Psoriasis is a chronic autoimmune condition that can lead to skin rashes, scaly patches, and other skin changes. Itching is a common symptom of psoriasis.
Some people with psoriasis experience intense itching, and scratching increases the risk of infection. While there is no cure for psoriasis, the right combination of creams, medications, and home remedies can relieve the itching.
In this article, we explain why psoriasis often causes itching and how to prevent it.
Between 70–90% of people with psoriasis experience itching.
Psoriasis develops when the immune system becomes overactive, causing the body to generate new skin cells much faster than usual. This results in raised white or silvery patches (plaques) that may be painful and itchy.
Inflammation causes the itching sensation. Inflammation is the process that the body uses to fight infection, to protect itself against disease-causing agents and respond to wounds.
When a person has psoriasis, however, the immune system incorrectly triggers inflammation, which leads to itching. Scratching the itchy patches may make the plaques worse and increase the risk of infection.
Frequent scratching can irritate the skin, causing wounds and increasing healing time. In response to this, the body increases levels of inflammation in an attempt to heal these wounds, making the itch worse.
The National Psoriasis Foundation advise that the itch from psoriasis may feel like a 'biting, burning sensation' similar to a fire-ant bite.
People with inverse or flexural psoriasis may also develop yeast infections on or near skin lesions. Yeast is a type of fungus that can increase the pain and itchiness of psoriasis.
Do all types of psoriasis itch?
Plaque psoriasis, a type that causes scaly, often gray-looking patches, is the most common type of psoriasis. It is also the most common cause of psoriatic itching, although other forms of psoriasis may also itch.
However, the severity of an itch may vary between one flare and the next. One psoriasis flare may only cause mild itching, while the following flare could result in severe itching sensations.
It is possible for one person to have multiple types of psoriasis at once and develop lesions that do not itch or only cause mild itching.
Many treatment options are available to help people who experience psoriatic itching.
Dry skin can make psoriasis worse, particularly in dry climates and during the winter months.
Applying heavy moisturizers after a shower and several times each day can help a person soothe itching, prevent dry, cracking skin, and promote faster healing.
The American Academy of Dermatology recommend that people with psoriasis apply moisturizer once a day, or more often if the skin becomes extremely dry.
Cool or warm compresses
Some people might experience temporary relief from the itching by using cold compresses and taking cool showers.
Others also find that warm compresses ease the pain, so alternating between warm and cold compresses may help with both itching and discomfort.
People should not take hot baths and try to avoid being in the shower for longer than 10 minutes, as this can increase irritation. Applying lotion after a cool bath can help a person retain moisture in the skin, reducing the risk of dryness and itching.
Numbing and anti-itch creams
Numbing creams and sprays, such as benzocaine, can offer temporary relief from itching.
Other products that the United States Food and Drug Administration (FDA) have approved as effective for psoriatic itch relief include:
- calamine lotion
- aloe vera gel
- diphenhydramine hydrochloride (HCl)
Some people get relief from applying calamine lotion or bathing in Epsom or Dead Sea salts, or oatmeal, then moisturizing and applying hydrocortisone, which is a mild steroid.
People can apply topical steroids directly to their skin. Hydrocortisone cream is safe for most people, can relieve itching, and is available over-the-counter (OTC).
If hydrocortisone helps but does not fully relieve the itch, a person may wish to see a doctor and request a stronger, prescription-only hydrocortisone cream.
Keratolytics are products that soften and remove psoriasis patches, speed up healing time, and help reduce itching. Removing scales can help relieve itching and enhance the effects of other itch-relief medications. Phenol, salicylic acid, and urea are some of the OTC keratolytic products available.
If OTC keratolytics do not work, a doctor can prescribe a stronger form.
Scratching lesions alone will not make the itch worse. It can also call attention to the itching, making it feel worse and more frustrating.
Scratching will not stop the itching. Frequent or intense scratching can open up psoriasis lesions, slowing healing time, and increasing the risk of infection. People who need to relieve the itch should try gently rubbing or tapping the area near the lesions.
Using other techniques and remedies to soothe the itch can help reduce the need to scratch.
Meditation and distraction
Distracting the mind can help reduce the impact of itching on daily life. An interesting hobby, such as drawing, gardening, or painting, may help divert a person's attention from the itch.
Other people find relief through meditative techniques, such as deep breathing or yoga.
Stress is also a potential trigger for psoriasis symptoms. Therefore, activities that reduce stress may help to reduce the number of flares
Lifestyle and dietary changes
If a person with psoriasis is overweight, it may exacerbate the severity of their symptoms, including itching. Increased body fat promotes inflammation, which can make itching worse and reduce the effects of treatment.
These lifestyle and dietary changes will not provide immediate relief but can help reduce the frequency and severity of psoriasis flare-ups over time.
People can purchase skin creams and other products from a pharmacy. They are also available to purchase online. People should check with their doctor before buying any creams to make sure the cream is suitable for them.
Psoriasis has involvement with the skin but also affects many other systems in the body. Home remedies and anti-itch medications will not treat the underlying condition.
The best way to relieve psoriatic itching is to treat the condition directly. While researchers are still working on a full cure, systemic medications that work across the whole body can help reduce the number of flares and the severity of symptoms.
Some treatment options include:
- Biologics: These products use chemicals taken from living cells to target specific parts of the immune system. A doctor will administer these by injection into a vein and usually only prescribe them to people who have not responded to other treatments.
- Methotrexate: People with severe psoriasis can use methotrexate to suppress the immune system and reduce its skin involvement. However, it is a potent medication. Those taking the drug will need to undergo regular liver function tests.
- Emollients: These are off-label for psoriasis, but doctors may still prescribe them to help a person with psoriasis retain moisture in the skin, reducing itching and tenderness.
- Oral retinoids: These vitamin-A-sourced drugs are helpful for people with severe psoriasis. They work across the whole body without suppressing the immune system. This can help people with reduced immune function, such as those with HIV, control itching and flares.
- Phototherapy: Phototherapy is a light therapy that exposes the skin to controlled doses of ultraviolet light. Exposure to the sun can have a similar benefit, but it is safer to undergo controlled phototherapy in a doctor's office.
Not every treatment will work for all people with the condition. A doctor can discuss the range of options that might be best for each person.
Is psoriatic itching the worst kind?
The scale in which a person experiences any itch will differ between individuals, and the same is true with psoriatic itch.
It will likely itch more than a mosquito bite, and it might range from a mild itching sensation to a severe itch that keeps a person awake at night. The main issue with an itch is the more you scratch it, the worse it will become.
Getting early treatment during a psoriasis flare will minimize the itch and reduce the time needed for any lesions to subside.Debra Sullivan, PhD, MSN, RN, CNE, COI Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.