A whole-body inflammatory condition, not just a skin one — which is why the joints and heart matter too.
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Psoriasis is an immune-mediated condition in which skin cells are produced far faster than the body can shed them. Normal skin turns over in about 28 days. In psoriasis it takes three to five, so cells pile up into the thickened, scaly plaques that give the condition its appearance.
It affects around 2% of people in the UK, commonly starting between 15 and 35, and it runs strongly in families. It is not contagious, not caused by poor hygiene, and not an allergy — it is an immune process, and the skin is where it shows.
Two things about psoriasis are consistently under-appreciated, and both matter more than the plaques themselves.
The first is that psoriasis is a systemic condition, not just a skin one. Around one in five people with skin psoriasis develop psoriatic arthritis, which causes permanent joint damage if it is not treated — and it is frequently missed for years because nobody connects the sore fingers to the rash. Psoriasis is also an independent risk factor for cardiovascular disease, so blood pressure, cholesterol and glucose deserve checking rather than being treated as unrelated.
The second is the psychological impact, which is substantial and well documented, and is a legitimate reason to treat psoriasis more aggressively rather than an afterthought.
Often itchy, sometimes sore, and plaques can crack and bleed — particularly over joints and on the hands. Bleeding from tiny points when scale is picked off is characteristic.
Psoriasis appears in skin that has been injured — a scratch, a scar, sunburn, a tattoo. It is a reason to treat cuts carefully and to think twice about tattoos over affected areas.
T-cells in the immune system become inappropriately activated and drive the rapid skin cell turnover. Genetics set the susceptibility — around a third of people have an affected relative — and an environmental trigger usually starts it off.
Not contagious, not an allergy, not caused by diet, and not a hygiene problem. There is no evidence that any particular diet treats psoriasis, though losing excess weight helps.
Psoriasis is diagnosed clinically — by the appearance and distribution of the plaques, the nails, and the family history. In typical cases no test is needed, and good photographs are usually enough to make the diagnosis remotely.
This is the part most often skipped, and the part that matters most:
Eczema (creases rather than outer surfaces, less defined edges), fungal infection — particularly for flexural and nail psoriasis, which are frequently treated with antifungals for months — seborrhoeic dermatitis on the scalp, and lichen planus.
Send clear photographs in natural daylight, including the scalp, nails, elbows and knees even if you think only one area is involved — the distribution helps confirm the diagnosis. See our guide to photographing a skin problem.
Thick emollients soften scale, reduce itch and cracking, and help every other treatment penetrate. Applied generously and often, they do more than people expect — and removing scale is what allows an active treatment to reach the skin underneath.
Calcipotriol slows the excessive skin cell turnover and is the mainstay for plaque psoriasis. It does not thin skin, so it can be used long term. It takes six to eight weeks to show full effect — slower than a steroid, which is why the two are usually combined.
A potent steroid with calcipotriol in a single preparation, once daily, is the standard first-line treatment for plaque psoriasis on the body. It works considerably faster than either alone. Typically used for four weeks to clear a flare, then stepped down to the vitamin D analogue for maintenance.
Scalp treatment fails mainly on practicality rather than pharmacology. A coconut-oil-based descaling preparation left on overnight lifts thick scale first; a steroid or combination gel or foam then reaches the skin. Applying an active treatment on top of thick scale achieves very little — the descaling step is what makes it work.
These need mild preparations or calcineurin inhibitors such as tacrolimus, not the potent steroids used on the body. Potent steroids in the groin and armpits cause thinning and stretch marks quickly.
We do not prescribe oral steroids for psoriasis, and we would advise against accepting them from anyone else for this purpose. The skin improves while you take them and then rebounds severely on stopping, which can precipitate generalised pustular psoriasis — a medical emergency.
Where psoriasis is extensive, not responding to proper topical treatment, or significantly affecting your life, dermatology can offer phototherapy, systemic treatments such as methotrexate or ciclosporin, and biologic drugs, which have transformed outcomes in moderate-to-severe disease. Any suspicion of psoriatic arthritis warrants prompt rheumatology referral — that one is time-sensitive. We arrange both.
