Is Psoriasis Painful?

Skin pain affects more than 40% of people with psoriasis. An autoimmune disease, psoriasis causes itchy, scaly patches of skin, most commonly on the knees, elbows, trunk, and scalp.

Psoriasis feels painful because of inflammation that irritates nerves in the skin. Psoriasis pain can be described as aching, burning, stabbing, throbbing, cramping, or stinging skin.

Psoriasis flare-ups can be triggered by the weather, foods you eat, skin trauma, and stress. Topical prescription medications, oral medications, and home remedies are used to treat psoriasis skin pain.

This article discusses psoriasis pain. It explains why psoriasis causes skin pain, triggers for psoriasis flare-ups, and how to find relief.

What Causes Psoriasis Skin Pain?

Psoriasis causes skin pain because of inflammation. Psoriasis is an inflammatory skin condition that causes skin cells to grow too fast and build up into patches, called plaques. The inflammation pushes against sensitive nerve endings in the skin, sending pain signals to the brain.

A 2014 study in the journal Nature suggested nociceptors, a type of nerve ending that promotes pain perception, help drive inflammatory responses leading to psoriasis flares. The study’s authors suggest these nociceptors affect the function of immune cells located in the skin.

Psoriasis plaques are also painful because they cause the skin to be tight, red, and itchy. Plaques can also become cracked and dry, causing further pain. Additionally, scratching psoriasis can cause further pain and lead to broken skin, bleeding, and infection.

How Psoriasis Skin Pain Feels

A study on plaque psoriasis and skin pain found 43.6% of participants reported skin pain in the prior week. In the study, published in the international journal Acta Dermato-Venereologica, subjects described psoriasis skin pain as:

• Aching
• Burning
• Cramping
• Hot
• Itchy
• Sensitive
• Tender
• Unpleasant

According to the study authors, the results highlight the importance of including pain management in psoriasis treatment.

What Triggers Psoriasis Pain?

Avoiding triggers for psoriasis flare-ups can help to prevent skin pain, according to the American Academy of Dermatology. Many people with psoriasis report the following common psoriasis triggers.

Weather

Both cold and dry weather can dry out the skin and make psoriasis flare-ups and skin pain worse. Researchers don’t know why cold and dry weather promotes flares, but some think it’s because cold, dark, and low-humidity conditions cause skin inflammation and thickening.

Since you may not be able to move to a warmer city during the winter months, try covering up to reduce your skin’s exposure to cold, dry weather.

Some Medications

If you are taking medications for other conditions, talk to your healthcare provider if you think they are contributing to psoriasis flare-ups. Medications such as lithium and beta-blockers are known for causing psoriasis flares.

Infections

Certain infections—such as strep throat—can cause psoriasis symptoms to worsen days or weeks after the infection.

Skin Trauma

Any type of trauma to the skin­—including cuts, burns, vaccinations, tattoos, and other skin conditions—can cause psoriasis to flare up, especially at the injury site. This reaction is called the “Koebner phenomenon.”

Alcohol and Tobacco

Excessive consumption of alcohol may increase the potential for a psoriasis flare. One study reported in 2015 in the journal Alcohol Research found alcohol can have a “detrimental effect” on psoriasis, especially in males.

Some experts believe smoking also worsens psoriasis symptoms.

Diet

Because psoriasis is an inflammatory disease, your diet might play a part in triggering inflammation and triggers. Foods that may promote inflammation and worsen psoriasis skin symptoms include:

• Gluten
• Processed foods
• Red meat

Eating a diet high in anti-inflammatory foods may help to reduce the frequency and severity of psoriasis flare-ups. Anti-inflammatory foods include:

• Fatty fish (such as salmon, herring, and sardines)
• Fruits and vegetables
• Heart-healthy oils

Nutritional supplements may also help to prevent psoriasis flare-ups. Research shows the following supplements may be beneficial for people with psoriasis:

• Fish oil
• Selenium
• Vitamin B-12
• Vitamin D

Home Remedies for Psoriasis Skin Pain

Even when you can’t avoid flares, you can find ways to cope and treat skin pain. Here are some self-care tips to help you manage pain.

Keep Skin Lubricated

Keeping your skin lubricated can prevent dry, itchy, and painful skin. It can also reduce redness and heal the skin. The National Psoriasis Foundation recommends heavy creams that lock in water.

