If you’ve been living with psoriasis for some time, you likely know that your symptoms can come and go. Starting a new treatment can help control your symptoms and encourage your skin to heal — but how do you know when a therapy is working? Although you might be eager for quick relief from psoriasis, it may take some time for your skin to begin clearing.
In this article, we’ll cover the three signs that show your psoriasis treatment is working. We’ll also cover how your dermatologist (skin specialist) measures the effectiveness of your treatment plan. Together, you and your dermatologist can find the best approach to keeping your skin clearer for longer.
Psoriasis is a chronic inflammatory skin condition that goes through periods of flares (worsening symptoms) and remission (symptom relief). During a flare, you may have dry, scaly patches of skin, itchiness, or rashes. The symptoms you experience depend on your type of psoriasis.
For example, plaque psoriasis causes dry, scaly raised areas of skin known as plaques. Guttate psoriasis is characterized by small, round, or teardrop-shaped discolored bumps. Erythrodermic psoriasis leads to peeling rashes with intense burning and itching.
Some psoriasis flare-ups can last several weeks or months and then go away for a while.
According to the American Academy of Dermatology (AAD), cold temperatures, stress, smoking, and skin injuries all raise the risk of a psoriasis flare. You can help prevent flare-ups by avoiding your psoriasis triggers.
In addition, your dermatologist can prescribe treatments to help control and limit flare-ups. Common treatment options include:
Whether your dermatologist prescribes topical treatments — like creams, lotions, or ointments — or an injectable biologic, you should see symptom improvement.
During a follow-up appointment, your dermatologist will likely ask if you’re experiencing less inflammation, discoloration, and flaking. Be ready to tell them about any changes you’ve noticed since starting your treatment — whether your symptoms are better or worse and if new ones have developed.
Some MyPsoriasisTeam members turn to others for help when looking for signs of healing. One asked, “I’m shedding like crazy from every skin surface. I’m not sure if this is a stage in the healing after two weeks of medication or something new in my psoriasis bag of tricks. Any ideas?”
Your dermatologist can help determine whether your skin is in the process of healing or if you may be reacting to your treatment. To learn more about the specific side effects of your psoriasis treatments, talk to your doctor.
Dermatologists use a few measurements to track how severe your psoriasis is and whether it’s responding to treatment. Body surface area (BSA) refers to the amount of skin affected by psoriasis. The National Psoriasis Foundation defines severity based on the the proportion of the body covered by psoriasis:
A tool called the Psoriasis Area and Severity Index (PASI) can help tell your dermatologist if your current treatment plan is effective. This scoring system takes several factors of your psoriasis into account. One factor is intensity, which is based on how discolored, scaly, and thick your skin is. Your PASI score also uses your BSA measurements. Your dermatologist will grade these factors on a scale and add them up to get your PASI score. The higher your PASI score, the more severe your psoriasis is.
If you’ve recently started treatment for psoriasis, you’re likely wondering when you’ll notice healing. The time it takes for treatments to work can depend on both your type of psoriasis and your treatment. For example, it may take up to six weeks to notice any improvement when using topical medications.
If you have severe psoriasis or psoriatic arthritis, which causes joint pain and stiffness as well as a rash, your doctor may prescribe immunosuppressive medication like methotrexate (Otrexup, Rasuvo, Trexall). While this drug usually begins working within four to six weeks, you might not see completely clear skin for up to six months.
Now that you have a better understanding of how dermatologists measure symptom improvement, we’ll cover three signs that your skin is healing from psoriasis.
As your skin begins to heal, you’ll likely notice that less is affected by psoriasis. When researchers study new psoriasis treatments, they use the PASI score to measure how well they work. This means they look for the treatments that help clear skin the most.
MyPsoriasisTeam members have shared how they attribute clearing skin to a particular treatment. One member wrote, “Today is a good day. The cream seems to be helping — no scaling, burning, or itching. Three of my spots are barely noticeable, and the six large patches aren’t really that bad.”
Another shared their success with a biologic: “My skin is slowly but surely clearing up. Except for some discoloration, there’s no more peeling and flaking.”
During a psoriasis flare, your skin may become intensely itchy. Scratching can temporarily help but ultimately will make your itching worse. Once your psoriasis treatment starts working, you’ll likely feel less itchy. You may also notice less flaking. In psoriasis, skin cells pile on the surface of plaques that flake off. When you treat the inflammation causing rapid skin cell growth, you can also treat the flaking.
Some MyPsoriasisTeam members have noticed that healing skin means symptom relief. “Been on treatment for less than two weeks — my elbows and hands are healing,” one member said. “I have new pink skin coming through, and my itching is under control.”
Inflammation from psoriasis can affect your skin tone. Some people with darker skin develop discoloration where they used to have plaques or rashes. A sign your skin is healing from psoriasis may be that your skin tone evens out. According to the AAD, it can take between three and 12 months for these lighter or darker patches to clear.
MyPsoriasisTeam members have also found that skin color improves over time. “The biologic I’ve been on for two-plus years has worked wonders, and the plaques on my legs have faded into the sunset, with only light discoloration where they once were,” shared one member.
Once you see your skin healing, you may be tempted to stop treatment. However, it’s important to keep up your treatment plan so your skin stays healed. The AAD notes that when you stop treatment, your symptoms may return and even be worse than before (known as a rebound).
Since psoriasis is a lifelong condition, it usually requires lifelong treatment. After your skin has healed, talk with your dermatologist about your next steps. You may need maintenance treatment, or you may be able to adjust some of your medications as your dermatologist sees fit. The overall goal is to help you stay in remission as long as possible and improve your overall quality of life.
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 125,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
What signs do you use to tell your skin is healing after a psoriasis flare-up? Share your experience in the comments below, or start a conversation by posting on your Activities page.