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Psoriasis & Psoriatic Arthritis

Thick, scaly, itchy patches of skin caused by an overactive immune system — and, for some people, painful swollen joints. Psoriasis is lifelong and has no cure, but today’s treatments can clear or calm it. A few forms are medical emergencies, and swollen joints should never wait.

Get emergency care — call 911 or go to an emergency room — if someone with psoriasis has:

  • Skin on most of the body that looks burned or fiery red, with chills or a fever. This is erythrodermic psoriasis. The person may also look extremely ill, with a rapid pulse, muscle weakness and severe itch; they may be unable to keep warm, so hypothermia can set in quickly. It usually happens in people who already have another type of psoriasis, often after it has been getting worse or not improving with treatment (American Academy of Dermatology). Triggers can include a serious sunburn, an allergic reaction, or stopping steroid pills or cyclosporine too quickly (AAD).
  • Pus-filled bumps over much of the skin, especially with fever or chills. This is generalized pustular psoriasis. The skin suddenly turns red and tender, pus-filled bumps cover most of it within hours, and the person feels very sick; medical care is often needed to save a life (AAD, AAD). The NHS also lists skin that quickly turns red with white, pus-filled bumps that join together, with a fast heartbeat, high temperature or shivering, as a reason to call emergency services (NHS). A rare form can appear in the third trimester of pregnancy and may be life-threatening for mother and baby (AAD).
  • Thoughts of suicide or a mental-health crisis. Psoriasis is linked with anxiety, depression and thoughts of suicide (AAD). Call or text 988, the free 24/7 Suicide & Crisis Lifeline (988 Lifeline).

Call your doctor the same day for fever, chills or other signs of infection while taking a medicine that dampens the immune system. Biologics raise the risk of serious infection (AAD), and methotrexate can reduce the body’s ability to fight infections; fever, chills, body aches, easy bleeding or bruising should be reported (AAD). Call soon — don’t wait for a routine visit — if a finger or toe swells, a joint becomes swollen and tender, the back of the leg just above the heel swells, or you have morning stiffness that eases as you move; these can be early signs of psoriatic arthritis, and untreated joint damage can be permanent (AAD).

No herb, supplement, tanning bed or complementary approach treats these emergencies.

What is psoriasis?

Psoriasis is a chronic, inflammatory, multisystem disease (AAD-NPF guideline, 2019). It is immune-mediated: an overactive immune system drives inflammation and speeds up skin growth (National Psoriasis Foundation). Immune cells called T-cells attack the body’s own skin cells, so the skin makes new cells in days instead of weeks. The extra cells pile up as thick, scaly patches (AAD, AAD). The patches usually itch, and may sting, burn or feel tight and painful (AAD). The American Academy of Dermatology says about 2% of people in the United States have psoriasis (AAD).

It is not contagious (AAD, NHS). It runs in families, but genes alone are not enough; scientists think a trigger is needed before it appears (AAD). It can start at any age, often between 15 and 25 or between 50 and 60 (NHS). It cannot be cured, but treatments can manage it (NHS). Most people have it for life, the main exception being some children with guttate psoriasis (AAD). Symptoms come and go in flare-ups (NHS). Because it can look like other skin diseases, a clinician may need to look at a small skin sample under a microscope (MedlinePlus). If a rash on your feet is the worry, see our Athlete’s Foot guide for fungal infections; for another itchy, flaky rash see Eczema.

Types of psoriasis

You can have more than one type, and the type on your skin can change over time (AAD).