Make sure you are using fragrance-and alcohol-free moisturizers. Fragrances and alcohol may dry out or irritate the skin.

Refrigerate Creams

Keep creams and moisturizers in your refrigerator. This helps keep them cold so they can soothe burning and itching.

Soften Scales

You can soften scales with lotions containing lactic, salicylic, or glycolic acids. These substances can break up dead skin cells that have built up on psoriasis plaques. Generously apply to skin at night and cover up with plastic wrap overnight. This way, the lotion stays and absorbs into the skin better. 

Coal Tar

An active ingredient in many psoriasis treatments, coal tar has been used for years to treat psoriasis. According to the American Academy of Dermatology, the benefits of coal tar for psoriasis include: 

• Lessens itching and flaking
• Reduces redness, swelling, and scaling
• Slows the rapidly growing skin cells

Coal tar can be found in shampoos, creams, ointments, and bath solutions for psoriasis.

Capsaicin

Check your drugstore for creams, lotions, and ointments containing capsaicin. Capsaicin is the ingredient in chili peppers that makes them hot. Products containing capsaicin block the nerve endings that cause pain.

Products containing capsaicin may also help reduce inflammation, redness, and scaling. However, there isn’t enough research to confirm these benefits in the long term or on the safety of capsaicin.

Control Itching

You have many options for over-the-counter (OTC) options for controlling itching. Itching can often feel like burning or stinging when you have psoriasis.

Ask your healthcare provider about recommendations for lotions that contain menthol or pramoxine. Hydrocortisone creams, which contain a mild steroid, are also helpful. 

Cold Therapy

Using cold packs confuses the brain. Your brain cannot feel the itch if you are feeling cold at the same time.

Take a Bath

Take a warm bath with some Epsom salt or oatmeal. Soak for about 15 minutes to smooth itchy skin and remove scales. After the bath, pat your skin dry and put on moisturizer right away.

Wash With Vinegar

Apple cider vinegar can calm itchy scalp psoriasis. Massage the vinegar into your scalp a few times a week.

If the vinegar causes burning, use a half-water and half-vinegar blend. Rinse your scalp after the vinegar dries to prevent irritation. You should see results in a couple of weeks. Don’t use vinegar if the scales on your scalp are bleeding or cracked.

Prescriptions to Treat Psoriasis Skin Pain

If home remedies are unable to manage psoriasis skin pain, your healthcare provider may prescribe medication. Prescription treatments for psoriasis include topical, oral, and injectable medications including:

• Biologic response modifiers, such as Cosentyx (secukinumab), Enbrel (etanercept), Humira (adalimumab)
• Disease-modifying anti-rheumatic drugs (DMARDS) such as methotexate
• Immunosuppressants, such as Cyclosporine
• Oral retinoids such as Soriatane (acitretin) 
• Phosphodiesterase 4 (PDE4) inhibitors such as Otezla (apremilast)
• Topicals such as corticosteroids, vitamin D-based medicines, retinoids, and anthralin

Phototherapy for Psoriasis Pain

Phototherapy—exposing the skin to ultraviolet light—is used to treat psoriasis flare-ups. Research shows phototherapy helps to relieve skin pain and other symptoms of psoriasis.

Also known as light therapy, phototherapy is typically performed in a dermatologist's office using artificial light or lasers. In some cases, patients may be prescribed a portable device for treatment at home.

Ultraviolet (UV) light-based therapies include:

• Narrowband and broadband UVB
• UVA in conjunction with photosensitizing agents known as psoralens
• Lasers treatments, such as excimer lasers, pulsed dye lasers, intense pulse light, and light-emitting electrodes
  

A Word From Verywell

Simply living with psoriasis is stressful enough, and many people with psoriasis report feeling more stressed during periods of flare-ups. Talk to your healthcare provider if you think psoriasis is causing you to feel stressed, anxious, or depressed. They may be able to offer some information on coping with stress or refer you to a mental health professional. It may also help to connect with others also living with psoriasis. Ask your healthcare provider’s office or search online for information on local and online support groups.

Exercise is another way to improve your mood. Even something as simple as a daily walk can help relax you and relieve stress.

Remember, self-care remedies don’t replace your healthcare provider’s advice or treatment plan. Call your healthcare provider if symptoms get worse, your skin feels red and inflamed all over, your joints hurt, or if you are feeling depressed.