Psoriasis does not lead directly to scarring, but it causes lesions that can be itchy, and a person may scratch them. If the itching is severe and the area is scratched, this can result in delayed healing, hyperpigmentation, or possible scarring.
Psoriasis is a chronic inflammatory disease that can affect the skin, joints, and other organ systems.
It causes raised, scaly, silvery plaques to form on various areas of the body. The plaques can be very itchy and thick. They may appear anywhere on the skin.
Symptoms can worsen at times, and people sometimes call these periods flares or relapses. The symptoms may then go away for a while before returning.
For many people with psoriasis, the skin may never be completely clear.
In addition to scratching, skin affected by psoriasis can become dry and might crack and break. Both of these factors can lead to scarring, and any scars that form are permanent.
However, receiving the right treatment and taking the right steps can reduce the risk of scarring.
Psoriasis scars can happen for a number of reasons, including when:
- a person breaks the skin by scratching it, causing bleeding
- continued scratching leads to open sores and skin infection
- cracks or breaks form in the dry skin on severely affected areas
With the right care, however, most people’s skin will improve after a flare, and they will have fewer lesions and no scars.
After a psoriasis relapse, skin discoloration often remains for a while before clearing. This discoloration is not a scar. Doctors usually call it post-inflammatory pigmentation.
Managing skin symptoms during a flare, especially itching, can reduce the risk of scarring.
If scarring does occur, however, treatment can help reduce the appearance or worsening of scars.
A doctor will make recommendations for treatment depending on the extent of the scarring and the reason that it developed.
These treatments may reduce or improve the appearance of scar tissue that has formed or prevent it from worsening.
Sunscreen, especially mineral-based sunscreen, is recommended for all scars. Consistently using sunscreen with an SPF of at least 30 protects against scar discoloration that can result from sun exposure.
Sunscreen can also prevent psoriasis symptoms from worsening due to excessive sun exposure.
However, exposure to the sun might also decrease flares. Some people with psoriasis benefit from limiting or controlling their sun exposure. Speak with a doctor about how much and what type of exposure is suitable.
Silicone gel or silicone gel sheets are often used to flatten or soften thick, raised scars during the healing process. These are available over the counter and are generally applied over the affected area daily.
More research is needed to understand exactly how they work for scar healing.
People using silicone sheets for psoriasis scars should be careful to make sure any adhesive bandages do not rip off and irritate the skin, which could cause a flare.
A doctor may prescribe tretinoin to reduce the scarring. Retinoids such as tazarotene may also help. The main aim of these medications is not to treat scarring. However, a doctor may prescribe them off-label for this purpose.
Dermabrasion can help with scarring that remains after a flare. However, skin injury can trigger psoriasis symptoms, and doctors do not often recommend this treatment for people with psoriasis.
The best way to prevent scarring is to minimize flares, prevent breaks in the skin, and avoid infections in the affected areas whenever possible.
There are also some treatment options to help with prevention.
Products containing the following ingredients may reduce flares and the risk of scarring when applied to the skin.
This is a common ingredient in over-the-counter (OTC) psoriasis treatments. It helps remove dead skin cells and reduce scaling. It is also available by prescription. Combining salicylic acid with corticosteroids or coal tar may increase its effectiveness.
This can help reduce the itchiness and scaling and, as a result, prevent scarring. It is an ingredient in a number of products, including soaps and shampoos.
A variety of topical corticosteroids can reduce inflammation and help manage symptoms of psoriasis.
Antihistamines and OTC anti-itch creams can help provide relief from psoriasis symptoms. Keeping itching under control can help reduce scratching, which can cause flares and scarring.
Laser and light therapy
Different types of light therapy can help reduce the risk of scarring by relieving symptoms.
Excimer laser therapy — for example, XTRAC — can help remove layers of skin by directing concentrated ultraviolet light to specific areas of the skin.
The advantage of laser therapy is that it targets lesions directly and does not affect other areas of the skin. Phototherapy is another option.
In addition to preventive treatment, a person can follow these tips to help prevent psoriasis scarring:
- Know the triggers: If stress, certain foods, or smoking seem to trigger a flare, try to avoid these factors. Exercise, such as yoga, may help with stress.
- Treat the psoriasis flare: This includes sticking to the treatment plan and attending routine follow-ups with a dermatologist. Usually, the best method to keep psoriasis flares under control is prescription medications.
- Avoid scratching: The skin damage from scratching can cause scar tissue to form.
- Treat infections: Without treatment, skin infections can lead to lasting damage to the skin and scarring. Be sure to monitor the skin for any infections and see a doctor for treatment when necessary.
- Manage sun exposure: Apply sunscreen before going out, even if the sun is not especially bright. Also, be aware that some medications — such as retinoids — can increase the risk of sun damage.
- Moisturize: Moisturizers can relieve dryness and itchiness. The American Academy of Dermatology recommends that people with psoriasis apply moisturizer within 5 minutes of taking a bath or shower.
Below we answer a few commonly asked questions about psoriasis and skin healing.
How do I get rid of psoriasis scars?
While scars are permanent, there are steps a person can take to reduce the appearance of psoriasis scars. Working with a dermatologist is the best way to create a plan of action for minimizing psoriasis scars.
Can topical treatments such as coal tar actually get rid of scars or only prevent them by reducing itchiness?
Topical treatments will not get rid of scarring. Adequate treatment of itching is crucial in preventing the damage that can result from scratching.
Several treatment options exist for psoriasis, such as topicals, phototherapy, and biologics. It is important to talk with a dermatologist about the most appropriate treatment option for psoriasis.
Does psoriasis leave dark spots?
After a flare, psoriasis can leave dark spots on the skin during the healing process. This is known as post-inflammatory hyperpigmentation. It may be more noticeable on darker skin tones compared with lighter ones.
For some people with darker skin tones, psoriasis might also leave lighter spots on the skin. This is called post-inflammatory hypopigmentation and should resolve over time.
Does psoriasis scar the skin?
The condition itself does not cause scars. However, when psoriasis causes severe itching that leads to scratching and breaks in the skin, this can lead to scarring. If the skin that is affected by psoriasis becomes infected, this can also lead to scars.
Can psoriasis skin heal?
Eventually, skin affected by psoriasis flares should return to its usual state, though this can take weeks of healing or longer in some cases.
Living with this chronic condition means managing continual cycles of flares. However, proper treatment can help keep symptoms under control.
Appropriate care and treatment can reduce the risk of scarring related to psoriasis.
Psoriasis can negatively affect a person’s mental health. If scarring occurs, the condition can have an even greater impact on a person’s self-esteem.
However, treatment is available, and a doctor can give advice about the best options. New medications called biologics may help reduce the frequency of flares and improve baseline psoriasis symptoms, especially among people with moderate to severe symptoms.