Psoriasis is a chronic autoimmune condition that affects the skin. Without treatment, the symptoms of psoriasis can worsen, and it can lead to other complications, such as psoriatic arthritis and diabetes.
Psoriasis causes the body to produce new skin cells in days rather than weeks. These cells accumulate on the skin’s surface, producing thick and scaly plaques that can be itchy.
This article explores what happens when a person does not receive psoriasis treatment. It also discusses the various types of psoriasis and the treatment and management options.
According to the American Academy of Dermatology (AAD), psoriasis can come and go. People can have periods of time when psoriasis calms down and their skin is nearly clear. It can also flare up again unexpectedly.
Treating psoriasis can help manage symptoms, avoid more severe flare-ups, and prevent the condition from worsening.
If a person does not receive treatment for psoriasis, the condition can continue to accelerate and worsen.
The National Psoriasis Foundation notes that a person may experience severe itching and pain affecting the skin. Psoriasis-related inflammation can also progress, leading to additional complications that affect other parts of the body.
Types of psoriasisLearn more about the different types of psoriasis:
Without treatment, psoriasis can affect a person’s quality of life significantly. Treatment is also crucial to manage psoriasis and prevent the development of other related conditions.
As an autoimmune disease, psoriasis results from immune cells in the body mistakenly attacking normal, healthy cells.
The appearance of symptoms can indicate inflammation in the body. Even a person with mild psoriasis, in which skin symptoms affect less than 3% of the body, may have substantial inflammation.
If a person does not receive psoriasis treatment, there is potential for other diseases to develop. Some of these are short-term, while others can be long lasting or even lifelong.
The short-term symptoms of psoriasis may include:
- thick, discolored skin plaques with a covering of scales that can be silvery-white, pink, salmon, gray, or violet, depending on a person’s skin tone
- dry and cracked skin that may bleed or itch
- thick, ridged, and pitted nails
Psoriasis can have periods of remission, meaning the skin is clear, and flares, which are active skin symptoms.
People with psoriasis also have an increased risk of developing other long-term conditions known as comorbidities. These may include:
Psoriatic arthritis
Psoriatic arthritis is a type of arthritis that can occur in up to 30% of people with psoriasis. It presents with symptoms that include pain and swelling in the joints and the areas where tendons and ligaments attach to bones.
Psoriatic arthritis typically occurs about
The risk of developing psoriatic arthritis increases in people who:
- have obesity
- experience stress, joint, or bone injuries
- develop infections
The severity of the psoriasis can also increase the risk of developing psoriatic arthritis.
Cardiovascular disease
People with psoriasis have an increased risk of developing cardiovascular disease.
Authors of a 2021 analysis suggest that the immune cells that cause the inflammation in psoriasis can travel in the blood, increasing the risk of cardiovascular disease.
The authors also state that risk factors for cardiovascular disease are very common in those with psoriasis, including:
- high blood pressure (hypertension)
- insulin resistance
- type 2 diabetes
- obesity
- depression
- metabolic syndrome
- imbalance of lipids in the blood (dyslipidemia)
Psoriasis may contribute to various cardiovascular-related conditions, including heart attack and stroke.
Metabolic syndrome
Metabolic syndrome occurs in approximately 20–50% of people with psoriasis and is more common in people with severe psoriasis. The risk of developing metabolic syndrome is more than twice that of people who do not have psoriasis.
Metabolic syndrome is a combination of various metabolic disorders, including:
- abdominal obesity
- insulin resistance
- type 2 diabetes
- elevated cholesterol
- high blood pressure
- Nonalcoholic liver disease
Type 2 diabetes
A 2019 review found an increased likelihood of type 2 diabetes in people with psoriasis.
In people with type 2 diabetes, the body does not react to insulin. Insulin is a hormone that helps regulate the movement of sugar in the blood into the body’s cells for energy.
Anxiety and depression
Psoriasis may have a significant effect on a person’s self-esteem and confidence.
Due to the visibility of the plaques on the skin, a person with psoriasis may fear stigmatization, which can lead to mental health conditions such as anxiety and depression.
Psoriasis flare-ups may also cause stress and depressive symptoms.
