What it is
Psoriasis is a long-term immune condition in which skin cells renew far too quickly, producing thickened plaques covered in scale, most often on the elbows, knees, lower back and scalp, and often affecting the nails and the skin folds. On deeper skin it tends to look violaceous or grey-brown rather than salmon-pink, the scale is thicker, and it leaves prominent pale or dark patches after it clears that patients often mistake for a new problem. The visit confirms the diagnosis, records how much skin and which sites are involved, asks about joints, and builds a treatment plan for a condition that relapses.
What this page covers
- Plaque psoriasis: diagnosis, extent, effect on daily life, and a topical plan of vitamin D analogue and corticosteroid combinations with emollients
- Scalp psoriasis, with the vehicle — oil, foam, gel or shampoo — chosen for hair texture and covering habits so the regimen is actually used
- Facial, flexural and genital (inverse) psoriasis, where potency is limited and steroid-sparing options carry most of the plan
- Nail psoriasis: pitting, oil-drop change, onycholysis and thickening, with fungal infection excluded by sampling first
- Psoriatic arthritis screening at every visit
- Phototherapy, systemic therapy and biologic referral, with tuberculosis and hepatitis screening and ongoing monitoring
- Recognition of the severe flare that follows abrupt withdrawal of oral or high-dose systemic steroids started elsewhere
- Metabolic risk review at diagnosis
- Separating scale-related shedding from a scarring alopecia before reassuring a patient about hair loss
Honestly
Psoriasis is lifelong and relapsing; treatment aims at control and at long quiet periods, and the pale or dark patches left after a plaque clears take months to even out. Joint pain is asked about at every visit because damage from untreated psoriatic arthritis does not reverse, and extensive or joint-involved disease belongs on a monitored systemic pathway, not in a cosmetic room.