Psoriasis: Types, Triggers and Treatment Options

Psoriasis: Types, Triggers and Treatment Options

Psoriasis is a long-term skin disease that causes itchy, scaly patches, most often on the elbows, knees, scalp and lower back. It happens when your skin produces more new cells than usual, so they pile up into thick plaques. There is no cure, but creams, light therapy and medicines that work throughout the body can clear or calm it for most people.

This article is for general information and is not medical advice.

Key takeaways

  • Psoriasis makes your skin produce more cells than usual, which leads to raised, scaly patches called plaques.
  • There are five main types: plaque, guttate, inverse, pustular and erythrodermic. Plaque psoriasis is by far the most common.
  • Common triggers include infections such as strep throat, skin injury, stress, smoking, heavy drinking, cold dry weather and some medicines.
  • Mild psoriasis is usually treated with creams and ointments. Moderate to severe psoriasis may need light therapy, pills or injected biologic medicines.
  • Psoriasis is not contagious, but it is linked to joint disease, heart disease, diabetes and depression, so regular checkups matter.

What is psoriasis and why does it happen?

Psoriasis is a chronic inflammatory skin condition in which the immune system speeds up skin cell growth. "Chronic" means it lasts a long time, often for life, and tends to come and go in cycles.

Normally your skin sheds and replaces its outer layer at a steady pace. With psoriasis, your skin produces more cells than it needs. Those extra cells build up on the surface and form plaques, which are raised patches covered in scale (flakes of dead skin). The Mayo Clinic notes that about a third of cases begin in childhood.

According to the NHS, the exact cause is unknown, but it is thought to involve the immune system, and you are more likely to have it if a close family member does. Psoriasis often first appears between the ages of 15 and 25 or between 50 and 60, and it is not contagious. You cannot catch it from someone or pass it on by touch.

Color varies with skin tone. The Mayo Clinic describes patches as pink or red with silver scale on white skin, and purple with gray scale on brown or Black skin. Other symptoms include dry, cracked skin that may bleed, itching, burning or soreness, and pitted or discolored nails.

What are the main types of psoriasis?

The five main types are plaque, guttate, inverse, pustular and erythrodermic, and each looks different and shows up in different places. You can have more than one type at the same time, and one type can change into another.

TypeWhat it looks likeWhere it usually appearsNotes
PlaqueRaised, dry, itchy patches with silvery or gray scaleElbows, knees, lower back, scalpMost common type by far
GuttateSmall, drop-shaped scaly spotsTrunk, arms, legsMostly affects children and young adults; often follows strep throat
InverseSmooth, inflamed patches without much scaleSkin folds: groin, buttocks, under the breastsWorsens with friction and sweating
PustularPus-filled blisters (pustules) on inflamed skinPalms and soles, or widespreadRare; the widespread form can be a medical emergency
ErythrodermicPeeling, intensely itchy or burning rednessMost of the bodyLeast common and most serious type; needs urgent care

Psoriasis can also affect the nails, causing pits, crumbling and nails lifting away from the nail bed. Scalp psoriasis is easy to mistake for heavy dandruff.

What triggers a psoriasis flare?

A flare is a period when symptoms get worse, and it is often set off by a specific trigger. If you have the genes for psoriasis, you may go years without symptoms until something sets it off.

The Mayo Clinic and NHS list these common triggers:

  • Infections, especially strep throat and skin infections.
  • Skin injury, such as cuts, scratches, bug bites or a bad sunburn. New patches appearing at the site of an injury is called the Koebner phenomenon.
  • Stress, which many people notice before a flare. Our piece on how chronic stress and cortisol show up on your skin explains the link.
  • Cold, dry weather, which dries skin and makes cracking more likely.
  • Smoking and heavy alcohol use. Smoking may raise both your risk of getting psoriasis and how severe it becomes.
  • Certain medicines, including lithium, some blood pressure drugs and antimalarials.
  • Stopping corticosteroid pills or injections suddenly.
  • Obesity and pregnancy, both noted by the NHS.

