Prognosis of Psoriasis: What Factors Play a Role

If you’ve just received a diagnosis of psoriasis from your doctor or dermatologist, you may be worried about how the disease will progress. You might also wonder whether you can do anything to prevent the condition from getting worse. It’s normal to feel anxious about your prognosis. 

While there is no cure for psoriasis, treatment can help ease and manage symptoms. But finding the proper treatment depends on several factors that may impact your prognosis. This article will discuss what affects the severity of psoriasis and your outlook with the condition.

Factors That Impact Prognosis of Psoriasis

Several factors can impact how your condition progresses. A person with more factors is more likely to experience progressive, worsening symptoms and a more severe form of the disease. 

Type of Psoriasis

The most common form of psoriasis is plaque psoriasis, characterized by scales and dry, itchy patches that flake off. The second most common form is guttate psoriasis, which appears as numerous small, teardrop-shaped bumps and may only occur once and not recur.

Some types of psoriasis cause more severe symptoms than others. Pustular psoriasis, for example, causes painful white pus-filled bumps. Another form of psoriasis that causes more intense, painful itching is inverse psoriasis, which appears in skin folds. 

Finally, erythrodermic psoriasis is a rare, life-threatening form of psoriasis that causes more than just a rash. If you have this type of psoriasis, you shed large areas of skin and may experience:

• Dehydration
• Severe itching
• Severe pain
• Nail changes
• Changes in heart rate 
  

Body Parts Affected

Psoriasis can appear anywhere on your skin. The following are the most commonly affected body parts:

• Genitals
• Scalp
• Face
• Hands or feet
• Nails
• Skin folds

Psoriasis in some areas, such as the genitals, may be more uncomfortable and challenging to manage. 

Disease location can also make treatment difficult. A person with psoriasis on the scalp, for example, may subject the area to repeated irritation, worsening symptoms.

Similarly, facial psoriasis is more commonly seen in those who:

• Have severe psoriasis
• Have a family history of the disease
• Have had the disease for a long period 
  

Because facial psoriasis is so visible, it can also significantly impact a person’s self-esteem and quality of life.

Disease Coverage

If your psoriasis is only in one area, your disease course may be less severe than someone who has symptoms in multiple locations on their body. 

Psoriasis and When Aggressive Treatment Is Needed

If your condition meets specific criteria, your healthcare provider may recommend more aggressive treatment. 

People With Large Amounts of Affected Skin

Research suggests that people who have multiple lesions at diagnosis are likely to continue experiencing various lesions. If you have extensive psoriasis affecting multiple spots on your body, doctors may recommend more aggressive treatment options like biologic therapy.

People With Signs of Arthritis

Experts also consider psoriasis more severe and aggressive if it’s coupled with joint disease. This is called psoriatic arthritis. Aggressive treatment may be required to address both conditions. 

People With Psoriasis Under Age 20

A clinical study from 2013 suggests that moderate to severe psoriasis may be more likely to occur in males.

While this early research associated being a young male with more severe psoriasis symptoms, later data suggest that developing psoriasis at a young age does not influence disease severity.

However, doctors may treat young people with psoriasis more aggressively since they may be more capable of handling adverse side effects than older adults. 

People With Very Bothersome Symptoms

When a person has symptoms that affect their quality of life, a doctor may recommend more aggressive treatment. Psoriasis can be hard to treat in some people, making it more likely to cause bothersome symptoms.

Outlook: Severe Psoriasis and Quality of Life

Severe psoriasis can have a significant impact on your quality of life, which may affect disease outlook.

Remission and Flare-ups

Psoriasis does not necessarily cause constant symptoms. Many people experience periods of remission, when symptoms improve, especially if they are receiving proper treatment. 

You may experience flare-ups, when symptoms worsen, because of various triggers such as physical irritation to the skin, food and drink, stress, dry weather, hot, sunny weather, smoking, infection, or certain medications.

Comorbidities

For people with severe psoriasis who also have other diseases (comorbidities), symptoms of the other conditions become severe as psoriasis symptoms ramp up.

Mortality

According to research from 2019, severe psoriasis may be associated with higher risk of dying. However, it’s difficult to say for sure whether this increased risk is due to the effects of psoriasis alone or other factors such as lifestyle and treatment.

