Psoriasis is a chronic inflammatory disease that can cause raised, scaly, silvery plaques to form on various areas of the skin. It does not necessarily lead to scarring, but if the itching is severe and the person scratches the area, scarring can occur.
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. Psoriasis is a chronic condition, and there are times when symptoms are better, then worse.
Psoriasis does not lead directly to scarring, but the lesions can be itchy, and a person may scratch them. Also, the skin can become dry, and it can 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.
There are several types of psoriasis, but they all involve periods of relapse and remission.
After a relapse, skin discoloration often remains for a while before clearing. This discoloration is not a scar. Doctors usually call it post-inflammatory pigmentation changes.
If a person receives effective treatment, their psoriasis is unlikely to cause scars.
Scarring can occur, for example, when a person breaks the skin by scratching it.
With the right treatment and care, however, most people’s skin will improve after a flare, and they will have fewer lesions and no scars.
Scarring does not usually lead to complications, but it can affect a person’s self-confidence.
Here, learn more about scalp psoriasis.
Managing skin symptoms during a flare can reduce the risk of scarring. If scarring does occur, however, treatment can help.
The following options can either help prevent scarring or reduce the appearance of scars:
- topical creams
- laser therapy
A doctor will make recommendations, depending on the extent of the scarring and the reason that it developed.
These mainly aim to limit the risk of scarring by helping to manage symptoms. They may also reduce scar tissue that has already formed.
A doctor may recommend using one or more of the following:
Sunscreen: This can prevent symptoms from worsening due to excessive sun exposure. Applying sunscreen to an area that is healing can also help prevent color changes due to exposure.
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.
Tretinoin cream: A doctor may prescribe tretinoin to diminish the scarring. Retinoids, such as tazarotene, may also help. The main aim of these medications is not to treat scarring, but a doctor may prescribe them off-label for this purpose.
Salicylic acid: This is a common ingredient in over-the-counter 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.
Coal tar: 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.
Topical corticosteroids: A variety of topical corticosteroids can reduce inflammation and help manage skins symptoms of psoriasis.
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 is targets lesions directly and does not affect other areas of the skin. Phototherapy is another option.
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.
Rarely, scars are severe enough to warrant a specialized grafting procedure. One option is punch graft surgery.
However, it is unusual for skin damage from psoriasis to need this kind of treatment. Anyone considering this type of treatment should first discuss all the options with their doctor.
The best way to prevent scarring is to avoid a flare, if possible, and to manage symptoms when a flare occurs.
Treating the psoriasis flare: This includes sticking to the treatment plan and attending routine follow-ups with a dermatologist.
Avoiding scratching: The skin damage from scratching can cause scar tissue to form. Using doctor-approved creams and ointments can help reduce itchiness and other discomfort.
Managing sunlight 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.
Moisturizing: Moisturizers can relieve dryness and itchiness. The American Academy of Dermatology recommend that people with psoriasis apply moisturizer within 5 minutes of taking a bath or shower.
Appropriate care and treatment can reduce the risk of scarring related to psoriasis.
New medications, called biologics, may help reduce the frequency of flares and improve baseline psoriasis involvement, especially among people with moderate to severe symptoms.
If scarring occurs, it can sometimes affect a person’s self-esteem. However, treatment is available, and a doctor can give advice about the best options.
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 see a dermatologist to discuss the most appropriate treatment option for psoriasis.
Owen Kramer, MD Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.