Call 999 or go to A&E for:
Seek assessment within days — do not wait — for:
Book a routine consultation if: topical treatment is not controlling it after eight weeks; psoriasis affects your scalp, face, hands, feet or genitals, where it disproportionately affects daily life; you are using potent steroids continuously; or psoriasis is affecting your mood, sleep, work or relationships. That last reason is as valid as any of the others.
Psoriasis cannot be prevented or cured, but flare frequency and severity respond substantially to what you do between flares.
Emollients and coal tar preparations are available over the counter cheaply, and your NHS GP treats psoriasis free. NHS dermatology is where the treatments that genuinely change severe psoriasis live — phototherapy, methotrexate, ciclosporin, and biologic therapy — and all of those are free on referral. None can be provided privately by an online GP, and where they are what you need we will refer rather than keep prescribing creams.
That is the important framing: for moderate to severe psoriasis, the NHS route is not the compromise option. It is the better one.
Where a consultation earns its fee is getting topical treatment right, which is where most primary care psoriasis management falls down: adequate quantities, correct potency for the site, a vitamin D analogue rather than steroid alone, and a proper plan for the scalp — which needs different preparations and is where most people give up.
The other genuinely valuable conversation is about what psoriasis means beyond the skin. Psoriatic arthritis affects a meaningful minority and is frequently missed for years — joint pain and stiffness alongside psoriasis warrants asking about, because early treatment prevents joint damage. Psoriasis also carries increased cardiovascular risk, which is worth checking rather than ignoring.
NICE CG153, Psoriasis: assessment and management, is the governing guideline. It sets out a stepped approach — potent corticosteroid with a vitamin D analogue for trunk and limbs, separate regimens for the scalp and face, and referral for phototherapy or systemic therapy where topical treatment fails.
CG153 recommends assessing for psoriatic arthritis annually using a validated tool such as PEST, which is the basis for the point above about joints.
CG153 also recommends cardiovascular risk assessment in people with severe psoriasis, recognising the association with cardiovascular disease and metabolic syndrome.
NICE technology appraisals govern access to biologic therapies, which are prescribed only through specialist dermatology services.
British Association of Dermatologists guidelines cover the systemic treatments and their monitoring requirements.
CG153 emphasises the psychological impact of psoriasis and recommends assessing it explicitly rather than by skin severity alone.
No. It cannot be passed to anyone by touch, sharing towels, swimming or any other contact. It is an immune condition, and nothing about it is transmissible.
Psoriasis is a long-term condition that comes and goes rather than one that is cured. Many people have long clear periods, and guttate psoriasis triggered by a throat infection often clears entirely within a few months. With modern treatment, including biologics for severe disease, completely clear skin is a realistic goal for a great many people.
Because around one in five people with psoriasis develop psoriatic arthritis, it usually appears years after the skin changes, and the joint damage it causes is permanent if treatment is delayed. Nail pitting and psoriasis in the scalp or between the buttocks all raise the odds. It is the single most important question we ask.
Stress is a genuine trigger for flares, but it is not the cause — the underlying condition is immune and genetic. It also works in reverse: psoriasis causes considerable stress, so the relationship runs both ways rather than being anyone's fault.
Potent topical steroids used continuously for months, particularly on the face, groin or armpits, cause thinning and stretch marks. Used as a defined course to clear a flare, at a potency matched to the site, they are safe and effective. The usual pattern is a combination product for four weeks, then maintenance with a vitamin D analogue that does not thin skin.
Because psoriasis rebounds badly when they stop — sometimes into generalised pustular psoriasis, which is a medical emergency. Oral steroids look effective in the short term and cause a worse problem afterwards. If another clinician offers them for your psoriasis, it is reasonable to question it.
No specific diet treats psoriasis, and no supplement has convincing evidence. What does help is losing excess weight if you are carrying it, and reducing alcohol — both measurably improve severity and treatment response.
No. Psoriasis produces thicker, well-defined plaques with silvery scale, typically on the outer surfaces of elbows and knees. Eczema is less well defined, favours the creases, and is generally itchier. They are treated differently, which is why getting the diagnosis right matters.
August 23, 2026
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Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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