  • Plaque psoriasis is the most common type, in about 80% to 90% of people: raised patches, often with silvery-white scale, most often on the scalp, elbows, knees and lower back (AAD, AAD).
  • Guttate psoriasis brings many small, pink to salmon-colored, scaly spots, often on the torso, arms and legs, in children and young adults after an infection such as strep throat. It often clears in weeks or months without treatment, and may never return (AAD, AAD). A Cochrane review found only one small trial of non-antibiotic treatments for it, so the evidence is very limited (Cochrane review).
  • Inverse psoriasis forms where skin touches skin — the armpits, groin, under the breasts — as smooth, red, raw-looking patches with little scale (AAD). Extra weight can raise the risk (AAD).
  • Pustular psoriasis causes pus-filled bumps, usually on the hands and feet. They look like infection, but the skin is not infected and the bumps contain no bacteria; the skin can be extremely sore (AAD). When pustules cover large areas, it is generalized pustular psoriasis (see the alert above).
  • Erythrodermic psoriasis is the rare, life-threatening form described above (AAD).
  • Nail psoriasis shows up as tiny pits, yellow, brown or white discoloration, a nail lifting away from the nail bed, or skin cells building up under the nail. About half of people with plaque psoriasis have nail changes at some point (AAD, AAD).

Psoriatic arthritis

Psoriatic arthritis (PsA) is arthritis caused by the same immune problem. The National Psoriasis Foundation says roughly 1 in 3 people with psoriasis also have it, and more than 15% may have it without knowing (NPF). Most people notice skin psoriasis first — PsA often follows 5 to 12 years later — but some develop joint symptoms first or at the same time, and no one can predict who will get it (AAD).

Early signs can be subtle: a swollen, tender joint, especially in a finger or toe; swelling on the back of the leg just above the heel; and morning stiffness that fades as you move (AAD). A whole finger or toe may swell like a sausage (dactylitis), and PsA can also bring foot and ankle pain, nail changes and pain in the lower back above the tailbone (NPF). Without treatment, PsA can worsen and cause irreversible joint damage and lifelong disability; treatment can prevent this (AAD). There is no cure (MedlinePlus).

See our Arthritis guide for how inflammatory arthritis differs from wear-and-tear arthritis, and our Ankylosing Spondylitis guide, since PsA can involve the spine (NPF).

What sets off a flare?

Triggers differ from person to person, and finding yours helps you have fewer flares (AAD). The AAD lists:

  • Stress (AAD).
  • Skin injury — a cut, scrape, sunburn, scratch, bruise, bug bite, shaving nick, tattoo or piercing — which can cause a flare in the same spot about 10 to 14 days later (AAD).
  • Infections such as strep throat, an earache or bronchitis, with flares 2 to 6 weeks later, especially in children (AAD); the NHS adds HIV (NHS).
  • Some medicines, including lithium, drugs taken to prevent malaria, some blood pressure and heart-rhythm medicines, some arthritis medicines, and strong steroid pills stopped too quickly. Don’t stop a medicine on your own; ask the prescriber (AAD).
  • Smoking and heavy drinking; and dry, cold weather (AAD).

Related health conditions

Psoriasis is more than skin deep. The AAD says people with psoriasis may have a higher risk of psoriatic arthritis, heart and blood vessel disease, diabetes, high blood pressure, unhealthy cholesterol, obesity, Crohn’s disease, liver, kidney and gum disease, eye problems, alcohol or tobacco addiction, and mood disorders including anxiety and depression (AAD). The NHS likewise names metabolic syndrome (which can lead to diabetes and heart disease) and inflammatory bowel disease (NHS). Research suggests the heart risk applies to moderate or severe psoriasis rather than mild, and that treating psoriasis may help; not every study agrees (AAD). See our guides on Heart, Diabetes, Cholesterol, Blood Pressure, Crohn’s Disease, Colitis, Depression and Anxiety. Ask your doctors what screening you should have (AAD).

How is it diagnosed?

A dermatologist can usually tell by looking at the skin: how the patches look, where they are, and whether they itch. A skin biopsy is sometimes done if it is unclear, but most often isn’t needed (NPF, AAD). Psoriatic arthritis has no single test. A doctor weighs your history, an exam, lab tests and imaging, and rules out other causes such as rheumatoid arthritis and gout; a rheumatologist usually makes the diagnosis (NPF, NHS).

