While there is no cure for psoriasis, treatment can help ease and manage symptoms. But finding the proper treatment depends on several factors that may impact your prognosis. This article will discuss what affects the severity of psoriasis and your outlook with the condition.
Factors That Impact Prognosis of Psoriasis
Several factors can impact how your condition progresses. A person with more factors is more likely to experience progressive, worsening symptoms and a more severe form of the disease.
Type of Psoriasis
The most common form of psoriasis is plaque psoriasis, characterized by scales and dry, itchy patches that flake off. The second most common form is guttate psoriasis, which appears as numerous small, teardrop-shaped bumps and may only occur once and not recur.
Some types of psoriasis cause more severe symptoms than others. Pustular psoriasis, for example, causes painful white pus-filled bumps. Another form of psoriasis that causes more intense, painful itching is inverse psoriasis, which appears in skin folds.
Finally, erythrodermic psoriasis is a rare, life-threatening form of psoriasis that causes more than just a rash. If you have this type of psoriasis, you shed large areas of skin and may experience:
DehydrationSevere itchingSevere painNail changesChanges in heart rate
Body Parts Affected
Psoriasis can appear anywhere on your skin. The following are the most commonly affected body parts:
Genitals Scalp Face Hands or feet Nails Skin folds
Psoriasis in some areas, such as the genitals, may be more uncomfortable and challenging to manage.
Disease location can also make treatment difficult. A person with psoriasis on the scalp, for example, may subject the area to repeated irritation, worsening symptoms.
Similarly, facial psoriasis is more commonly seen in those who:
Have severe psoriasisHave a family history of the diseaseHave had the disease for a long period
Because facial psoriasis is so visible, it can also significantly impact a person’s self-esteem and quality of life.
Disease Coverage
If your psoriasis is only in one area, your disease course may be less severe than someone who has symptoms in multiple locations on their body.
Psoriasis and When Aggressive Treatment Is Needed
If your condition meets specific criteria, your healthcare provider may recommend more aggressive treatment.
People With Large Amounts of Affected Skin
Research suggests that people who have multiple lesions at diagnosis are likely to continue experiencing various lesions. If you have extensive psoriasis affecting multiple spots on your body, doctors may recommend more aggressive treatment options like biologic therapy.
People With Signs of Arthritis
Experts also consider psoriasis more severe and aggressive if it’s coupled with joint disease. This is called psoriatic arthritis. Aggressive treatment may be required to address both conditions.
People With Psoriasis Under Age 20
A clinical study from 2013 suggests that moderate to severe psoriasis may be more likely to occur in males.
While this early research associated being a young male with more severe psoriasis symptoms, later data suggest that developing psoriasis at a young age does not influence disease severity.
However, doctors may treat young people with psoriasis more aggressively since they may be more capable of handling adverse side effects than older adults.
People With Very Bothersome Symptoms
When a person has symptoms that affect their quality of life, a doctor may recommend more aggressive treatment. Psoriasis can be hard to treat in some people, making it more likely to cause bothersome symptoms.
Outlook: Severe Psoriasis and Quality of Life
Severe psoriasis can have a significant impact on your quality of life, which may affect disease outlook.
Remission and Flare-ups
Psoriasis does not necessarily cause constant symptoms. Many people experience periods of remission, when symptoms improve, especially if they are receiving proper treatment.
You may experience flare-ups, when symptoms worsen, because of various triggers such as physical irritation to the skin, food and drink, stress, dry weather, hot, sunny weather, smoking, infection, or certain medications.
Comorbidities
For people with severe psoriasis who also have other diseases (comorbidities), symptoms of the other conditions become severe as psoriasis symptoms ramp up.
Mortality
According to research from 2019, severe psoriasis may be associated with higher risk of dying. However, it’s difficult to say for sure whether this increased risk is due to the effects of psoriasis alone or other factors such as lifestyle and treatment.
