psoriasis that comes and goes

Overview

Psoriasis is a skin condition where the immune system is overactive and speeds up the life cycle of skin cells. This causes extra skin cells to pile up on the surface, leading to red, scaly patches. In psoriasis that 'comes and goes,' you have periods when your skin gets worse (flare-ups) and times when it clears up or shows very mild symptoms (remission).

Yes, psoriasis is a common skin condition. It affects millions of people around the world, regardless of age, sex, or skin color.

Psoriasis can affect anyone. It often appears between the ages of 15 and 35, but can also start in childhood or later adulthood. Men and women get it equally. The way it looks and where it appears can vary from person to person.

Symptoms

Common symptoms

• Red patches of skin covered with thick, silvery scales. On darker skin, these patches may look purple, brown, or grey.
• Dry, cracked skin that may bleed or itch.
• A burning or sore feeling on the skin.
• Thickened, pitted, or ridged nails.
• Scalp flaking that looks like dandruff but is accompanied by red patches underneath.

Symptoms in children

• Smaller, finer scales that may just look like dry, red skin.
• In babies, psoriasis can appear in the diaper area and be mistaken for a rash.
• Children often have scaling on the scalp, elbows, and knees.
• Itchiness can disturb sleep and concentration at school.

Symptoms in older adults

• The skin tends to be drier, so plaques may be less scaly and more shiny or silvery.
• Patches commonly appear on the lower back, limbs, and in skin folds.
• Older adults are more likely to develop joint pain (psoriatic arthritis) alongside skin symptoms.
• Healing can be slower, and the condition may affect comfort and mobility.

Causes

Main causes

• The immune system mistakenly attacks healthy skin cells, causing new skin cells to form too quickly.
• Genetics play a role – psoriasis often runs in families.
• Common triggers include stress, skin injuries, certain infections (like strep throat), cold dry weather, smoking, and heavy alcohol use.
• Some medicines can make psoriasis worse. Always talk to a doctor before stopping or changing any medicine.

Risk factors

• Family history of psoriasis or psoriatic arthritis.
• Being a current or former smoker.
• Obesity, which can make flare-ups more likely.
• Stress and anxiety.
• Having an immune system condition, or taking medicines that suppress the immune system.

When to see a doctor

See a doctor urgently if:

• If you have joint pain, stiffness, or swelling – especially in the hands, feet, or spine.
• If you have signs of a skin infection, such as spreading redness, heat, pain, or discharge.
• If your skin is so sore or itchy that it interferes with work, sleep, or daily life.
• If you have a sudden severe flare that covers a large area of your body.

Book a routine appointment if:

• Any time you notice new or persistent skin patches that look like psoriasis.
• If you are unsure whether a skin change is psoriasis or another condition.
• At least once a year to review your treatment and self-care plan.
• If your flare-ups become more frequent, last longer, or feel harder to control.

Diagnosis

A doctor, usually a general practitioner or a skin specialist called a dermatologist, diagnoses psoriasis by looking at your skin, scalp, and nails, and by asking about your symptoms, triggers, and family history. In most cases, no special tests are needed.

Tests that may be done

• Visual examination – checking the location, shape, and appearance of the patches.
• Medical history interview – discussing your symptoms, triggers, and whether any family members have psoriasis.
• Skin biopsy – a small sample of skin is taken and looked at under a microscope if the diagnosis is unclear.

What to expect at your appointment

At your appointment, the doctor will ask what you have noticed, when flare-ups happen, and about any joint pain. They may examine your scalp and nails as well as your skin. If a biopsy is needed, a small numbing medicine is used, and a tiny sample of skin is removed. The sample is then examined in a lab. You usually get the result within a week or two.

Treatment

There is no cure for psoriasis, but treatments can reduce inflammation, clear the skin, and make flare-ups less severe and less frequent. The goal is to find a plan that fits your lifestyle and helps you feel comfortable both during flare-ups and between them.