When to see a doctor: if you have symptoms of psoriasis, if treatment isn’t working or is causing side effects, or if you have joint pain, stiffness and swelling that keeps coming back (NHS). The NHS says to see a doctor about joint symptoms even if you have no skin psoriasis (NHS).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Moisturizer and gentle skin care; prescription creams (steroids, vitamin D analogs, retinoids, calcineurin inhibitors); light therapy; pills such as methotrexate, cyclosporine, acitretin, apremilast and deucravacitinib; and biologic injections (TNF, IL-17, IL-23 and IL-12/23 blockers) for moderate to severe psoriasis or psoriatic arthritis. Cost estimate being researched. No cure, but many people reach clear or nearly clear skin, and treatment protects joints. Several medicines need blood tests, a tuberculosis test or pregnancy precautions, and some carry boxed warnings — ask about risks and benefits.
Chiropractic No role in treating psoriasis. For psoriatic arthritis, check with your rheumatologist before any spinal manipulation. Not a treatment for psoriasis, so no cost is listed. We found little research. Never let it delay care for the emergency signs or early joint signs above.
Acupuncture Needles (or pressure) at acupuncture points, tried as an add-on for skin psoriasis. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Reviews find some possible short-term benefit, but the trials are small and mixed. Studies in psoriatic arthritis are missing. An add-on, not a replacement.
Herbal medicine Aloe vera gel, Oregon grape (Mahonia) cream, turmeric or curcumin and fish oil are the best known. Cost estimate being researched. Evidence is thin and mixed; fish oil may help only alongside standard treatment. The NHS advises people with psoriatic arthritis not to use herbal remedies because they may interfere with medicines.
Massage therapy Gentle bodywork for stress and muscle tension, kept away from inflamed or broken skin. At one national chain, a 60-minute massage runs about $125–$160 for non-members, with memberships about $70–$90 a month. We found no psoriasis-specific trials, and reviewers call studies in psoriatic arthritis “conspicuously absent.” Skin injury can trigger flares.
MBHA Wellness Coach A trigger diary, stress and sleep habits, a skin-care routine, cutting back alcohol, quitting smoking, healthy weight and joint-friendly exercise, and keeping up with check-ups. Cost estimate being researched. Healthy habits can make treatment work better and lower the risk of related conditions. They support medical care — never replace it.

Approach 1 of 6

Conventional medicine (AMA)

Most people start with medicine applied to the skin. If that isn’t enough, a dermatologist may add light treatment or medicine that works throughout the body (American Academy of Dermatology). Joint AAD and National Psoriasis Foundation guidelines cover topical treatments and biologics (AAD-NPF topical guideline, 2021, AAD-NPF biologics guideline, 2019). Below are the classes of treatment. We don’t list doses — follow your prescriber and the drug label.

1. Moisturizer and over-the-counter care

Moisturizer helps anyone with psoriasis; thick creams, ointments or oils work better than lotions. Over-the-counter coal tar, salicylic acid (which loosens scale) and mild hydrocortisone suit very mild psoriasis (AAD).

2. Prescription skin treatments

  • Steroid creams and ointments are the most-prescribed psoriasis medicine and come in strengths from mild to extremely strong. Strong steroids on thin skin, such as the face, can cause thinning, spider veins and stretch marks, so use them only where and for as long as your dermatologist says (AAD).
  • Vitamin D analogs (such as calcipotriene) slow skin-cell growth and can be combined with a steroid (AAD). The label says to avoid the face, notes that blood calcium can rise (reversibly), and advises avoiding excessive sunlight or tanning booths (calcipotriene label).
  • Retinoids (tazarotene) reduce skin thickness and scale and can irritate skin and increase sun sensitivity (AAD). Tazarotene is contraindicated in pregnancy (Tazorac label).
  • Calcineurin inhibitors (tacrolimus, pimecrolimus) are FDA-approved for eczema; dermatologists prescribe them off-label for plaque psoriasis on delicate skin and for inverse psoriasis. The FDA warning about lymphoma and skin cancer is based on animal studies, and dermatologists advise staying out of the sun and tanning beds while using them (AAD).