Associated Factors
If you have psoriasis, the following may influence the severity of your disease and impact your prognosis:
Smoking: Daily smoking may increase your risk of developing new symptoms or experiencing flare-ups. Alcohol consumption: Drinking alcohol may also be a risk factor for psoriasis. People with alcohol use disorder may be at higher risk for a more severe disease course. Obesity: Research suggests that obesity may have a link to more severe psoriasis symptoms. Depression: Because psoriasis is a chronic condition that can affect self-esteem, confidence, and quality of life, a person with the disease may be more likely to experience depression. Cancer: A 2019 systematic review and meta-analysis concluded that people with psoriasis may be more likely to develop site-specific cancers such as squamous cell carcinoma and basal cell carcinoma. Diabetes: People with psoriasis may have a higher risk of developing type 2 diabetes. However, there’s limited evidence to suggest diabetes increases the severity of psoriasis symptoms. Arthritis: About one-third of people with psoriasis also have psoriatic arthritis, which can cause additional symptoms such as joint pain and swelling. Kidney, cardiovascular, and respiratory diseases: People with psoriasis may be more likely to develop these conditions. Cardiovascular disease, in particular, has a strong association with psoriasis. And evidence suggests that severe psoriasis can increase a person’s chance of experiencing a stroke or other serious cardiac event.
Effects of Aggressive Treatments
While aggressive treatments can help with symptoms and potentially affect disease prognosis, they may also cause side effects that affect a person’s quality of life. Strong steroid medications, for example, are more likely to cause side effects than lower potency topicals. They may even make psoriasis symptoms worse.
Psoriasis Treatments
There are several treatment options for psoriasis. Your doctor will recommend treatments based on the severity of and type of psoriasis you have.
Over-the-Counter Treatments
Over-the-counter (OTC) treatments like moisturizers can help relieve dryness that leads to itching. However, OTC products may cause irritation if they contain ingredients that trigger your symptoms. Additionally, OTC treatments are unlikely to help in cases of severe disease.
Home Remedies
Home remedies such as taking baths with moisturizing additives may help relieve symptoms. Still, they aren’t a substitute for medical treatments, especially if you have severe psoriasis.
Topical Corticosteroids
Topical steroids come in different formulations and potencies. They can help reduce itching and inflammation. However, potent corticosteroids may cause side effects such as:
Thinning of the skinWorsening of plaque psoriasis symptomsTriggering pustular psoriasis
They’re also a poor long-term solution for symptom relief.
Coal Tar
Coal tar treatment is typically used for scalp and plaque psoriasis. Side effects include:
Irritation of the skinIncreased sensitivity to sunlightStaining of the skin
Other Topicals
Doctors also prescribe the following topicals for certain types of psoriasis:
Anthralin (dithranol) Protopic (tacrolimus) ointment Elidel (pimecrolimus) cream Topical retinoids Keratolytic agents such as products with salicylic acid Dovonex (calcipotriene topical) Vectical (calcitriol topical) Curatoderm (tacalcitol)
Biologics
Biological therapies are medications that effectively treat psoriasis. However, because they affect the immune system, they can have serious side effects. Doctors usually prescribe biologics when other treatments have failed to treat moderate to severe disease.
It is the first and only FDA-approved non-steroidal topical medication in its class.
Light Therapy
UV (ultraviolet) light therapy is a second-line treatment used when topical medications are ineffective or can’t be used.
Side effects may include:
SunburnRashesSkin agingSkin cancer
Other Medications
Other medications that a doctor may prescribe for psoriasis include:
Trexall (methotrexate), which may be used if someone has psoriasis and psoriatic arthritis Cyclosporine Soriatane (acitretin) Otezla (apremilast) Fumaric acid esters
How Long Does Psoriasis Treatment Take?
Treatment length depends on the type of medication prescribed. With very mild psoriasis, a doctor may suggest simply avoiding apparent triggers.
Severe psoriasis may require the use of immune-suppressing drugs that cannot be given long-term due to their side effects. Additionally, corticosteroids are meant to be used temporarily or during flare-ups.
Ultimately, psoriasis is a chronic condition, so treatment is lifelong.
Summary
Psoriasis is a chronic condition that requires lifelong treatment and management of symptoms. There is no cure. Disease severity depends on multiple factors and can be influenced by the type of psoriasis, the number of lesions, and whether a person has any other medical conditions, such as psoriatic arthritis.
A Word From Verywell
Symptoms of psoriasis can vary from mild to severe. While some factors can influence the severity of your symptoms, effective treatments are available regardless of how bad your symptoms are.
Some treatment options, such as UV light therapy or medications that lower your immune system response, may increase your chances of cancer or developing potentially fatal infections.
