriasis is a complex, autoimmune condition with a genetic basis that causes the immune system to mistakenly attack healthy skin cells.

It’s like the body’s security system is overzealous–working too hard to protect you–but in doing so, it creates the thick, scaly patches that characterize this condition. These patches can appear anywhere on the body, but mainly on the lower back, elbow, knee, or scalp.

While there’s no cure yet, with the right combination of treatments and lifestyle changes, many people with psoriasis live full, active lives with minimal symptoms.

What Are the Symptoms and Early Signs of Psoriasis?

Psoriasis manifests in several distinct forms that can occur individually or together, sometimes shifting over time. The most common type, plaque psoriasis, accounts for about 85 percent to 90 percent of all cases.

Plaque psoriasis typically starts with small, symmetrical skin lesions about 1/8 inch wide, which gradually grow. The condition varies widely between people, with a range of common symptoms, including: Thick, red patches of skin covered with silvery-white scales on areas like elbows, knees, and scalp

Dry, cracked skin

Itching, stinging, or bleeding

Nail pitting, discoloration, or separation

Severe dandruff-like scaling

Joint or tendon pain and itching

The National Psoriasis Foundation classifies psoriasis based on how much of the body surface area is affected: Mild: Affects less than 3 percent of the body

Moderate: Affects 3 percent to 10 percent of the body

Severe: Affects more than 10 percent of the body

Other forms of psoriasis include: Scalp: Appears as thick, red, scaly patches on the scalp that may extend beyond the hairline. Hair loss can occur in severe cases due to scratching or excessive combing.

Guttate: Appears as small, red, drop-like spots on the torso or limbs.

Nail: Involves pitting, discoloration, thickening, or separation of the nails, and can be mistaken for a fungal infection.

Inverse: Appears as smooth, red, irritated patches in skin folds like the groin, underarms, and under the breast. Symptoms often worsen with friction and sweating.

Pustular: Presents as white, pus-filled bumps on red skin and may be accompanied by tenderness or burning.

Erythrodermic: Involves widespread redness and scaling over most of the body and can cause severe itching, burning, fever, chills, fatigue, rapid heartbeat, joint pain, and swollen lymph nodes. This is the most severe and rare form of psoriasis.

Psoriasis is marked by unpredictable cycles of flare-ups and remission.

Flare-ups occur when symptoms become more intense or widespread, often triggered by specific factors.

Remission can last from a few months to several years, though its timing is difficult to predict.

What Causes Psoriasis?

At its core, psoriasis occurs when your immune system speeds up skin cell production. Normally, skin cells take about a month to travel from deeper layers to the surface. In people with psoriasis, this process takes just a few days, causing cells to build up and form the condition’s characteristic thick, scaly patches.

Psoriasis is driven by a combination of genetic and environmental factors, including stress, obesity, and chemicals that affect skin cell growth.

1. Genetics

Genetics play a major role in psoriasis, with heritability estimates ranging from 60 percent to 90 percent. If one parent has psoriasis, a child has about a 14 percent chance of developing it. If both biological parents are affected, the risk increases to approximately 40 percent.

2. Environmental Factors

Various external factors can trigger or worsen psoriasis, especially in people who are genetically predisposed. These triggers differ from person to person and can influence how often flare-ups occur and how severe they become.

Infections: Streptococcal infections, human immunodeficiency virus, and certain strains of human papillomavirus have been associated with psoriasis flares.

Stress: Both physical and emotional stress can trigger symptoms. A 2024 study found that adolescents with poor stress resilience had a 31 percent higher risk of developing psoriasis in adulthood compared to peers with high resilience.

Chemical exposure and pollution: Exposure to pollutants–such as heavy metals like cadmium and volatile organic compounds–may aggravate symptoms.

Certain medications: Some blood pressure medications, lithium, and nonsteroidal anti-inflammatory drugs have been linked to flare-ups–especially when discontinued abruptly.

Obesity: Obesity may worsen psoriasis by increasing water loss, sebum production, and sweating, while impairing lymphatic flow and skin barrier function.

Skin injuries: Even minor injuries–scratches, pinpricks, or sunburns–can lead to new psoriatic lesions, a reaction known as the Koebner phenomenon.

Smoking: Smoking may trigger or worsen psoriasis by increasing oxidative stress, disrupting immune pathways, and interacting with psoriasis-related genes.