3. Light therapy — and tanning beds

Phototherapy slows rapid skin-cell growth, calms the immune system and reduces itch. Narrowband UVB is the most used type; others are the excimer laser and PUVA (a light-sensitizing medicine plus UVA light). Most people need treatments two or three times a week for weeks. Possible effects include sunburn-like reactions and dark spots, and, over the long term, early skin aging and a higher skin-cancer risk. It is not recommended after skin cancer or with certain light-sensitive conditions or medicines (AAD).

A tanning bed is not phototherapy. Commercial tanning beds give off mostly UVA, while UVB does most of the good for psoriasis. The NPF does not support tanning beds as a substitute for supervised phototherapy, and notes that the AAD, FDA and CDC all discourage them; indoor tanning raises melanoma risk (NPF). A 2016 article in the Journal of the American Academy of Dermatology describes tanning-bed self-treatment of psoriasis as a significant health threat (article, PubMed).

4. Older pills that work throughout the body

  • Methotrexate is FDA-approved for adults with severe, disabling psoriasis not controlled by skin treatments or light, and also helps psoriatic arthritis and nail psoriasis. You need blood tests and a tuberculosis test first, regular blood tests for liver effects, and should avoid alcohol, sunlamps and tanning beds (AAD). Boxed warning: methotrexate can cause fetal death and is contraindicated in pregnancy for non-cancer uses; serious reactions, including death, affect the bone marrow, digestive tract, liver, lungs, skin and kidneys; and taking it daily by mistake has caused deaths (methotrexate label).
  • Cyclosporine works quickly for extensive or disabling psoriasis. Its most serious risks are kidney damage and high blood pressure, so you need blood pressure checks and blood tests; it also raises the risk of squamous cell skin cancer, especially after many PUVA treatments (AAD). Boxed warning: it suppresses the immune system, raising the risk of infection and cancer, and in psoriasis it can cause high blood pressure and kidney damage; psoriasis patients previously treated with PUVA face a higher skin-cancer risk (Neoral label).
  • Acitretin, a vitamin A–related pill, does not suppress the immune system and is especially useful for pustular psoriasis (AAD). Its label warns of severe birth defects: it must not be used by females who are pregnant or who intend to become pregnant during treatment or within 3 years after stopping, and women of childbearing potential must not drink alcohol during treatment or for 2 months after (acitretin label).

5. Newer oral medicines

  • Apremilast (a PDE4 inhibitor) treats plaque psoriasis and psoriatic arthritis and, unlike the older systemic medicines, does not require routine lab tests (AAD). Its label warns about depression and suicidal thoughts, severe diarrhea, nausea and vomiting, and weight loss; people with a history of depression should weigh the risks (Otezla label).
  • Deucravacitinib (a TYK2 inhibitor) is approved for adults with moderate-to-severe plaque psoriasis and active psoriatic arthritis. Its label calls for tuberculosis evaluation before starting and warns of infections, herpes virus reactivation and malignancies (Sotyktu label).

6. Biologics

Biologics block specific parts of the immune system. The main classes are TNF blockers (adalimumab, for example), IL-17 blockers (secukinumab, ixekizumab), IL-23 blockers (guselkumab) and IL-12/23 blockers (ustekinumab) (Humira label, Cosentyx label, Taltz label, Tremfya label, Stelara label). Many treat both psoriasis and psoriatic arthritis; the AAD lists others, including etanercept, infliximab, certolizumab, risankizumab, tildrakizumab and brodalumab. They can be very effective, but no single biologic works for everyone, and stopping and starting can make one less effective (AAD).

