During a psoriasis flare, parts of the immune system disrupt the production of melanocytes, the cells responsible for giving skin color. People with lighter skin tones can experience hypopigmentation, where patches of skin become lighter than the surrounding skin. These individuals’ plaques typically appear as raised red patches covered with a silvery white buildup of dead skin cells or scale. With darker skin tones and skin of color, the issue can also be hyperpigmentation, where patches of skin become darker than the surrounding skin, according to Amy Kassouf, MD, a dermatologist at the Cleveland Clinic in Ohio. These individuals’ On skin of color, plaques may appear darker and thicker and more of a purple or grayish color or darker brown.
“The skin tone typically goes back to normal once the inflammation goes away,” Dr. Kassouf says. “However, it can take time, from months to even over a year, for things to completely even out. During that time, it can really look like scarring.”
The good news is that this discoloration from psoriasis is usually temporary and changes in pigment can improve and, in many cases, completely disappear. Still, although rare, scarring can happen, particularly if you scratch or pick at plaques or misuse steroid creams. Here’s how to help prevent scars when you’re living with plaque psoriasis.
1. Moisturize Your Skin at Least Twice a Day
Using emollients (moisturizers) is key to reducing itching and scaling from psoriasis. Over-the-counter moisturizers containing active ingredients like salicylic acid and coal tar can be particularly helpful. “It should be done in addition to whatever therapy is prescribed by your doctor,” says Michelle Pelle, MD, a dermatologist in San Diego. Apply moisturizer twice a day for the best results. You can also use it to soothe itchiness, which can help you resist the urge to scratch.
2. Avoid Picking at Scales
“Scarring doesn’t typically occur unless people scratch or manipulate their plaques,” Dr. Pelle says. “This can cause trauma to the skin and result in linear scarring (like a scar from a cut or incision). Plaque psoriasis can also cause skin to become dry, then crack and bleed, which can sometimes lead to scarring.
“Pulling up scales can cause bleeding and trauma to skin, which can increase risk of scarring,” explains Kassouf. Instead, use emollients to keep scales in place until they exfoliate naturally.
3. Apply Cooling Relief
If itchiness is really driving you crazy, try a cool cloth or even an ice pack as an alternative to scratching. Scratching a plaque can worsen a flare, which increases your risk of discoloration.
4. Skip Shaving During Flares
Shaving with psoriasis can worsen areas of plaques and lead to scars, especially for people affected by the Koebner phenomenon, a reaction that causes new plaques to form on the site of a skin infection or injury. “Even shaving an area where the skin is normal can be risky because you might cause a small abrasion, and the psoriasis may then jump to that area,” explains Kassouf.
5. Use Steroid Creams as Directed
In some cases, psoriasis treatments can contribute to the problem. Overuse of topical steroids, for example, can thin the skin and cause changes to its collagen structure. This can lead to an atrophic (or indented) scar or even stretch marks, notes Kassouf.
Use only mild corticosteroid ointments on sensitive areas, such as your face or skin folds, and for treating widespread patches, recommends Kassouf. Use potent steroid creams for only a short time and only on thick areas of skin.
6. Talk to Your Doctor About Updating Your Treatment Plan
Psoriasis treatments (including oral, topical, and injectable medications and light therapy) can help reduce inflammation, heal lesions, and help skin resume normal function. If you’re having difficulty managing flares, talk with your dermatologist about new treatments to consider. “We have such good medications now that many patients who have had persistent plaques for years are able to experience clear skin,” says Kassouf.
7. Weigh the Risks and Benefits of Phototherapy
Speaking of phototherapy (light therapy) can be an effective treatment for plaque psoriasis, it stimulates the skin’s pigment cells, which can make discoloration caused by psoriasis plaques more noticeable, and occasionally permanent. “This was more of a problem with older forms of light treatment,” Kassouf notes. “Newer, narrow band UVB therapy has significantly minimized the risk of permanent pigment changes, but there is still some risk.” Talk to your dermatologist about the pros and cons of light therapy for your individual health.
8. Consider Laser Treatment if You Have Any Scarring
If you have scars or pigment changes from psoriasis flares that don’t improve with time and treatment, ask your dermatologist if you’re a candidate for laser treatment, Kassouf recommends. “In some cases, we will use fractional or vascular lasers to treat scarring,” she says Kassouf. “The laser sends signals to that area of skin to tell it to keep remodeling, which can encourage those scars to get closer to normal.”
The Takeaway
Scarring from psoriasis is rare but can happen particularly with scratching or picking at plaques or not using steroid cream as directed.
Moisturizing regularly and applying a cool cloth to affected areas can help relieve itchiness, while avoiding shaving during flares help prevent complications and scarring.
Talk to your doctor about updating your treatment plan if you’re having difficulty managing flares.
