Ways to Prevent Psoriasis Spotting and Scarring

More than 8 million Americans are currently navigating life with psoriasis, and roughly 150,000 more will be diagnosed this year. About 80 to 90 percent of them have the form of psoriasis known as plaque psoriasis, characterized by inflamed, itchy, painful areas of skin.

On white skin, plaques typically appear as raised red patches covered with a silvery white buildup of dead skin cells or scale. On skin of color, plaques may appear darker and thicker and more of a purple or grayish color or darker brown, according to the National Psoriasis Foundation.

Psoriasis Can Cause Pigment Changes That Can Last for Months

One of the most common longer-term effects of psoriasis flares is skin discoloration. During a flare, parts of the immune system disrupt the production of melanocytes, the cells responsible for giving skin color.

People with lighter skin tones can experience hypopigmentation, where patches of skin become paler than the surrounding skin. With darker skin tones and skin of color, the issue can also be hyperpigmentation, where patches of skin become darker than the surrounding skin, according to Amy Kassouf, MD, a dermatologist at the Cleveland Clinic in Ohio.

Itching Psoriasis Plaques Can Cause Scars

Scarring from psoriasis isn’t common, but it can happen. “Scarring doesn’t typically occur unless people scratch or manipulate their plaques,” says Michelle Pelle, MD, a dermatologist in San Diego. This can cause trauma to the skin and result in linear scarring (like a scar from a cut or incision). Plaque psoriasis can also cause skin to become dry, then crack and bleed, which can sometimes lead to scarring.

In some cases, psoriasis treatments can contribute to the problem. Overuse of topical steroids, for example, can thin the skin and cause changes to its collagen structure. This can lead to an atrophic (or indented) scar or even stretch marks, notes Dr. Kassouf.

While phototherapy (light therapy) can be an effective treatment for plaque psoriasis, it stimulates the skin’s pigment cells, which can make discoloration caused by plaques more noticeable, and occasionally permanent. “This was more of a problem with older forms of light treatment,” Kassouf notes. "Newer, narrow band UVB therapy has significantly minimized the risk of permanent pigment changes, but there is still some risk.”

How to Avoid Scarring From Psoriasis

Here are some key ways to keep skin feeling and looking good.

1. Moisturize at Least Twice a Day

Using emollients — especially creams with exfoliating acids such as lactic, glycolic, or salicylic acid — is key to reducing itching and scaling. “It should be done in addition to whatever therapy is prescribed by your doctor,” Dr. Pelle says. Apply moisturizer twice a day for the best results. You can also use it to soothe itchiness and help you resist the urge to scratch.

2. Avoid Picking at Scales

“Pulling up scales can cause bleeding and trauma to skin, which can increase risk of scarring,” explains Kassouf. Instead, use emollients to keep scales in place until they exfoliate naturally.

3. Apply Cooling Relief

If itchiness is really driving you crazy, try a cool cloth or even an ice pack as an alternative to scratching. Scratching a plaque can worsen a flare, which increases your risk of discoloration.

4. Skip Shaving During Flares

Shaving with psoriasis can worsen areas of plaques and lead to scars, especially for people affected by the Koebner phenomenon, a reaction that causes new plaques to form on the site of a skin infection or injury. “Even shaving an area where the skin is normal can be risky because you might cause a small abrasion and the psoriasis may then jump to that area,” explains Kassouf.

5. Use Steroid Creams as Directed

Long-term use or overuse of strong corticosteroids can thin the skin and potentially cause scarring. Use only mild corticosteroid ointments on sensitive areas, such as your face or skin folds, and for treating widespread patches, recommends Kassouf. Potent steroid creams should be utilized for only a short time and only on thick areas of skin.

6. Update Your Treatment Plan

Psoriasis treatments (including oral, topical, and injectable medications and light therapy) can reduce inflammation, heal lesions, and help skin resume normal function. If you’re having difficulty managing flares, talk with your dermatologist about new treatments to consider. “We have such good medications now that many patients who have had persistent plaques for years are able to experience clear skin,” says Kassouf.

7. Consider Laser Treatment if You Have Any Scarring

If you have scars or pigment changes from psoriasis flares that don’t improve with time and treatment, ask your dermatologist if you’re a candidate for laser treatment. “In some cases, we will use fractional or vascular lasers to treat scarring,” says Kassouf. “The laser sends signals to that area of skin to tell it to keep remodeling, which can encourage those scars to get closer to normal.”

Additional research by Julia Califano.

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