psoriasis flare ups

Overview

Psoriasis is a chronic (long-term) skin condition where the immune system attacks healthy skin cells by mistake. This causes new skin cells to form too quickly and build up, leading to red, scaly patches. A flare-up is when these patches get noticeably worse or spread.

Yes. Psoriasis is one of the most common chronic skin conditions, affecting around 2-3% of people worldwide.

It can start at any age, but it usually first appears between 15 and 35. It affects men and women equally, and can run in families.

Symptoms

Common symptoms

• Red, inflamed patches of skin, often with silvery-white scales
• Itching, burning, or soreness around the patches
• Dry, cracked skin that may bleed
• Thickened, pitted, or ridged nails
• Patches commonly appear on elbows, knees, scalp, and lower back

Symptoms in children

• Patches may be smaller, drier, and less scaly than in adults
• The scalp, face, and nappy area are often affected
• Itching can be intense, and children may feel embarrassed or self-conscious

Symptoms in older adults

• Flare-ups may appear less red but have thicker scales
• Skin can become very dry and fragile with age
• Consideration of other health conditions and medicines is important in treatment

Causes

Main causes

• The immune system is overactive, causing skin cells to grow too quickly
• A combination of genes and external triggers is involved
• The exact cause is unknown, but it is not caused by poor hygiene or an allergy

Risk factors

• Family history of psoriasis or psoriatic arthritis
• Infections, especially strep throat (a common trigger in children)
• Stress and emotional upset
• Skin injuries such as cuts, scrapes, sunburn, or insect bites
• Smoking and heavy alcohol use
• Some medicines – always talk to your doctor about possible skin side effects

When to see a doctor

See a doctor urgently if:

• If your flare-up suddenly becomes much worse, very painful, or spreads quickly
• If you have joint pain, stiffness, or swelling that affects how you use your hands or move
• If your skin becomes hot, swollen, or shows signs of infection

Book a routine appointment if:

• If psoriasis is affecting your daily life, sleep, or emotional wellbeing
• If moisturisers and gentle skin care are not controlling symptoms
• If you're considering changing your treatment or have questions about side effects

Diagnosis

A doctor (usually a dermatologist, a skin specialist) can often diagnose psoriasis by looking at your skin, scalp, and nails. They will also ask about your symptoms, family history, and any triggers.

Tests that may be done

• Usually no tests are needed
• A skin biopsy – a small sample of skin removed for lab testing – may be done when the diagnosis is unclear
• Blood tests may be used to rule out other conditions if joint symptoms are present

What to expect at your appointment

During your appointment, the doctor will examine the affected areas and ask about your history and lifestyle. They will discuss possible triggers and treatment options with you, and may refer you to a dermatology team for ongoing care.

Treatment

Treatment aims to slow skin cell growth, reduce inflammation, and control symptoms. It usually includes daily skin care, avoiding triggers, and sometimes medical treatments. A personalised plan is best.

Self-care at home

• Keep skin well moisturised every day using a rich, fragrance-free moisturiser
• Take short, lukewarm baths with added emollients or bath oils
• Gently remove scales with a soft cloth – never scratch or pick
• Avoid strong soaps, perfumes, and harsh detergents
• Protect skin from sunburn and cold, dry air
• Manage stress with relaxation, breathing exercises, or activities you enjoy

Medical treatments

Medical treatment for psoriasis may include topical creams and ointments applied directly to the skin, phototherapy (controlled ultraviolet light), and systemic treatments (tablets or injections) that work throughout the body. These are prescribed based on how severe the psoriasis is and your overall health. Your doctor will explain the benefits and possible side effects of each option.

When is surgery considered?

Surgery is not a treatment for psoriasis itself. It is rarely considered for joint damage caused by severe psoriatic arthritis. In most cases, medical and self-care treatments are enough to manage the condition.

Living with this condition

Living with psoriasis means learning your triggers and building a simple, consistent skin care routine. Many people find that keeping a diary helps them notice patterns – such as stress, weather, or infections – that lead to flare-ups.

Lifestyle tips

• Wear soft, loose clothing – cotton can feel more comfortable than synthetic fibres
• Try to stop smoking and limit alcohol, as both can make flare-ups worse
• Get regular sunlight in short, safe amounts to help skin improve
• Keep a regular sleep schedule to support your immune system
• Find an activity that helps you relax, whether it's reading, walking, or listening to music

Diet and exercise

There's no special diet that cures psoriasis, but eating a balanced, anti-inflammatory diet with plenty of fruits, vegetables, and whole grains may help. Regular exercise can lower stress, help manage weight, and improve overall wellbeing – all of which may reduce flare-ups.

Mental health and emotional wellbeing

Psoriasis can affect how you feel about yourself, especially when patches are visible. It's normal to feel frustrated, embarrassed, or anxious. Talking to someone you trust, joining a support group, or seeing a mental health professional can help. Remember, your skin does not define your worth.

Prevention

You cannot prevent the start of psoriasis because it's linked to genes and the immune system. But you can do a lot to reduce flare-ups by understanding your triggers and sticking to a regular skin care routine.

Vaccines

Vaccines are important for everyone, including people with psoriasis. If you take certain medicines that suppress the immune system, some live vaccines may be unsafe. Always tell your doctor or pharmacist about your psoriasis treatments before getting vaccinated.

Screening programmes

There is no routine screening test for psoriasis in the general population. If psoriasis runs in your family, be alert to early symptoms. For people with psoriasis, regular check-ups can help detect conditions linked to psoriasis, like high blood pressure and joint problems.

Complications

If left untreated

• Psoriasis can spread and become more painful or itchy
• Inflammation from untreated psoriasis may increase the risk of psoriatic arthritis
• People with psoriasis have higher rates of heart disease, diabetes, and high blood pressure
• Constant scratching and visible patches can lead to skin infections and emotional stress

Long-term outlook

With good care, most people are able to control their symptoms and enjoy long clear periods. Psoriasis is a long-term condition, but it doesn't have to control your life. New treatments and self-care approaches continue to improve the outlook for everyone.

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