Safety. Serious infection is the biggest concern, and risk is higher with diabetes, tobacco use or past infections. Blood tests and tuberculosis testing are typically required first (AAD). The adalimumab label carries a boxed warning for serious infections leading to hospitalization or death, including tuberculosis, bacterial sepsis and invasive fungal infections, and for lymphoma and other cancers in children and teens; it says to test for latent tuberculosis first and monitor for active TB during treatment (Humira label). The IL-17, IL-23 and IL-12/23 labels also warn about infections and call for tuberculosis evaluation before starting (Cosentyx label, Taltz label, Tremfya label, Stelara label).

7. Generalized pustular psoriasis

This needs urgent medical care. The IL-36 blocker spesolimab is the only medicine the FDA has approved for it, including to treat flares; infliximab and acitretin are also used (AAD). Its label warns of infections and calls for tuberculosis evaluation (Spevigo label).

8. Psoriatic arthritis treatment

The NHS lists anti-inflammatory pain relievers for mild symptoms, steroid injections into a joint, disease-modifying drugs (which can take months to work) and biological treatments, plus physical and occupational therapy (NHS). Several medicines above treat skin and joints together (AAD).

What it costs

Dermatology visits, prescription creams, light therapy and biologics: MBHA cost estimate being researched. The AAD notes that financial help may be available if you can’t afford a prescribed medicine (AAD).

How well it works — what to expect

Psoriasis is lifelong, and symptoms can resolve and return (NPF). With a dermatologist’s help, many people see clearer or clear skin and feel better (AAD). Treatment can also prevent psoriatic arthritis from worsening (AAD).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating psoriasis. We found little research on spinal manipulation for psoriasis or psoriatic arthritis; a 2020 review of complementary medicine in psoriatic arthritis found a significant knowledge gap (review, Current Rheumatology Reports).

A cautious note. Psoriatic arthritis can inflame the spine and the places where tendons attach to bone (NPF), and damaged joints may not recover (AAD). As a precaution, ask your rheumatologist before any neck or back manipulation, and don’t let any visit delay a diagnosis. See our Ankylosing Spondylitis guide.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been tried for psoriasis skin, with weak evidence:

Safety: complications are uncommon, but improper delivery can cause infections and organ or nerve injury (NCCIH). Skin injury can also trigger a psoriasis flare 10 to 14 days later (AAD), so choose a licensed practitioner and avoid needling plaques.

Cost: about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Natural products have been studied for psoriasis, but the research is limited and mixed. The NHS advises people with psoriatic arthritis not to use herbal remedies because they may interfere with medicines (NHS). Tell your dermatologist about everything you use. The National Psoriasis Foundation also urges talking with your provider before changing a treatment plan (NPF). We don’t list doses.

Aloe vera gel

Two trials point different ways. In 40 people, a commercial aloe gel was modest and not better than placebo (trial, JEADV, 2005); in 80 people with mild to moderate psoriasis, aloe cream did slightly better than a steroid cream over 8 weeks, with no follow-up afterward (trial, JEADV, 2010). The NIH says a small amount of research suggests topical aloe may help psoriasis, and that topical gel is generally well tolerated, with occasional burning, itching or rash (NCCIH).

Oregon grape (Mahonia)

A 200-person placebo-controlled trial of a Mahonia aquifolium cream (described as a homeopathic product) over 12 weeks reported improved scores and mostly minor side effects such as rash and burning (trial, American Journal of Therapeutics, 2006). It is the only trial of it we found.

Turmeric and curcumin

In a small open-label trial without a placebo group, only 16.7% of people with moderate to severe psoriasis responded to oral curcumin; the authors called for larger placebo-controlled trials (trial, JAAD, 2008). The NIH says we don’t know enough to conclude turmeric is beneficial for any purpose, and that highly bioavailable curcumin products have been linked to liver damage (NCCIH).

Fish oil

A review of 18 randomized trials (927 people) found fish oil alone did not change psoriasis scores, but fish oil combined with conventional treatment lowered them, with no safety difference; the authors say it may help alongside standard treatment (review, Nutrition Reviews, 2020).