Keeping a simple flare diary (date, what you ate, sleep, stress level, illness, weather) can help you and your doctor spot your personal patterns.

How is psoriasis different from eczema?

Psoriasis usually forms thick, well-defined, scaly plaques on the outside of the elbows and knees, while eczema tends to cause intensely itchy, less sharply bordered patches in the creases of the elbows and knees. Both are inflammatory and both can itch, so they are easy to confuse.

The AAD comparison of eczema and psoriasis notes that eczema itch can be intense, while psoriasis itch in children is often milder, and that eczema is far more common in children (psoriasis affects almost 1% of children). Some people have both conditions. For a full look at the other condition, read our guide to eczema (atopic dermatitis) symptoms, triggers and treatment.

Facial redness is a third source of confusion. If your redness centers on the cheeks and nose with flushing and small bumps, it may be rosacea, which has its own types and triggers. A dermatologist can usually tell these apart by looking at your skin, nails and scalp, and occasionally takes a small skin sample (biopsy) to confirm.

What treatments work for psoriasis?

Treatment depends on the type of psoriasis, how much skin it covers and how much it affects your life, and many people use a combination. There is no single best treatment, so you may try a few before finding what works.

Topical treatments

Topicals are medicines you apply to the skin, and they are usually the first step for mild to moderate psoriasis. Options listed by the American Academy of Dermatology (AAD) and the NHS include:

  • Corticosteroids (steroid creams, ointments, lotions and foams) to reduce inflammation and itch.
  • Vitamin D analogues, synthetic forms of vitamin D that slow skin cell growth and help flatten thick plaques.
  • Calcineurin inhibitors (tacrolimus and pimecrolimus), often used on sensitive areas such as the face and skin folds.
  • Tazarotene, a topical retinoid often paired with a steroid. It makes skin more sensitive to the sun.
  • Coal tar, an older treatment for scale and itch, and salicylic acid, which helps lift scale.

Phototherapy

Phototherapy (light therapy) exposes your skin to controlled amounts of ultraviolet light, usually in a clinic, a few times a week. It is often considered when creams are not enough and should only be done under a dermatologist's supervision. Home tanning beds are not a substitute for supervised treatment, and the AAD notes that some topicals, such as tazarotene, require sun protection. Our guide to checking moles with the ABCDE rule is useful if you have had a lot of UV exposure.

Systemic medicines

Systemic medicines work throughout the whole body and are used for more extensive or disabling psoriasis. The AAD lists:

  • Methotrexate, used for decades for severe psoriasis. You should avoid alcohol while taking it.
  • Cyclosporine, a fast-acting option for extensive or disabling disease.
  • Acitretin, an oral retinoid (vitamin A related drug).
  • Apremilast, a twice-daily pill for plaque psoriasis and psoriatic arthritis.

Biologics

Biologics are injected or infused medicines made from living cells that block specific parts of the immune system driving psoriasis. They are an important option for moderate to severe psoriasis and psoriatic arthritis. A peer-reviewed review in the National Library of Medicine groups them by target:

  • TNF inhibitors: adalimumab, etanercept, infliximab, certolizumab pegol.
  • IL-12/23 inhibitor: ustekinumab.
  • IL-17 inhibitors: secukinumab, ixekizumab, brodalumab.
  • IL-23 inhibitors: guselkumab, tildrakizumab.

"IL" stands for interleukin, a type of immune signaling protein. Biosimilars are medicines highly similar to an existing biologic. Because systemic drugs and biologics affect the immune system, your doctor will screen you before you start and monitor you with regular checkups.

How can you care for psoriasis skin at home?

Gentle bathing and daily moisturizing are the core of home care, because they soften scale, ease itch and protect cracked skin. They do not replace medical treatment, but they make it work better.

