Psoriasis: Symptoms and Treatment

What is Psoriasis?

Psoriasis, medically known as psoriasis, is a chronic, inflammatory disease associated with the immune system. It most commonly causes sharply defined, red plaques on the skin covered with white to silvery scales.

However, psoriasis is not just a skin disease. It can also affect the nails and joints; and it is more frequently associated with certain metabolic and cardiovascular diseases.

The disease may flare up and relapse periodically. While there is currently no single treatment that completely eliminates it, long-term disease control can be achieved with very effective treatment options. Current treatment goals are no longer just "slight improvement," but are approaching near-complete skin clearance in suitable patients.

Briefly, what you need to know

Psoriasis is not contagious.

It should not be considered merely a skin disease.

Genetic predisposition and the immune system play an important role.

Factors such as stress, infections, certain medications, and skin trauma can trigger flare-ups in some people.

Nails and joints may be affected.

The severity of the disease is not determined solely by the area of skin it covers.

Today, in addition to conventional drugs, there are highly effective targeted and biological therapies available. (Turkish Archives of Dermatology and Venereology)

What does psoriasis look like?

The most common form is plaque psoriasis.

Red, well-defined, and scaly plaques may appear on areas such as the knees, elbows, scalp, and trunk.

However, psoriasis doesn't look the same in everyone.

Plaque psoriasis: This is the most common form.

Guttate psoriasis: This can manifest as numerous small, droplet-shaped lesions, particularly on the trunk. It may appear following certain infections.

Inverse psoriasis: Occurs in skin folds such as the armpits, groin, or under the breasts. Because it is located in moist areas, the classic thick scaling may be less pronounced.

Pustular psoriasis: It has different forms characterized by pustules that have a purulent appearance but are not due to infection.

Erythrodermic psoriasis: A rare condition that can affect very large areas of the skin and requires serious medical evaluation.

Psoriasis is not just a disease characterized by scaling on the elbows; it can have different clinical subtypes and affected areas.

What causes psoriasis?

There isn't just one reason.

Genetic predisposition and a dysregulated inflammatory response of the immune system play a role together. Inflammatory pathways such as TNF, IL-17, and IL-23 are particularly important in the development of the disease.

A better understanding of these mechanisms has led to significant changes in psoriasis treatment in recent years. Today, some biological drugs can directly target these inflammatory pathways.

Is psoriasis contagious?

No.

Psoriasis is not a bacterial, fungal, or viral infection.

It is not transmitted to another person through touching, using the same towel, swimming in a pool, or sexual contact.

This is a significant misconception, particularly prevalent in the social lives of patients with visible lesions.

What can trigger psoriasis?

Triggers are not the same for everyone.

In some people:

stress,

infections,

trauma to the skin,

some medications,

cigarette,

alcohol,

obesity

It may be related to the onset or exacerbation of the disease.

A long and general list of prohibitions is not helpful for most patients. Illness is not caused solely by a mistake in one's lifestyle.

Can psoriasis occur on the scalp?

Yes.

The scalp is a common area affected by psoriasis. Red, thick, scaly areas may appear, extending beyond the hairline.

It can sometimes be confused with seborrheic dermatitis.

Can nails get psoriasis?

Yes.

On the nails:

small pits,

color changes,

thickening under the fingernail,

separation of the nail from the nail bed

Changes like these may occur.

Nail involvement should not be considered merely a cosmetic issue. It is also important in clinical evaluation due to its association with psoriatic arthritis.

Does psoriasis affect the joints?

Some patients with psoriasis may develop psoriatic arthritis.

Symptoms may include joint pain, swelling, or stiffness; swelling throughout the fingers and pain where tendons attach to the bone.

In psoriasis patients, especially those experiencing morning stiffness, swollen joints, or recurring joint complaints, it's crucial not to dismiss this as simply "rheumatism.".

Early diagnosis is crucial for preventing permanent joint damage.

Is psoriasis related to other diseases?

Psoriasis, especially in moderate to severe cases, is considered a systemic inflammatory disease that is not limited to the skin alone.

Obesity can be associated with metabolic syndrome, cardiovascular diseases, inflammatory bowel diseases, and some psychological problems.

This does not mean that these will necessarily develop in a person with psoriasis.

However, it is important to consider comorbidities when necessary during dermatological evaluation. Current guidelines specifically take comorbidities into account when choosing treatment.

How is psoriasis diagnosed?

In most patients, the diagnosis is made through dermatological examination.

The appearance and distribution of the lesions, as well as findings related to the scalp and nails, are evaluated.

Not every patient requires a blood test or biopsy.

In selected cases where the diagnosis is uncertain, a skin biopsy may be performed.