Cost: cost estimate being researched.

Approach 5 of 6

Massage therapy

We found no clinical trials of massage for psoriasis, and for psoriatic arthritis reviewers describe studies of massage and acupuncture as “conspicuously absent” (review, Current Rheumatology Reports). Massage may still help with stress and tension, which can feed flares (AAD); it isn’t a psoriasis treatment.

  • Ask the therapist to skip cracked, bleeding, inflamed or infected skin. Skin injury can cause a flare about 10 to 14 days later (AAD).
  • Choose gentle techniques for swollen joints. Serious harm from massage is rare, but has involved vigorous types such as deep-tissue massage (NCCIH).
  • Use your own fragrance-free moisturizer if skin is dry; fragrance and other ingredients can irritate.

Cost: at one national chain, franchise price lists show about $125–$160 for a 60-minute massage for non-members, and memberships run about $70–$90 a month (The Pricer). Tips are extra.

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help turn your clinician’s plan into habits you can keep — alongside medical care, never instead of it.

Another approach

Diet, weight, alcohol and smoking

Diet is no substitute for treatment, but dermatologists recommend a healthy, balanced diet, and what you weigh can matter (American Academy of Dermatology).

Another approach

Sun, climate and the Dead Sea

Sunlight contains UVB, which helps psoriasis, but the National Psoriasis Foundation says sun is less effective than prescription phototherapy, isn’t right for everyone, and should be limited if you use PUVA or certain medicines (NPF). Sunburn can itself trigger a flare, so protect healthy skin with broad-spectrum SPF 30 or higher (AAD).

Dead Sea climatotherapy combines supervised sun exposure and bathing. The evidence is encouraging but small and short-lived. In 27 people treated for 28 days, scores fell by 81.5% and 48% cleared completely, with remission averaging 3.3 months (study, JAAD, 2003). In a 2020 cohort of 18 patients treated for 4 weeks at Ein Gedi, Israel, scores fell by 88%, but skin symptoms returned after about 94 days on average, and the authors saw no long-term control (cohort, Frontiers in Medicine). It means weeks away from home; talk with your dermatologist first.

Another approach

Pregnancy, breastfeeding and family planning

Psoriasis can improve, stay the same or worsen in pregnancy. Moisturizers and low- to mid-strength steroid creams are usually first choices, and narrowband or broadband UVB is considered safe, though folic acid should be discussed (AAD).

  • Avoid: acitretin, methotrexate and tazarotene can cause severe birth defects or pregnancy loss. Stop acitretin 3 years, and methotrexate or tazarotene at least one menstrual cycle, before pregnancy; men should stop methotrexate 3 months before trying to conceive (AAD). The acitretin label also bars alcohol for women who could become pregnant (acitretin label), and the methotrexate label contraindicates it in pregnancy for non-cancer uses (methotrexate label).
  • Pustular psoriasis of pregnancy is rare and can be life-threatening to mother and baby; see the alert at the top (AAD).
  • Breastfeeding: little is known about what passes into milk, and flares are common after birth (AAD). Talk with your dermatologist and obstetric provider about any change; the NHS says to speak with your doctor or pharmacist if you are trying to get pregnant (NHS).

Another approach

Psoriasis on brown and Black skin

  • Color: on light skin psoriasis looks red or pink with silvery scale; on Black skin it often looks violet with gray scale, and on dark skin it can be dark brown and hard to see (American Academy of Dermatology). The NHS describes patches that look grey on brown or black skin with dark marks after clearing (NHS).
  • Color changes after clearing: lighter or darker patches may appear. They are not scars and eventually fade, but clearing can take 3 to 12 months or longer (AAD).
  • Treatment is essentially the same for all skin colors, but light therapy can darken skin and make dark spots more noticeable; tell your dermatologist if that worries you (AAD). Research suggests psoriasis may be more common in skin of color than once thought (AAD).

If patches keep returning but don’t look “red,” say so.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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