Alcohol: Heavy alcohol use is associated with more severe, widespread psoriasis. It often affects the face, groin, and skin folds or presents as thickened lesions on the limbs.

Vaccines: COVID-19 m RNA vaccines have been associated with new-onset psoriasis or flares, primarily after the second dose. A direct causal relationship has not been established. Other vaccines, including H 1 N 1 and tetanus-diphtheria, have also been linked to psoriasis in some cases.

Colder weather: Psoriasis is more common and tends to develop earlier in colder climates. Higher prevalence has been observed among African and Caucasian Americans living in cold regions compared to people of any ethnicity living in Africa.

Other risk factors for psoriasis: Race: More common in Caucasians than in other ethnic groups.

Age: Typically begins during one of two peak periods–ages 30 to 39 or 60 to 69.

How Is Psoriasis Diagnosed?

Psoriasis is usually diagnosed clinically by a dermatologist. There’s no single blood test for psoriasis, so doctors rely on a physical examination of the skin, nails, and scalp. They also ask about family history and discuss possible symptoms and potential triggers.

Tests used to diagnose psoriasis and related complications include:

Skin biopsy: Confirms a diagnosis of psoriasis and rules out other skin conditions. Involves taking a small sample of skin, which is examined under a microscope by a pathologist.

Uric acid test: Measures the level of uric acid in the blood or urine to check for gout, a condition that can occur alongside psoriasis.

Psoriasis area and severity index: The most widely used tool for assessing the severity and extent of psoriasis.

What Are the Natural and Lifestyle Approaches to Psoriasis?

Some lifestyle strategies may be effective and have fewer side effects, but it’s important to consult a doctor before trying them.

1. Spa Therapy

Spa therapy, which uses natural resources such as mineral baths, is often used to treat certain skin conditions. A 2022 study found that spa therapy improved symptoms such as itchiness in both the short and long term.

Combining sun exposure with Dead Sea bathing has shown notable short-term improvement in psoriasis symptoms. Even indoor saltwater baths combined with ultraviolet B(UVB)therapy have been found to be more effective than UVB therapy alone.

2. Natural Topical Treatments

Some naturally derived ingredients may help ease psoriasis symptoms when applied directly to the skin. While results can vary, several topical options have shown promise in reducing inflammation, scaling, and discomfort.

Turmeric: A plant that contains curcumin, a powerful anti-inflammatory compound. May be applied topically as a paste or taken as a supplement.

Oregon grape: Used in 10 percent topical creams, shown to reduce symptoms in studies.

Dead Sea products: Include saltwater baths and minerals that may help normalize immune responses.

3. Anti-Inflammatory and Gluten-Free Diets

Dietary changes and nutritional therapy may help improve psoriatic skin lesions and lower the risk of related complications. Several eating patterns have been shown to reduce symptoms, including: Anti-inflammatory diets

Your food choices can significantly affect psoriasis severity. Focus on: Fish rich in omega-3 s: Help reduce inflammation. Examples include salmon, mackerel, and sardines. A 2020 review of nearly 1, 000 participants found that fish oil, when used alongside standard treatments, may help improve psoriasis and related conditions such as obesity, heart disease, and metabolic disorders.

Colorful fruits and vegetables: Packed with antioxidants that help fight inflammation.

Whole grains and legumes: Provide steady energy and dietary fiber.

Nuts and seeds: Offer healthy fats and minerals.

Mediterranean diet: Research consistently shows that the Mediterranean diet helps manage psoriasis. Rich in olive oil, fish, vegetables, and moderate red wine, it naturally reduces inflammation throughout the body.

Gluten-free trial

Some people with psoriasis have silent gluten sensitivity. If you have moderate to severe psoriasis, a 3-month gluten-free trial may help reveal if gluten is triggering your flares.

Other foods to limit or avoid include: High in additives and preservatives

Excessive alcohol

High-fat dairy products

High in added sugars

4. Low-Impact Activities

Although exercise may seem challenging, it can reduce psoriasis symptoms by lowering the risk of related conditions, and easing stress, depression, and anxiety.

Low-impact activities such as swimming, walking, and cycling–along with strength training–are commonly recommended for people with psoriasis.

Moderate to vigorous exercise may also help prevent psoriasis. Using exercise as a weight management strategy can reduce disease severity, especially in people who are overweight. It’s important to avoid overexertion and seek personalized advice from a physical therapist.

