Is Psoriasis Painful?

Intensity and Pain Levels Explained

Psoriasis is a chronic, autoimmune disease characterized by inflamed, scaly patches or lesions on the skin. Psoriasis can develop anywhere on the body, including the scalp and even the nails. Over 8 million Americans alone have psoriasis. Nearly one-third of these patients will develop psoriatic arthritis.

As with other autoimmune diseases, psoriasis can be cyclical, having an active, flaring phase and a period of diminished symptoms. People may experience varying intensities of pain in either their skin lesions or their joints.

This article will explain the intensity and location of psoriasis pain, pain relief remedies, and prevention guidelines.

White man scratching both legs while sitting on the ground.

Getty Images / Tharakorn Arunothai / EyeEm

Is Psoriasis Painful?

It is important to be aware that not all forms of psoriasis are the same. Psoriasis is characterized by inflamed patches of skin, but people with psoriasis may experience varying levels of symptoms. The number of skin lesions and intensity of associated pain may vary from person to person.

Psoriasis can vary from one inflamed, raised, and red patch of skin to several white-silver scales scattered across the body. The skin lesions themselves are typically the source of pain and discomfort.

Frequency and Location

The type of psoriasis a person has may impact their pain level. The most common subtype of psoriasis is plaque psoriasis, affecting 80% to 90% of those with the condition. People with plaque psoriasis may experience raised, thickened patches of skin known as plaques.

Sometimes plaques are covered by a thin layer of dry, white, or silver coatings of skin, known as scales. Common locations for plaque psoriasis are on the scalp, elbows, knees, and low back.

Guttate psoriasis appears as small, red, or salmon-colored bumps on the arms, torso, or legs. It is more commonly seen after an infection. Guttate psoriasis may develop once in a person's lifetime or persist throughout life.

People with inverse psoriasis tend to develop smooth, red patches between skinfolds, such as in the armpits, groin, and buttock. These patches tend to feel sore and painful.

Pustular psoriasis can vary from small pus-filled bumps on the skin to severe skin peeling. The more severe the disease course is, the more pain is typically experienced with pustular psoriasis.

Psoriasis Pain Intensity

The severity of symptoms and the disease course in psoriasis are individualized. Patients record their pain levels using a psoriasis symptom inventory. The survey attempts to gauge the severity and nature of discomfort experienced by people with psoriasis.

It differentiates pain from such descriptors as "burning or stinging sensations." Pain was the fourth most commonly reported symptom and was described as varying from mild to very severe.

Mild

Mild pain is described as "superficial pain" initiated by scratching or hitting the affected area. Others described it as feeling "uncomfortable," with symptoms not lasting too long.

Moderate

Moderate pain was described as self-starting pain, meaning no scratching or hitting the affected skin areas was necessary for onset of pain. Others described moderate pain level as the time when they would consider "seeking medication to relieve the pain."

Severe

Severe and very severe pain was described as intense "stinging" and "burning" pain that made it difficult to function through day-to-day activities. Some said that when the pain is severe, their plaques were very inflamed, cracked, thickened, and even bleeding.

Be Mindful of These Triggers

As is the case with other autoimmune diseases, there are some known triggers of psoriasis and psoriatic arthritis. These include but are not limited to:

  • Increased or new stress
  • Viral or bacterial illnesses
  • Injury to the skin, such as scratches, bug bites, sunburns
  • Changes in the weather, particularly colder, drier climates
  • Moderate alcohol consumption and smoking
  • Certain medications such as lithium, hydroxychloroquine, and certain high blood pressure medicines

Being aware of and mindful of these triggers may help a person decrease the amount and severity of flare-ups.

Co-Occurring Psoriatic Arthritis

Up to 40% of people with psoriasis will develop psoriatic arthritis (PsA). PsA is another autoimmune, inflammatory disease affecting joints, eyes, skin, and nails. People with psoriasis and PsA can experience not only painful and swollen joints and decreased range of motion, but also inflamed psoriatic plaques and patches throughout the body and pitting of the nails.

Treatment of PsA aims to decrease inflammation throughout the entire body, which would help manage the disease and help clear up the skin lesions. Managing the underlying inflammation will help prevent flare-ups and long-term skin and joint disease.

Why It’s Difficult to Describe Psoriasis Pain

Pain is a tricky symptom to describe because everyone experiences pain differently and to varying degrees. People may be familiar with the numerical pain scale, ranging from zero (no pain) to 10 (the most intense possible pain).

Sometimes the pain associated with psoriasis is difficult to describe because it's different from other types of pain. It's not like the pain of a sprained ankle, but rather a stinging, burning, or cracking, with bleeding of plaques and scales causing discomfort.

Pain Relief and Remedies

While psoriasis cannot be cured, it can be managed. Over-the-counter (OTC) creams such as hydrocortisone and anti-itch creams can help reduce inflammation and soothe itchy plaques and rashes. For people with scalp psoriasis, coal tar and medicated shampoos can help relieve symptoms.

If OTC remedies don't work, it may be time to talk with your healthcare provider. Topical and oral medications can help decrease symptoms' severity and frequency.

Phototherapy, using ultraviolet A or B light, can also be used to treat symptoms. Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate and cyclosporine have been proven to be effective therapies for psoriasis.

In more severe cases, a biologic medication may be appropriate. Biologics target specific components in the inflammatory pathway to decrease inflammation throughout the body. Biologics that treat psoriasis include but are not limited to:

  • Cosentyx (secukinumab)
  • Humira (adalimumab)
  • Enbrel (etanercept)
  • Stelara (ustekinumab)

Summary

Skin pain is a common symptom of psoriasis, but it can be difficult to describe. It can range from nearly no pain to very severe and debilitating pain. Factors contributing to psoriatic skin pain include the form of psoriasis present and the location. Working closely with your healthcare provider can offer sustained long-term disease management.

A Word From Verywell

If you or someone you know has had difficulty describing psoriatic pain, know that it is not uncommon. Difficulty describing symptoms can lead to frustration and delay in appropriate treatment.

This is why monitoring and tracking symptoms and having a real and honest conversation with your healthcare provider is important. Thankfully, several treatment options are available that can help manage psoriatic symptoms and prevent flare-ups in the future.

Frequently Asked Questions

  • Why is psoriasis pain so painful?

    Psoriasis is an inflammatory skin condition. Inflammation of the skin can lead to plaques, scales, and even pustular formations (bumps filled with pus). Sometimes skin lesions can become raw or cracked leading to significant pain.

  • Do you get psoriasis before psoriatic arthritis?

    About 40% of people with psoriasis will develop psoriatic arthritis (PsA).

  • How long do psoriasis flare-ups last?

    Some psoriatic flare-ups may resolve within a few days to one week, while others that are more severe can last weeks to months.

  • How effective is pain medication compared to natural remedies for psoriasis?

    While natural remedies may provide relief, getting down to the root cause of the flare-up is key. If known triggers can be identified, then they can be modified or avoided. If an increase in inflammation levels within the body is causing a psoriatic flare up, then conventional medicine ranging from nonsteroidal anti-inflammatory drugs (NSAIDs) to biologic medications may be necessary, as they are more effective in treating the underlying cause

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Katherine Alexis Athanasiou, PA-C
Katherine Alexis Athanasiou is a New York-based certified Physician Assistant with clinical experience in Rheumatology and Family Medicine. She is a lifelong writer with works published in several local newspapers, The Journal of the American Academy of PAs, Health Digest, and more.