How is the severity of the disease determined?

Just:

“"What percentage of the body is affected by psoriasis?"”

It's not enough to just look at it that way.

Dermatologists may use measures such as PASI, BSA, and DLQI (which assesses quality of life) as needed.

However, even a disease in limited areas such as the palms of the hands, soles of the feet, genital area, face, scalp, or nails can seriously affect a person's life.

Therefore, a small area does not equal an insignificant disease.

The Turkish Psoriasis Treatment Guidelines also emphasize the importance of considering both disease severity and quality of life when choosing a treatment. (Turkish Archives of Dermatology and Venereology)

How is psoriasis treated?

Treatment for the disease:

Severity + location + type of psoriasis + joint involvement + comorbidities + previous treatments + patient characteristics

They are planned by evaluating them together.

Topical treatments

In mild and limited cases, topical treatments are often the first line of treatment.

Corticosteroids, vitamin D analogs, and various topical options can be used depending on the affected area.

Treatment for a thick plate in the elbow or knee may not be the same as treatment for a thick plate in the face or crease areas.

Phototherapy

Controlled ultraviolet therapy can be used in suitable patients.

Especially in more widespread disease, it can be one of the options between topical and systemic treatments. In the Turkish guidelines, phototherapy is also an important part of the treatment algorithm. (Turkish Archives of Dermatology and Venereology)

Classical systemic treatments

In patients with moderate to severe disease or those with specific clinical features:

methotrexate,

cyclosporine,

acitretin

Classic systemic medications such as these can be considered.

Each has different efficacy, side effects, and follow-up characteristics.

Targeted and biological therapies

One of the biggest advances in psoriasis treatment is therapies that target specific parts of the disease's inflammatory mechanisms.

Today, there are numerous options available for suitable patients, including biologics that target the TNF, IL-17, and IL-23 pathways.

Targeted oral small molecules such as deucravacitinib have also been incorporated into modern treatment algorithms. The 2026 S3/EuroGuiDerm adaptation includes bimekizumab and deucravacitinib among current treatment options.

The important point from the patient's perspective:

“"For psoriasis, there is no longer a treatment world consisting only of creams and old systemic medications."”

There are quite effective treatments available today.

Do biological therapies completely shut down the immune system?

No.

Biological therapies do not “shut down” the entire immune system; they work against specific inflammatory targets that play a role in the development of psoriasis.

However, these are serious medical treatments. The risk of infection, comorbidities, and other drug-specific safety concerns are evaluated before and during treatment.

The 2026 guidelines specifically emphasize the combined assessment of efficacy, safety, comorbidities, and individual patient characteristics when choosing a treatment.

Will psoriasis completely disappear?

Psoriasis is a chronic disease.

Current treatments do not eliminate genetic predisposition; however, the disease can be controlled very well.

With modern treatments, the goal is not just partial remission. The current 2026 guidelines state that PASI 90 or absolute PASI <2 are among the desired treatment goals.

We will translate this to the patient as follows:

With appropriate treatment, near-complete skin clearance may be possible in some patients.

There is no guaranteed permanent cure for psoriasis that provides complete results for everyone; the goal is to safely control the disease.

What precautions can be taken at home?

Regular moisturizing can help reduce dryness and flaking.

In addition:

avoiding traumatizing the skin,

to use the prescribed treatment regularly,

recognizing personal triggers,

avoiding smoking,

maintaining a healthy body weight

It can contribute to general disease management.

No single diet is a proven replacement for standard treatment in all psoriasis patients.

When should you consult a dermatologist?

Dermatological evaluation is necessary, especially if the condition is spreading, affecting specific areas such as the scalp/nails/genital area, if it cannot be controlled with topical treatments, or if it significantly impacts quality of life.

It is especially important to mention any joint pain, swelling, or morning stiffness.

Unusually severe presentations, such as widespread rash, fever, or large areas of pustular lesions, require faster medical evaluation.

Frequently Asked Questions

Is psoriasis contagious? No.

Can psoriasis be caused by stress? Stress can trigger flare-ups in some people, but it is not the sole cause of the disease.

Is psoriasis a fungal infection? No. Psoriasis is an inflammatory disease.

Is psoriasis hereditary? Genetic predisposition is important; however, having a family history of psoriasis does not necessarily mean that a person will develop the disease.

Can psoriasis affect the joints? Some patients may develop psoriatic arthritis. Early assessment of joint symptoms is important.

Can psoriasis patients use biological treatments? Biological treatments are among the current treatment options for suitable patients with moderate to severe psoriasis. Which treatment is appropriate is determined according to the patient's psoriasis characteristics and overall health condition.