By Steven R. Feldman, MD, PhD, as told to Jodi Helmer
When you have psoriasis, your immune system overreacts and causes inflammation. It can cause plaques -- red, thick, itchy, inflamed patches of skin -- along with silver-colored scales, cracked skin, and swollen and stiff joints. These can be embarrassing and uncomfortable, and may leave you wondering whether the symptoms will ever disappear.
There's no cure for this disease. But there are treatments that work to reduce symptoms and can help you achieve the goal of clear skin or remission.
Older medicines used to treat psoriasis were quite toxic. So we'd try to get the disease under control, then reduce your dose to the lowest amount of medication possible. We usually didn’t clear the skin completely because the doses of the drugs needed to do that caused too many serious side effects.
Newer medications are much safer. So complete clearing is more common than it used to be. Once your psoriasis is clear, doctors often recommend that you stay on the medicine to keep it that way. Your symptoms might not come back, but that may not mean the disease is in remission.
What Is Remission in Psoriasis?
There's no standard definition for remission in psoriasis. You and your dermatologist may use the word “remission” when almost all lesions have disappeared from your skin. But the more accurate term for that state is "nearly clear."
You’re considered "completely clear" when you don't have any psoriasis lesions. The Psoriasis Area and Severity Index (PASI) score doctors use to evaluate the color, thickness, and scaling of psoriasis shows a 100% reduction in lesions when you're clear. Having far fewer (or no) lesions is the goal of treatment. But even having zero lesions doesn’t mean your psoriasis is in remission.
True remission means that your skin is completely clear and you’re no longer taking medication to control the disease.
The two terms – “completely clear” and “remission” -- are often used to mean the same thing. A 2022 study found that almost 80% of people with psoriasis who believe their psoriasis is in remission are still getting treatment for the condition. Among this group, the average remission (or symptom-free period) lasted 31 months.
The new medications for psoriasis are so effective that we wonder if some patients who are clear while on treatment might be in remission, meaning they could stay clear when they're off treatment. With some treatments, you just need a dose of medication every few months to keep your psoriasis under control. Current medications are very safe, too, so there’s no need to stop taking them once your symptoms clear.
Making Psoriasis Remission Last
Your immune system is complicated, and it can be hard to predict who'll have long-term remission.
People with psoriasis are genetically prone to make too much of the signaling molecules that cause inflammation and other symptoms. They may not have a drug-free remission because stopping the medication doesn't change their genes.
We do know that people with guttate psoriasis -- a form of the disease that causes sudden breakouts of small plaques on your arms, legs, and torso -- tend to have long remissions once medication clears their symptoms.
In most cases, you may have alternating periods of clear skin and psoriasis flares. But there isn’t much data about how long psoriasis remission lasts.
The American Academy of Dermatology Association notes that most periods of remission last between 1 and 12 months. Separate research shows that more than 41% of those who achieved psoriasis remission started taking medication again after a year. And 86% went back on their medication after 5 years in remission.
You can take steps to make your remission periods last longer:
Avoid injuries. Psoriasis plaques tend to pop up in areas where you have injuries to your skin. Avoiding bumps, cuts, and bruises may help prevent flares.
Keep your skin moisturized. Psoriasis flares are more common in dry skin. Dry skin is also more likely to crack and bleed, making psoriasis symptoms worse. Using moisturizer and a humidifier can keep your skin from drying out and prevent flares. Also avoid harsh soaps and detergents, which dry your skin.
Spend time outside. The sun helps calm your skin’s immune system, which could reduce psoriasis symptoms. But wear a hat and sunscreen on unaffected skin, even on cloudy days. Sunburn injures your skin, increasing the risk that psoriasis will come back.
Eat healthy foods. Obesity is linked to increased inflammation. And eating anti-inflammatory foods like salmon, lean meats, low-fat dairy products, and lots of fruits and vegetables might help ease psoriasis symptoms. For some people, a gluten-free diet may also help. Limit alcohol, which may make your psoriasis symptoms worse.
Take your medication. Staying on your psoriasis medicine even after your skin clears can help keep your psoriasis under control and let you stay symptom-free for longer periods.
Work with your dermatologist to come up with a treatment plan that will help clear your skin, ease your symptoms, and maybe even get you to remission.
Show Sources
Photo Credit: LightFieldStudios / Getty Images
SOURCES:
Steven R. Feldman, MD, PhD, professor of dermatology, Wake Forest University School of Medicine, Wake Forest, NC.
Dermatology Therapy: “Demographic and Clinical Factors Associated with Patient-Reported Remission in Psoriasis.”
American Academy of Dermatology Association: “How Long Will I Have to Treat My Psoriasis?”
Dermatology Therapy: “Remission Duration and Long-Term Outcomes in Patients with Moderate-to-Severe Psoriasis Treated by Biologics or Tofacitinib in Controlled Clinical Trials: A 15-Year Single-Center Experience.”
National Psoriasis Foundation: “Dietary Modifications.”
