Complete skin clearance means all visible signs of psoriasis are gone — the ultimate goal of treatment for many people with this skin condition.

“I love it — 95 percent clearance and only one shot a month,” one MyPsoriasisTeam member said of their biologic — a type of medication that targets parts of the immune system. Another member said they started a biologic and, within five weeks, “achieved 100 percent clear skin.”

Thanks to newer treatments, complete skin clearance is possible for some people for the first time. However, it can take a while to reach this goal, and no psoriasis treatments bring about total skin clearance for 100 percent of the people who try them. Still, many people living with psoriasis can see significantly reduced symptoms and improved quality of life.

What Is Complete Skin Clearance?

People with psoriasis who reach complete skin clearance no longer have lesions — bumpy, discolored patches that itch, hurt, crack, and bleed. Other symptoms (such as joint pain in psoriatic arthritis) might remain, but the skin no longer shows evidence of the condition.

Complete skin clearance also means that common psoriasis symptoms — such as itching, burning, cracking, or bleeding skin — are gone and no longer require topical treatments. However, prescribed medications such as biologics may still be needed to keep this chronic (long-term) condition under control.

Here are some facts to help you better understand skin clearance and how it may be achieved.

1. Skin Clearance Can Be Measured

Severity of psoriasis is generally measured using either the Psoriasis Area and Severity Index (PASI) or the Physician Global Assessment (PGA). PASI is based on severity and the amount of body surface area affected by discoloration, thickness, and scaling across the head, upper limbs, trunk, and lower limbs.

Once you start a new biologic, it can take one to four months to see how well it works.

A PASI score under five is considered mild disease, and a score over 10 is considered severe disease. The maximum PASI score is 72.

PGA is typically a six-point scale that assesses severity but not specific body surface area. A PGA score of zero indicates clear skin, while a score of four or higher is considered severe.

Many clinical trials measure the change in PASI scores to assess a drug’s effectiveness. In this context, the term “PASI 75” means a person reduced their starting PASI score by 75 percent — a significant improvement in psoriasis symptoms. “PASI 100” would be complete skin clearance, but a perfect score may not be achievable for everyone. Talk with your dermatologist about what’s realistic for you.

2. Biologic Treatments May Lead to Complete Clearance

Biologics can help some people with psoriasis achieve completely clear skin. These treatments are made from proteins that target specific parts of the immune system involved in inflammation, which plays a key role in psoriasis symptoms. Many biologic medications are available, and it can take time to find out which one works best for you with the fewest side effects.

Biologics don’t work for everyone, but they’ve made a big difference for many people. In one study of 846 people with psoriasis, about 25 percent achieved complete skin clearance after six months of biologic treatment. Other studies have found that 30 percent to 45 percent of participants reached clear skin with biologics.

Although older treatments rarely led to full clearance, biologics have made that goal possible — and they’ve helped many people improve not just their skin but also their quality of life.

3. Skin Clearance Is More Achievable Than Ever

When biologics were introduced nearly 20 years ago, 75 percent skin clearance was considered a great success. Treatment options have come a long way since then. Newer biologics make it possible to achieve at least 90 percent clearance.

However, complete skin clearance may not be a realistic treatment outcome or end point for everyone. Several factors may affect how well biologics work, including your:

• Specific medication
• Severity of symptoms before treatment
• Body weight
• Overall health

4. Psoriasis Severity Can Affect Treatment Results

Your disease severity before starting treatment can affect how likely you are to achieve complete skin clearance. In a study of 515 people who began using biologics for psoriasis, those with more severe disease showed the biggest PASI score improvements — to a point. People with a starting score over 30 were less likely to achieve complete clearance. Still, all participants reported experiencing fewer symptoms and a better quality of life after beginning treatment.

At times, more severe skin psoriasis may be linked with psoriatic arthritis — a form of joint inflammation that can cause pain and stiffness. Not all biologics work for both skin and joint symptoms, so be sure to tell your dermatologist if you also have joint pain.

5. Skin Clearance May Require Finding the Right Medication

Even if biologics work for you, it may take some time to find the one that leads to clear skin. There’s no test to show which biologic will work best for you, so the process may take some trial and error.

Health insurance coverage can also affect your options. Your plan may not cover some biologics, and newer treatments may be available only for participants in clinical trials (studies that test whether therapies are safe and effective in people).

Once you start a new biologic, it can take one to four months to see how well it works. Additionally, even if you’ve reached full skin clearance, biologics may gradually stop working as well. Over time, you may stop responding to the medication, sometimes because your body develops antibodies that block the treatment’s effects.

6. Biologic Treatment May Gradually Become Less Effective

With some biologics, you may need to change to a different drug within five years. However, some newer biologics have shown sustained durability with at least five years of consistent results. The U.S. Food and Drug Administration (FDA) has approved more than a dozen biologics to treat psoriasis, so you have multiple options if a medication doesn’t work for you or stops working over time.

Biologics are systemic medications, meaning they work throughout the whole body. They’re usually given by injection or IV infusion. Some biologics can be self-administered at home, whereas others require going to a clinic or doctor’s office for an infusion every few weeks. These appointments can take time, and some people don’t feel well for a few days afterward.

It also may be several weeks before you notice any major improvements in your symptoms. Biologics differ in how often they’re administered, so talk with your dermatologist about which options might work best with your lifestyle.

7. Body Weight May Affect How Well Biologics Work

Some biologic medications may not be as effective for people with higher body weights. A review of studies found that biologics in specific drug classes had lower success rates in people with a body mass index (BMI) of 30 or higher. A few biologics also have been linked to weight gain as a side effect, which may further complicate treatment outcomes.

Not all biologics are affected by body weight. Some can be dosed based on weight or have shown consistent results across weight groups. If you have a higher body weight, talk with your dermatologist about which biologics might be the best options for you.

8. Biologics May Not Be Right for Everyone

Because they change the way the immune system works, biologics can increase your risk of infections and also make it harder for your body to heal. If you’ve tested positive for certain infections, such as hepatitis B or tuberculosis, your doctor may recommend different treatments.

Before you start a biologic, your care team may ask you to get tested for TB or other infections. This helps make sure the medication is safe for you. The latest biologics target specific parts of the immune system, which may lower the risk of serious infections compared to older drugs, but side effects are possible. Some people experience skin reactions, like itchiness or discoloration, especially at the injection site.

9. Working With Your Doctor Can Lead to Better Results

It’s important to talk with your dermatologist about setting goals for the management of psoriasis. Your doctor knows the specifics of your health history and your psoriasis, and they can help you make informed decisions about treatment goals and medication options.

Be sure to tell your dermatologist about all your symptoms, including those beyond the skin, such as joint pain or gastrointestinal issues. It’s also important to work with your healthcare team to manage any comorbidities (coexisting health conditions, such as inflammatory bowel disease or cardiovascular disease).

It’s essential to stick with your treatment plan, which may include medications, at-home skin care, lifestyle changes, or phototherapy. Although there’s no cure for psoriasis, the right treatment may keep your condition in remission (periods of fewer or no symptoms) longer.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 134,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you wondering if complete skin clearance is possible for you? Have you talked with your doctor about biologics? Share your questions or experiences in the comments below or by posting on your Activities page.