Self-care at home

• Moisturize your skin every day, especially right after bathing, to lock in moisture.
• Use gentle, fragrance-free cleansers and warm, not hot, water.
• Avoid scratching – keep nails short and apply a cool compress to itchy areas.
• Take short baths with lukewarm water and a mild bath oil or oatmeal product.
• Ask your pharmacist about over-the-counter itch-relief creams or ointments.
• Protect your skin from extreme cold and from sunburn. Moderate sunlight helps some people, but always check with your doctor first.
• Practice stress management with relaxation, breathing exercises, or enjoyable activities.

Medical treatments

Doctors have several general approaches to treat psoriasis. First-line treatments are usually topical treatments – creams, ointments, or gels applied directly to the skin. If these are not effective, or the psoriasis is widespread, a doctor may recommend phototherapy (carefully measured exposure to ultraviolet light) or systemic treatments – oral medicines or injections that calm the immune system throughout the body. The choice depends on how much skin is affected, how severe the symptoms are, and your overall health. Your doctor will discuss the benefits and risks, including any monitoring you may need. Never start, stop, or change a psoriasis treatment without consulting your healthcare provider.

Living with this condition

Living with psoriasis that comes and goes means building a regular skin care routine and learning what helps you stay comfortable. Keep a gentle moisturizer within reach. Wear soft, breathable clothing to avoid irritating the skin. Keep your nails trimmed to reduce damage from scratching. Remember that flare-ups are temporary, and you can take steps to make them shorter and less intense.

Lifestyle tips

• Quit smoking – smoking can trigger or worsen psoriasis.
• Limit alcohol, as heavy drinking is linked to flare-ups.
• Aim for a healthy weight to reduce stress on your skin and joints.
• Practice stress management, since stress is a well-known trigger.
• Get enough sleep – good rest supports a balanced immune system.

Diet and exercise

There is no special diet that cures psoriasis. However, eating a balanced diet with plenty of vegetables, fruits, whole grains, and lean protein supports overall health and immunity. Regular gentle exercise, such as walking or swimming, can reduce stress, support a healthy weight, and improve joint flexibility. Some people notice certain foods, like dairy or gluten, seem to make their skin worse, but this varies from person to person. If you suspect a link, keep a food diary and discuss it with your doctor.

Mental health and emotional wellbeing

Psoriasis affects more than your skin. It can affect your confidence, mood, and how you see yourself. It is normal to feel frustrated, embarrassed, or low during flare-ups. Speaking with a mental health professional or joining a support group can help you cope. If you ever have thoughts of harming yourself, please reach out to your local crisis service or emergency number immediately. You are not alone.

Prevention

You cannot prevent getting psoriasis if you are genetically prone to it. But you may be able to reduce flare-ups by identifying and avoiding your personal triggers, such as stress, skin injuries, cold weather, smoking, and infections. Working with your doctor to adjust your routine early in a flare can often help shorten it.

Vaccines

Staying up to date with recommended vaccines, such as the flu vaccine, may help prevent infections that can trigger psoriasis. If you take medicines that affect your immune system, ask your doctor which vaccines are appropriate for you.

Complications

If left untreated

• Psoriatic arthritis – a condition that causes joint pain, swelling, and stiffness, which can lead to joint damage if not treated.
• Skin infections – from scratching or open cracks, which may need medical treatment.
• Nail damage – including pitting, thickening, or lifting of the nails.
• Emotional distress – including low self-esteem, anxiety, and depression.
• Reduced quality of life – due to itching, pain, and embarrassment.

Long-term outlook

With today’s treatments, most people with psoriasis can control their symptoms and enjoy long periods of clear skin. It is a long-term condition, but it is manageable. Many people live full, active, and confident lives. Working closely with your healthcare provider and following a consistent skin-care routine can make a significant difference. Even during flare-ups, remember that clearer periods are likely and can last a long time.

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