Psoriasis in older adults

Overview

Psoriasis is a long-lasting skin condition where the body makes new skin cells too quickly. This causes thick, red, scaly patches to form on the skin. In older adults, it often first appears after age 60 or can be a condition they have had for many years.

Yes, psoriasis is fairly common, affecting about 2–3% of people worldwide. In older adults, the number of new cases tends to rise after age 60.

Psoriasis can affect anyone, but it often first appears between ages 15 and 35. However, many older adults develop it later in life, especially after age 60. Both men and women are affected, and it tends to run in families.

Symptoms

Common symptoms

• Red, raised patches of skin covered with silvery-white scales
• Itching, burning, or soreness on the skin
• Dry, cracked skin that may bleed
• Thickened, pitted, or ridged fingernails and toenails
• Stiff, swollen joints (possible psoriatic arthritis)

Symptoms in older adults

• Patches often appear in body folds like the armpits, groin, or under the breasts (called inverse psoriasis)
• Skin may be thinner and more fragile, so patches can be more painful
• Nail changes are more common and can be mistaken for fungal infections
• Joint pain and swelling (psoriatic arthritis) may develop and limit daily activities
• Skin symptoms may be less widespread but more stubborn to treatment

Causes

Main causes

• Psoriasis is caused by a combination of genetic and immune system factors. Your immune system sends faulty signals that speed up skin cell growth.
• The exact trigger is not always known, but the condition is not caused by anything you did or did not do.

Risk factors

• Family history of psoriasis or psoriatic arthritis
• Stress – emotional or physical stress can trigger flares
• Infections, especially strep throat
• Certain medications, such as those for high blood pressure or malaria (but do not stop any medicine without talking to your doctor)
• Injury to the skin, like cuts, scrapes, or sunburn (this is called the Koebner phenomenon)
• Smoking and heavy alcohol use

When to see a doctor

See a doctor urgently if:

• If you develop a widespread red, peeling rash that covers a large area of your body (possible erythrodermic psoriasis)
• If you have a fever along with your psoriasis flare
• If you have severe joint pain or swelling that makes it hard to move

Book a routine appointment if:

• If you notice new patches of scaly skin that do not go away with moisturising
• If you have nail changes like thickening or pitting
• If you have joint stiffness or swelling, especially in the morning
• If your current treatments are not helping or are causing side effects

Diagnosis

A doctor, usually a dermatologist (skin specialist), will look at your skin, nails, and joints. They will ask about your symptoms, family history, and any triggers.

Tests that may be done

• Usually no tests are needed – the appearance of the skin is often enough for a diagnosis.
• Occasionally, a small skin sample (biopsy) is taken to rule out other conditions.
• Blood tests are not used for psoriasis but may be ordered to check for related health issues.

What to expect at your appointment

The doctor will gently examine your skin and nails. They may ask about joint pain. The diagnosis is often made during the visit, and you will discuss treatment options. It is a straightforward process.

Treatment

Treatment for psoriasis aims to reduce inflammation, slow skin cell growth, and improve quality of life. Your doctor will consider your age, overall health, and how much the psoriasis affects you. There is no cure, but treatments can keep symptoms under control.

Self-care at home

• Keep your skin well moisturised with fragrance-free creams or ointments to reduce dryness and scaling.
• Gently remove scales using a soft cloth after a warm bath, but do not scrub hard.
• Avoid triggers such as stress, skin injuries, and infections.
• Use mild, soap-free cleansers and avoid hot water when bathing.
• Wear loose, soft clothing to avoid irritation on affected areas.

Medical treatments

Doctors may prescribe creams, ointments, or lotions that you apply directly to your skin (topical treatments). These include corticosteroids, vitamin D analogues, and other medicines that calm the immune system in the skin. If topical treatments are not enough, light therapy (phototherapy) using ultraviolet light can help. For moderate to severe cases, oral or injected medications that work throughout the body (systemic treatments) may be recommended. These include older immune-suppressing drugs and newer biologic therapies that target specific parts of the immune system. Your doctor will help choose the safest option based on your health.

When is surgery considered?

Surgery is not used for psoriasis itself. However, if you develop severe joint damage from psoriatic arthritis, joint replacement surgery may be considered. This is rare.

Living with this condition

Living with psoriasis in older age can be challenging, but many people manage well. Daily moisturising, gentle skin care, and avoiding triggers can reduce flares. You may need to adjust activities during flares, but regular gentle exercise and social activities are still important for your overall health.

Lifestyle tips

• Manage stress through relaxation techniques like deep breathing, meditation, or gentle yoga.
• Avoid smoking and limit alcohol, as both can worsen psoriasis.
• Protect your skin from sunburn, but moderate sunlight can sometimes help – talk to your doctor first.
• If you have joint pain, consider using assistive devices like jar openers or padded handles to make daily tasks easier.

Diet and exercise

There is no special diet for psoriasis, but eating a balanced diet rich in fruits, vegetables, whole grains, and healthy fats may help reduce inflammation. Staying at a healthy weight is important because excess weight can make psoriasis worse. Gentle exercises like walking, swimming, or tai chi can improve joint mobility and mood without stressing your skin.

Mental health and emotional wellbeing

Psoriasis can be distressing and may lead to feelings of embarrassment, anxiety, or depression. It is normal to have these feelings. Talk to your doctor or a mental health professional about support. If you are feeling overwhelmed, reach out to a crisis helpline in your area for immediate help.

Prevention

Psoriasis cannot be prevented because it is largely genetic. However, you can reduce the chance of flares by staying healthy, managing stress, avoiding skin injuries, and treating infections promptly. Quitting smoking and limiting alcohol can also help.

Vaccines

Some vaccines, like the flu shot and pneumonia vaccine, are recommended for older adults. Talk to your doctor about which vaccines are appropriate for you. If you are on certain psoriasis treatments that suppress the immune system, your doctor may advise avoiding live vaccines.

Screening programmes

There is no routine screening for psoriasis. However, if you have psoriasis, your doctor may check you regularly for related conditions such as psoriatic arthritis, high blood pressure, and diabetes.

Complications

If left untreated

• Untreated psoriasis can lead to persistent skin discomfort, itching, and pain.
• It may increase the risk of psoriatic arthritis, which causes joint damage and disability.
• It can affect your quality of life, leading to social isolation, depression, and anxiety.
• Severe, widespread psoriasis can strain the heart and blood vessels, raising the risk of heart attack and stroke.

Long-term outlook

With proper treatment and self-care, most older adults with psoriasis can control their symptoms and live well. Advances in treatment mean many options are available that are safe for older people. While psoriasis is a lifelong condition, it does not have to define your life. Working closely with your healthcare team can help you manage flares and stay healthy.

Find support

Local organisations

• Your local dermatology department or NHS skin clinic · United Kingdom

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