Psoriasis scars: What you should know

Psoriasis is a chronic inflammatory condition that can cause the development of elevated, scaly, silvery plaques on different skin areas. It doesn’t usually lead to scarring, but scarring can occur if the itching is serious and the individual scratches the area.

At times, symptoms can intensify, and people often call these periods flares or relapses. The signs may then go away for a while, before returning.

The skin can never be fully clear for many individuals with psoriasis. There are periods when symptoms are better, and worse, and psoriasis is a chronic disease.

Psoriasis does not lead to scarring directly, but it may itch the lesions, and a person may scratch them. The skin can become dry as well, and it can crack and break. All of these variables may contribute to scarring, and any scars that form are permanent.

The risk of scarring can, however, be minimized by getting the right treatment and taking the right measures.

Learn more about psoriasis here.

Formation

A man looking at the mirror
Psoriasis does not usually leave scars, but scratching the affected regions will sometimes..

There are various forms of psoriasis, but all of them include relapse and remission periods.

Skin discoloration sometimes persists for a while after a relapse before clearing up. This discoloration is not a scar. Typically, physicians call it post-inflammatory changes in pigmentation.

If a person receives successful therapy, it is unlikely that their psoriasis will cause scars.

Scarring may occur when a person cuts the skin by scratching it, for example.

However, with the right therapy and treatment, after a flare, most people’s skin will improve and they will have less lesions and no scars.

Scarring typically does not lead to problems, but it can affect the self-confidence of an individual.

Psoriasis scarring can rarely occur on the scalp, and this can result in hair loss, a disorder called scarring alopecia by physicians.

Find out all about scalp psoriasis here.

Treatment

During a flare, treating skin symptoms may reduce the risk of scarring. However, if scarring does occur, medication will help.

The following alternatives can either help stop scarring or decrease the presence of scars:

  • topical creams
  • surgery
  • laser therapy

Depending on the level of the scarring and the reason why it has grown, a doctor will make recommendations.

Topical treatments

Sun protecting
People with psoriasis should use sun protection and avoid too much sun exposure.

These are largely aimed at reducing the risk of scarring by helping to control symptoms. They can also reduce the already developed scar tissue.

A doctor may suggest that you use one or more of the following:

Sunscreen: Due to prolonged sun exposure, this will prevent symptoms from worsening. It may also help avoid color changes due to exposure by adding sunscreen to an area that is healing.

Some psoriasis individuals benefit from reducing or regulating their exposure to the sun. Speak to a physician about how much and what sort of exposure is acceptable.

Tretinoin cream: In order to decrease scarring, a doctor can prescribe tretinoin. Retinoids can also aid, such as tazarotene. The main goal of these drugs is not to treat scarring, but they can be administered off-label for this purpose by a doctor.

Salicylic acid: In over-the-counter medications for psoriasis, this is a common ingredient. This helps to eliminate dead skin cells and to decrease scaling. It is available by prescription as well. It can increase its efficacy by combining salicylic acid with corticosteroids or coal tar.

Coal tar: This will help minimize scratching and scaling, and avoid scarring as a result. In a number of products, it is an ingredient, including soaps and shampoos.

Topical corticosteroids: Inflammation can be minimized by a range of topical corticosteroids and help manage skin symptoms of psoriasis.

Laser and light therapy

By relieving symptoms, various forms of light therapy may help minimize the risk of scarring.

Excimer laser therapy can help to dissolve skin layers by directing intense ultraviolet light to particular areas of the skin, for instance, XTRAC.

The benefit of laser therapy is that it directly attacks lesions and doesn’t affect other skin areas. Another option is phototherapy.

Dermabrasion

Dermabrasion can assist with scarring that is left after a flare. Skin injury, however, can cause symptoms of psoriasis, and for people with psoriasis, doctors do not always prescribe this treatment.

Grafting surgery

Scars are rarely serious enough to require a specialist procedure for grafting. Punch graft surgery is one option.

It is rare, however, for skin damage from psoriasis to require this form of treatment. Anyone considering this form of treatment should explore with their doctor all the options first.

Prevention

A lady using face cream
Itching can be eased by creams and lotions and help avoid scratching.

Avoiding a flare, if possible, and controlling symptoms when a flare arises is the best way to prevent scarring.

Tips include:

Knowing the triggers: Try to avoid these factors if stress, certain foods, or smoking appear to cause a flare. Exercise can help with stress, such as yoga.

Psoriasis flare medication: This means adhering to the treatment plan and attending scheduled follow-up with a dermatologist.

Avoiding scratching: The damage to the skin caused by scratching may produce scar tissue. It can help decrease itchiness and other irritation by using doctor-approved creams and ointments.

Managing sunlight exposure: Even if the sun is not very bright, apply sunscreen before going out. Also, be aware that certain drugs may increase the risk of sun exposure, such as retinoids.

Moisturizing: Dryness and itchiness may be relieved by moisturizers. Within 5 minutes after taking a bath or shower, the American Academy of Dermatology suggests that people with psoriasis apply moisturizer.

Interpretation

The risk of psoriasis-related scarring may be minimized by proper care and treatment.

New drugs, called biologics, can help reduce the frequency of flares and improve the involvement of baseline psoriasis, especially in people with moderate to severe symptoms.

It can often affect the self-esteem of a person if scarring occurs. Treatment is available, however, and a doctor may offer advice on the best choices.

Sources

  • 8 ways to stop baths and showers from worsening your psoriasis. (n.d.).
    (LINK)
  • Almeida, M. C., et al. (2013). Psoriatic scarring alopecia. 
    (LINK)
  • Clark, R. A. (2011). Gone but not forgotten: Lesional memory in psoriatic skin.
    (LINK)
  •  Menter, A., et al. (2019). Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics.
    (LINK)
  • Shilpa, K., et al. (2016). Outcome of dermal grafting in the management of atrophic facial scars.
    (LINK)
  • Torsekar, R., & Gautam, M. M. (2017). Topical therapies in psoriasis.
    (LINK)
  • Medical news today – Psoriasis scars: What can I do about them? (LINK)

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