The AAD's bathing tips for psoriasis suggest this routine:

  1. Bathe or shower once a day, keeping showers to about 5 minutes and baths to 15 minutes or less.
  2. Use warm, not hot, water.
  3. Wash with a gentle, moisturizing cleanser for sensitive skin. Skip deodorant soaps and scrubs.
  4. Use your hands instead of washcloths, loofahs or buff puffs, which can irritate skin.
  5. Rinse gently but thoroughly, then pat dry, leaving skin slightly damp.
  6. Within five minutes, apply a fragrance-free moisturizer to all of your skin. A thick cream or ointment works best.
  7. Apply another layer of thick cream or ointment before bed.

Many of the habits in our skincare routine for dry skin and winter care also help psoriasis, especially in cold months. Beyond skin care, quitting smoking, limiting alcohol and managing stress can reduce flares. Simple tools from our daily stress management toolkit are a good place to start.

Common mistakes when managing psoriasis

  • Picking or scratching scale. Injury can trigger new patches. Soften scale with moisturizer or a salicylic acid product instead.
  • Stopping treatment as soon as skin clears. Ask your doctor how to taper or maintain. The Mayo Clinic lists rapid withdrawal of corticosteroid pills or injections as a flare trigger.
  • Using leftover steroid creams on the face or skin folds without guidance. These areas need a treatment chosen for them, such as the calcineurin inhibitors the AAD lists for sensitive skin.
  • Trying to self-treat with sunburn or tanning beds. Severe sunburn is a known trigger, and light therapy works best when a dermatologist controls the dose.
  • Ignoring joint pain. Stiff, swollen joints may be psoriatic arthritis, which needs its own treatment.
  • Using hot water and fragranced products. Both dry and irritate skin.

When to see a doctor

See a doctor if you think you have psoriasis or your treatment is not working. Get urgent care for the signs the NHS marks as emergencies.

  • Skin quickly turns red and is covered in white, pus-filled bumps that join together (seek emergency care).
  • Patches on the feet turn yellow-brown and fill with pus, or red, scaly, pus-filled bumps appear on the fingertips or toes.
  • Rash or redness covers most of your body, especially with fever, chills, a fast heartbeat or feeling very unwell (seek emergency care).
  • Recurring joint pain, stiffness or swelling, which may signal psoriatic arthritis.
  • Patches that are painful, bleeding, cracking or spreading.
  • Side effects from your treatment, or no improvement after several weeks.
  • Eye pain, redness or blurred vision, since psoriasis is linked to eye inflammation.
  • Psoriasis that is affecting your mood, sleep, work or relationships.

Frequently asked questions

Is psoriasis contagious?

No. The NHS confirms psoriasis is not contagious. It is driven by your immune system and genes, so you cannot catch it from or spread it to anyone, even through direct skin contact.

Can psoriasis go away on its own?

Psoriasis usually cycles between flares and calmer periods that can last weeks or months, but the Mayo Clinic describes it as a chronic condition with no cure. Treatment can keep it quiet for long stretches.

Does diet affect psoriasis?

No single diet cures psoriasis, but the NHS lists obesity and alcohol as triggers, and the Mayo Clinic links psoriasis to diabetes and heart disease. Keeping a healthy weight and drinking less can help both your skin and your overall health.

Are biologics safe?

The AAD calls biologics an important option for moderate to severe psoriasis and psoriatic arthritis. Because they act on the immune system, your doctor will check your health before you start and monitor you with regular follow-up visits.

What to do next

  1. Book an appointment with your doctor or a dermatologist to confirm the diagnosis and type of psoriasis.
  2. Start the daily bathing and moisturizing routine above.
  3. Keep a flare diary for a month to identify your triggers.
  4. Tell your doctor about any joint pain, nail changes, mood changes or other health conditions.
  5. Follow up regularly so your treatment plan can be adjusted as your skin changes.

Sources

Last reviewed: November 2026.

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