5. Meditation

Meditation and mindfulness-based stress reduction may be helpful complementary treatments. A 2022 systematic review found that these practices can improve short-term psoriasis symptoms. In one study, patients who listened to mindfulness meditation audio during UVB or psoralen plus ultraviolet A(PUVA)therapy–a type of phototherapy–reached both halfway and full-clearing milestones significantly faster than those who received light treatment alone.

What Are the Medical Treatments for Psoriasis?

Psoriasis has no known cure, but treatment focuses on effective symptom management. Care typically begins with milder therapies and progresses to stronger options. Treatments are often combined for better results.

1. Topical Treatments

Topical treatments are the first-line option for mild to moderate psoriasis. Low-strength creams and ointments are available over the counter, while stronger versions require a prescription.

Emollients: Moisturizers that soften and hydrate the skin.

Corticosteroids: Creams that reduce inflammation, itching, and excess skin cell growth.

Vitamin D analogs: Synthetic forms of vitamin D(such as calcipotriene and calcipotriol)that slow skin cell production and reduce inflammation.

Calcineurin inhibitors: Creams like tacrolimus and pimecrolimus that reduce inflammation. Best for sensitive areas such as the face or skin folds.

Salicylic acid: An exfoliating ingredient that softens and removes plaques.

Retinoids: Vitamin A-based treatments, such as tazarotene, that reduce scaling, redness, and plaques.

Coal tar: Slows cell growth and reduces inflammation. May cause irritation or staining and is not recommended during pregnancy or breastfeeding.

Dithranol (anthralin): Slows skin cell growth and may lead to long-term remission. Best for chronic psoriasis, but not for inflamed areas.

Tapinarof cream: A newer anti-inflammatory treatment. About 40 percent of users had clear or nearly clear skin after 12 weeks.

Roflumilast cream: Quickly reduces inflammation and itching, and works well on sensitive skin.

Occlusive tapes: Applied to palms and soles to lock in moisture and boost absorption of topical treatments.

2. Light Therapy

Phototherapy, or light therapy, uses natural or artificial light to treat psoriasis and must be administered under a dermatologist’s supervision.

Heliotherapy: Involves exposure to natural sunlight to reduce the extent and severity of psoriasis.

UVB: Shortwave ultraviolet B light slows skin cell growth and reduces inflammation. Typically delivered in a booth with fluorescent lights, two to three times per week for up to three months.

PUVA: Combines a light-sensitizing drug with ultraviolet A light that penetrates deeper into the skin. Carries higher risks, including nausea and an increased risk of skin cancer.

3. Systemic Treatments

When psoriasis is widespread or treatment-resistant, systemic medications may be used. These include nonbiological(typically oral)and biological(typically injectable)therapies.

Nonbiological medications: Include methotrexate(slows skin cell growth), cyclosporine(reduces inflammation), apremilast(clears plaques), retinoids(such as acitretin and isotretinoin), and deucravacitinib. These drugs are often called small-molecule treatments, which are chemically synthesized, low-molecular-weight compounds that target specific inflammatory pathways. Not all nonbiological drugs fall into this category.

Biologics: This group includes genetically engineered drugs that precisely target specific parts of the autoimmune response. Includes tumor necrosis factor-alpha(TNF-alpha)inhibitors–which block a protein that drives inflammation–such as adalimumab and etanercept. Other biologics include interleukin inhibitors, which target other inflammation-related pathways.

4. Supplements

Certain supplements may help improve psoriasis symptoms when used alongside standard care.

Genistein: An isoflavone found in soybeans with anti-inflammatory and antiproliferative effects. Genistein is safe and well-tolerated and has shown positive effects on inflammatory markers in mild to moderate psoriasis.

Pine bark extract: In a 2014 observational study, 73 adults with moderate to severe plaque psoriasis took 150 milligrams of Pycnogenol–a standardized French maritime pine bark extract–daily for three months, in addition to standard treatment. Participants who received the supplement saw significantly better outcomes than those receiving standard care alone, including improved skin hydration and reduced redness, thickness, and scaling.

5. Apitherapy

Apitherapy, a traditional folk medicine practice, uses honey bee products for healing. Propolis, a resin made by bees from plant substances, has anti-inflammatory and immune-regulating properties. A 2018 study found that a 50 percent propolis and 3 percent aloe vera ointment significantly improved mild to moderate palmoplantar psoriasis.

          (The Epoch Times. com)