Inflammatory bowel disease
Inflammatory bowel disease (IBD) occurs when there is inflammation in the gastrointestinal tract. IBD is an umbrella term for conditions that include ulcerative colitis and Crohn’s disease.
There is a higher incidence of Crohn’s disease than ulcerative colitis among people with psoriasis.
Kidney disease
Kidney disease occurs when the kidneys cannot filter blood properly, resulting in fluid and waste staying in the body.
According to a 2018 meta-analysis, the risk of chronic kidney disease and end stage renal disease is significantly higher in people with psoriasis than in those without this condition.
There is currently
Treatment options will vary among individuals, depending on the type and severity of their psoriasis. However, standard approaches include:
Topical treatment
The first-line treatment for psoriasis is typically topical.
Topical steroids include corticosteroids that inhibit inflammation and reduce swelling and discoloration.
Corticosteroids usually require a prescription, but mild topical corticosteroids may be available over the counter (OTC). However, using topical steroids can cause side effects, so a physician will manage them.
OTC topical treatments, such as lotions, bath solutions, and shampoos, are also available. These treatments contain salicylic acid or coal tar to soften scales and improve the skin’s appearance.
Nonsteroidal topical treatments may also relieve psoriasis symptoms, including:
- vitamin D analogs
- roflumlast
- vitamin A derivatives
- anthralin (Drithocreme)
Systemic treatment
Systemic treatments include prescription medications that act on the whole body.
Moderate to severe psoriasis and psoriasis that is unresponsive to topical treatments and UV light therapy may require systemic treatment. These drugs help slow skin cell growth and reduce inflammation.
Traditional systemics include:
- acitretin (Soriatane)
- cyclosporine (Gengraf)
- methotrexate (Trexall)
- apremilast (Otezla)
Biologics
Biologics target specific immune cells or proteins of the immune system. Doctors generally prescribe them for moderate to severe plaque psoriasis and psoriatic arthritis. They include:
- tumor necrosis factor-alpha inhibitors
- interleukin-12, -17, and -23 inhibitors
- T-cell inhibitors
Phototherapy
Phototherapy involves exposing psoriatic skin to ultraviolet B, which is present in sunlight. Its actions include:
- slowing rapid skin cell growth
- suppressing the overactive immune system
- reducing inflammation
- reducing itchiness
The AAD states that psoriasis is often a lifelong condition.
It requires long-term and ongoing treatment strategies to help prevent and manage flare-ups and prevent psoriasis from worsening.
However, the type of treatment a person needs may change. A person can continue working with a dermatologist to create treatment plans that are appropriate for them.
Psoriasis can go into remission, meaning a person will have clear skin and no symptoms. This can last for years, but most often lasts between 1 and 12 months.
What happens if a person stops treatment?
If a person stops treatment for psoriasis, the AAD says that one of three things can happen. The psoriasis may:
- stay in remission
- return and look and feel as it did before
- return and is worse than before
What happens can depend on a variety of factors, including:
- the medication a person was using
- how well a person can manage their triggers for psoriasis
- a person’s medical history
Treatments can help reduce psoriasis symptoms. However, a person can also take steps in their daily life to help manage psoriasis.
The AAD recommends:
- avoiding skin injuries, cuts, and bug bites as much as possible
- taking measures to avoid getting a sunburn, such as using sunscreen and covering bare skin in direct sunlight
- treating psoriasis to reduce or stop itching
- refraining from scratching the affected skin
- using fragrance-free moisturizers
- limiting showers to 5 minutes and baths to 15 minutes or less
- quitting smoking, if applicable
- limiting alcohol consumption
- maintaining a moderate weight and exercising regularly
- eating a well-balanced, nutritious diet
The AAD also recommends screening for other related diseases. People can see a doctor if they notice other symptoms that may signal comorbidities, such as psoriatic arthritis.
Psoriasis is a chronic autoimmune skin condition that causes thick skin plaques to form on the body.
Without treatment, psoriasis can cause symptoms such as itchiness and pain. It can also lead to other conditions, such as cardiovascular disease, psoriatic arthritis, and type 2 diabetes.
The best treatment will depend on the type and severity of psoriasis. Some options include topical treatments, systemic treatments, biologics, and phototherapy.
A person can also manage their condition by taking steps to avoid triggers, such as sunburn and skin injuries, and making lifestyle adjustments.