Medical News Today: How is severe psoriasis treated?

Psoriasis is a skin disease that causes new skin cells to grow too quickly and build up in thick patches. Psoriasis has many forms and can range from mild to severe, depending on how much of a person’s body it affects.

Many treatments for psoriasis are available. Doctors will often consider a different treatment approach for people with severe psoriasis than that for those with mild or moderate psoriasis.

What is severe psoriasis?

Severe psoriasis.
Severe psoriasis is diagnosed if the psoriasis covers over 10 pecent of the body, or sometimes if the psoriasis causes significant disruption to daily life.

Psoriasis is classified by severity based on how much of the body it affects:

  • mild psoriasis affects less than 3 percent of the body

  • moderate psoriasis affects between 3 and 10 percent of the body

  • severe psoriasis affects more than 10 percent of the body

Sometimes psoriasis that affects less than 10 percent of the body will still seriously disrupt a person’s life.

An example of this is when the psoriasis is on a person’s palms or the soles of their feet.

When the emotional or physical effects of psoriasis greatly impact on someone’s life, the condition may be classified as severe, regardless of what percentage of the body it affects.

People with erythrodermic psoriasis will almost always have severe psoriasis. Erythrodermic psoriasis not only covers the majority of the body in a painful red, peeling rash, but it can lead to serious complications, including infection, heart failure, and death.

Severe psoriasis treatment options

Medications and therapies include the following:

  • Biologics: Drugs are given intravenously or intramuscularly to target specific areas of the immune system and block overactive skin formation.

  • Systemics: Oral or injected drugs that work throughout the whole body.

  • Topical creams: Lotions applied directly to the skin, often containing steroids.

  • Phototherapy: Controlled exposure to UV light.

  • Complementary therapy: Use of diet and lifestyle remedies to help manage psoriasis.

Topical creams, phototherapy, and complementary therapy or lifestyle remedies are usually not enough to manage severe psoriasis.

It may take some trial and error before a person with severe psoriasis finds the right treatment combination to manage their symptoms.

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How is treating severe psoriasis different?

white pills spilling out of an orange medicine bottle
Severe psoriasis cannot be treated with topical ointments or natural remedies alone, unlike mild psoriasis. Instead, systematic drugs or biologics may be recommended.

The treatment approach for severe psoriasis is different to that for mild to moderate psoriasis.

In cases of mild psoriasis, topical creams and ointments may be enough to manage the condition. Additionally, people with mild psoriasis find greater success with natural remedies. Most people with mild psoriasis will not need biologics or systemic drugs to manage their psoriasis symptoms.

For people with severe psoriasis, the reverse is true. Their symptoms often do not respond to lifestyle or complementary remedies and topical treatments.

Often, for a person to find relief, biologics or systemic drugs must be used in conjunction with other treatment methods.

In extreme instances, a person with severe psoriasis may need hospitalization to bring a flare under control.

Natural treatment options for severe psoriasis

Some natural treatment options can sometimes be used in addition to other treatments, to help soothe the skin of a person with severe psoriasis.

Some of those affected by severe psoriasis may find extra relief from the following natural treatment options:

  • Aloe vera lotions: These can soothe the skin irritation.

  • Turmeric supplements: This common spice may reduce psoriasis inflammation.

  • Oatmeal baths or pastes: These treatments can sometimes relieve itching.

  • Epsom salt baths: Again, this soaking treatment can relieve itching and scaling

Other natural treatment options for psoriasis may not be appropriate, as they may further irritate the skin.

People with severe psoriasis should always consult their doctor before trying any natural treatment method.

Severe psoriasis symptoms

Psoriasis on the inside of a person's wrist.
Psoriasis symptoms commonly include patches of red, ‘scaly’ skin, and discomfort or pain in the affected areas.

Psoriasis symptoms will vary from person to person and will depend largely on what form of the condition an individual has.

Usually, people with the most common form of psoriasis, called plaque psoriasis, will experience some of the following symptoms:

  • burning, sore, or itchy areas on the skin

  • patches of thick skin with silvery scales

  • scaly dots on skin

  • swollen or stiff joints

  • red areas on their body

  • thickened nail beds

  • hair loss if psoriasis affects the scalp

  • areas of peeling or flaking skin

For cases of psoriasis to be considered severe, those symptoms must affect more than 10 percent of the body, or affect an area of the body to the extent that the person’s life is disrupted.

In cases of erythrodermic psoriasis, which is a severe and sometimes life-threatening form of the disease, symptoms can include the following:

  • large areas of redness that cover most of the body

  • skin that appears burned

  • pain, burning, and itching on the red areas

  • extreme skin irritation

  • sheets of peeling skin, as opposed to smaller areas of flaking skin

  • rapid heart rate

  • inability to maintain body temperature

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Prevention of severe psoriasis

People with psoriasis should try to take steps to avoid a flare of their condition. To prevent their psoriasis from becoming severe, they can take the following actions:

  • take all psoriasis medications, as directed

  • bathe daily, using oatmeal or Epsom salts, as needed

  • manage stress with meditation or other relaxation practices

  • avoid sunburn while still getting exposure to UV light regularly

  • treat any illness promptly

  • avoid injury and trauma to the skin

Avoiding flares can prevent a person having to deal with the symptoms of severe psoriasis.


Severe psoriasis can be a very uncomfortable condition that seriously disrupts a person’s life. Treatment options are available for people with severe psoriasis that can help manage the symptoms.

In some cases, hospitalization may be necessary to treat serious flares of severe psoriasis.

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