What to Know About Surgery When You Have Active Psoriasis

Medically Reviewed by Stephanie S. Gardner, MD on March 23, 2022
5 min read

Any surgery comes with risks. It’s always a good idea to know what they are before your operation. There are some added risks that come with getting surgery when you’re living with psoriasis.

Once you’ve learned about them, you can talk things over with your surgeon before your procedure. This could lower your chances of having psoriasis-related problems after your surgery, improving the odds that your skin heals well.

If you have surgery on a body part with a psoriasis patch (or “plaque”), there’s a chance that your psoriasis symptoms could spread from the surgical cut, says Raman Madan, MD, a dermatologist in New York.

Or, if you get an operation on a part of your body with clear skin, it’s possible for new psoriasis symptoms to appear where your surgeon made the incision -- even if it’s far away from the part of your body where you usually get psoriasis, says Dawn Davis, MD, a professor of dermatology and pediatrics with Mayo Clinic in Rochester, MN.

These are both examples of what doctors call the Koebner phenomenon. That’s when trauma to the skin brings on new symptoms of your skin condition. It can happen with a few conditions, and in the case of psoriasis, it causes new patches to appear. Surgery is just one example of the types of trauma that can trigger this effect, Davis says. Others include piercings, tattoos, and bad sunburns.

Not everyone with psoriasis experiences the Koebner phenomenon, Davis says. Still, if it doesn’t happen after one bout of skin trauma, it’s possible to have it down the road after another trauma, she says.

If you get psoriasis symptoms due to the Koebner phenomenon, they often respond well to treatment, Davis says. But sometimes they can be challenging for dermatologists to treat, since the skin has also been traumatized, she says.

Yes, an operation on a body part with active psoriasis could raise your chances for bleeding from that area, Madan says. That’s another reason why surgeons try to avoid operating on psoriasis-affected skin, he says.

If you need to get surgery on a body part with active psoriasis, ideally you’d want to wait until your skin becomes healthier, he says.

Yes. Even though most people who have surgery don’t get an infection, it’s still a risk to be aware of, especially when you have psoriasis.

A psoriasis plaque is extra-thick inflamed skin, and it’s more likely to be vulnerable to an infection than skin that isn’t inflamed, Davis says. If your surgeon must cut through an active psoriasis patch, they’ll need to take extra care with it, she says.

Infected skin makes your psoriasis less likely to respond to treatment, a problem that could stick around until your doctor treats your infection, Davis says.

If you think you got an infection from your surgery, let your surgeon know right away. Symptoms can include:

  • Redness and pain around the body part that was operated on
  • Cloudy fluid coming out of your surgical wound
  • Fever

If you are a person of color, surgery raises your risk for scarring that stands out a bit more, whether you have a condition like psoriasis or not, Madan says.

People of color, especially if you’re Black, have higher odds of getting a couple of types of thick, raised scars -- called hypertrophic and keloid scars -- any time the skin is traumatized, including from surgery, Davis says. These scars can be painful, and you might be disappointed by how they look.

Surgery on skin of color with an active psoriasis patch could heal worse than skin of color without psoriasis, Madan says. And if the psoriasis spreads, it usually leaves a bit of a darker mark that may take a couple months to fade, he says.

Anytime skin of color becomes inflamed or gets disturbed, like it does with surgery, it can affect cells called melanocytes that make skin-darkening pigments, Davis says. That can cause the cells to release all their pigment too soon, causing a darker patch of skin (or “hyperpigmentation”) around the surgery site. Or it can cause the cells to stop making pigment, leading to a patch of lighter skin (or “hypopigmentation”).

Either of these can be frustrating for patients, Davis says, and it can take weeks to months for your regular skin tone to return. Talk to your dermatologist and ask them what treatment options they’d recommend.

If you need surgery on a body part with psoriasis, you can lower your chances for skin color changes by getting your psoriasis as under control as possible before your operation, Madan and Davis say.

Your surgeon and care team will give you exact instructions.

To lower your chances of getting an infection, be sure to ask your surgeon how they’d like you to clean your skin while your surgical wound is healing, Davis says.

And if the skin around your incision is itchy due to psoriasis, resist the urge to scratch. Instead, talk to your surgeon and your dermatologist. They may decide to treat the psoriasis patch with a topical steroid, Madan says. Even though that’s not a typical step to take when it comes to wound healing after surgery, he says, your dermatologist will weigh the pros and cons to figure out if it’s right for you.

Yes. Long before you get surgery, make sure your surgeon knows you have psoriasis. If possible, you want to avoid getting an operation on skin with active symptoms, Madan says.

Your dermatologist may be able to improve your skin in time for a scheduled surgery. For example, say you have one or two patches of psoriasis on a body part that’s due to get operated on. Your dermatologist might decide to give you localized cortisone shots a week before your surgery to clear those spots up, Madan says. That type of treatment isn’t practical if you have several psoriasis patches though, he says.

Even if you don’t have active psoriasis symptoms before your surgery, let your surgeon know you have a history of the condition, Davis says. Skin that’s clear before surgery could still be affected by the Koebner phenomenon, leading to new psoriasis symptoms while you’re healing, she says. If your surgeon knows you have a history of psoriasis, they’ll be more likely to understand why your healing skin looks unusual, and they’ll be better prepared to help you heal.