Associated Factors

If you have psoriasis, the following may influence the severity of your disease and impact your prognosis:

• Smoking: Daily smoking may increase your risk of developing new symptoms or experiencing flare-ups.
• Alcohol consumption: Drinking alcohol may also be a risk factor for psoriasis. People with alcohol use disorder may be at higher risk for a more severe disease course. 
• Obesity: Research suggests that obesity may have a link to more severe psoriasis symptoms.
• Depression: Because psoriasis is a chronic condition that can affect self-esteem, confidence, and quality of life, a person with the disease may be more likely to experience depression.
• Cancer: A 2019 systematic review and meta-analysis concluded that people with psoriasis may be more likely to develop site-specific cancers such as squamous cell carcinoma and basal cell carcinoma.
• Diabetes: People with psoriasis may have a higher risk of developing type 2 diabetes. However, there’s limited evidence to suggest diabetes increases the severity of psoriasis symptoms.
• Arthritis: About one-third of people with psoriasis also have psoriatic arthritis, which can cause additional symptoms such as joint pain and swelling.
• Kidney, cardiovascular, and respiratory diseases: People with psoriasis may be more likely to develop these conditions. Cardiovascular disease, in particular, has a strong association with psoriasis. And evidence suggests that severe psoriasis can increase a person’s chance of experiencing a stroke or other serious cardiac event.

Effects of Aggressive Treatments

While aggressive treatments can help with symptoms and potentially affect disease prognosis, they may also cause side effects that affect a person’s quality of life. Strong steroid medications, for example, are more likely to cause side effects than lower potency topicals. They may even make psoriasis symptoms worse.

Psoriasis Treatments

There are several treatment options for psoriasis. Your doctor will recommend treatments based on the severity of and type of psoriasis you have. 

Over-the-Counter Treatments

Over-the-counter (OTC) treatments like moisturizers can help relieve dryness that leads to itching. However, OTC products may cause irritation if they contain ingredients that trigger your symptoms. Additionally, OTC treatments are unlikely to help in cases of severe disease.

Home Remedies

Home remedies for psoriasis such as taking baths with moisturizing additives may help relieve symptoms. Still, they aren’t a substitute for medical treatments, especially if you have severe psoriasis.

Topical Corticosteroids

Topical steroids come in different formulations and potencies. They can help reduce itching and inflammation. However, potent corticosteroids may cause side effects such as:

• Thinning of the skin
• Worsening of plaque psoriasis symptoms
• Triggering pustular psoriasis 
  

They’re also a poor long-term solution for symptom relief.

Coal Tar

Coal tar treatment is typically used for scalp and plaque psoriasis. Side effects include:

• Irritation of the skin
• Increased sensitivity to sunlight
• Staining of the skin
  

Other Topicals

Doctors also prescribe the following topicals for certain types of psoriasis:

• Anthralin (dithranol)
• Protopic (tacrolimus) ointment
• Elidel (pimecrolimus) cream
• Topical retinoids
• Keratolytic agents such as products with salicylic acid
• Dovonex (calcipotriene topical)
• Vectical (calcitriol topical)
• Curatoderm (tacalcitol)

Biologics

Biological therapies, such as Xeljanz (tofacitinib) and Sotyktu (deucravacitinib), are medications that effectively treat certain types of psoriasis. However, they can have serious side effects because they affect the immune system. Doctors usually prescribe biologics when other treatments have failed.

Light Therapy

UV (ultraviolet) light therapy is a second-line treatment used when topical medications are ineffective or can’t be used. 

Side effects may include:

• Sunburn
• Rashes
• Skin aging
• Skin cancer

Other Medications

Other medications that a doctor may prescribe for psoriasis include:

• Trexall (methotrexate), which may be used if someone has psoriasis and psoriatic arthritis
• Cyclosporine
• Soriatane (acitretin)
• Otezla (apremilast)
• Fumaric acid esters
  

How Long Does Psoriasis Treatment Take?

Treatment length depends on the type of medication prescribed. With very mild psoriasis, a doctor may suggest simply avoiding apparent triggers. 

Severe psoriasis may require the use of immune-suppressing drugs that cannot be given long-term due to their side effects. Additionally, corticosteroids are meant to be used temporarily or during flare-ups.

Ultimately, psoriasis is a chronic condition, so treatment is lifelong. 

Summary

Psoriasis is a chronic condition that requires lifelong treatment and management of symptoms. There is no cure. Disease severity depends on multiple factors and can be influenced by the type of psoriasis, the number of lesions, and whether a person has any other medical conditions, such as psoriatic arthritis. 

A Word From Verywell 

Symptoms of psoriasis can vary from mild to severe. While some factors can influence the severity of your symptoms, effective treatments are available regardless of how bad your symptoms are.