Psoriasis is an 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 patches that can be itchy.
In this article, we explore what happens when a person does not receive psoriasis treatment. We also discuss the types of psoriasis and the treatment and management options.
If a person does not receive treatment for psoriasis, the condition continues 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.
As an autoimmune disease, psoriasis results from immune cells in the body mistakenly attacking normal, healthy cells.
The appearance of symptoms can indicate inflammation occurring in the body. Even a person with mild psoriasis, in which skin symptoms affect less than 3% of the body, may have substantial inflammation.
Without treatment, psoriasis can affect a person’s quality of life significantly. Treatment is crucial to manage psoriasis and prevent the development of other related conditions.
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 patches with a covering of silvery scales
- dry and cracked skin that may bleed or itch
- thick, ridged, and pitted nails
These symptoms may occur in flares, meaning that they come and go. There may be periods during which a person does not have these 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
Psoriatic arthritis typically occurs about
The risk of developing psoriatic arthritis increases in people who:
- have obesity
- have severe psoriasis
- experience stress, joint, or bone injuries
- develop infections
Without treatment, psoriatic arthritis can result in severe disability.
Cardiovascular disease
People with psoriasis have an increased risk of developing cardiovascular disease.
The immune cells that cause the inflammation in psoriasis can travel in the blood, increasing the risk of cardiovascular disease. Psoriasis may contribute to various cardiovascular-related conditions, including:
- heart attack
- stroke
- heart failure
- irregular heart rhythm, called arrhythmia
- heart valve issues
Metabolic syndrome
Metabolic syndrome occurs in approximately 20–50% of people with psoriasis and is more common in people who have 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
- elevated blood sugar
- elevated cholesterol
- high blood pressure
Type 2 diabetes
A 2019 review found that there is 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 transport 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 patches 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 of ulcerative colitis among people with psoriasis.
Kidney disease
Kidney disease occurs when the kidneys cannot filter blood normally, 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 are different types of psoriasis, and a person can have more than one type. They include:
Plaque psoriasis
Plaque psoriasis causes thick raised skin patches with layers of silvery scales. These plaques typically appear on the scalp, lower back, elbows, and knees, but they can appear anywhere on the skin. Approximately 80–90% of people with psoriasis develop plaques.
Scalp psoriasis
Scalp psoriasis occurs on the scalp, and thick patches may sometimes lead to hair loss. The patches could also extend down to the forehead, neck, or ears.
Nail psoriasis
Nail psoriasis can develop with any type of psoriasis. Yellow-brown or white spots may appear on the nails, which may also be pitted, crumbling, or separating from the fingers or toes.
Guttate psoriasis
Guttate psoriasis occurs in young adults and children. Small, discolored, scaly spots appear on the skin. An upper respiratory tract infection — most often strep throat — generally
Inverse psoriasis
Inverse psoriasis occurs in skin folds, which include the armpits and the area under the breasts. Sweating or rubbing can irritate the condition further.
In a 2016 study, the prevalence of inverse psoriasis among 3,825 participants with psoriasis was
Pustular psoriasis
In people with pustular psoriasis, pus-filled bumps known as pustules
Pustular psoriasis may occur in a particular region, such as the hands or feet, or it may present across the entire body.
Triggers of this condition include infections, overexposure to UV light, certain medications, and stress.
Erythrodermic psoriasis
Erythrodermic psoriasis is a rare type of psoriasis that often affects most of the body and can be life threatening.
It may cause problems with the body’s fluid balance and temperature, causing a person to experience swelling in their feet or ankles and shivering episodes.
Triggers for erythrodermic psoriasis
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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).
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, such as vitamin D analogs, vitamin A derivatives, and anthralin (Drithocreme), may also relieve psoriasis symptoms.
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)
- apremalist (Otezia)
Biologics
Biologics target specific immune cells or proteins of the immune system. Doctors generally prescribe them for 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 UVB, which is present in sunlight. Its actions include:
- slowing rapid skin cell growth
- suppressing the overactive immune system
- reducing inflammation
- reducing itchiness
Treatments can help reduce psoriasis symptoms. However, a person can also take steps in their daily life to help manage psoriasis.
The American Academy of Dermatology Association (AAD) recommends:
- avoiding skin injuries, cuts, and bug bites, as far 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 should 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 patches 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, but the options include:
- topical treatments
- systemic treatments
- biologics
- phototherapy
A person can also manage their condition by taking steps to avoid triggers, such as sunburn and skin injuries, and making lifestyle adjustments.