Psoriasis is a chronic skin condition characterized by the rapid turnover of skin cells, leading to raised, scaly patches. After active lesions clear, marks often remain, prompting questions about their nature and persistence. This article explores the types of marks that can follow psoriasis flares and discusses their resolution.
Understanding Psoriasis Marks
Marks remaining after psoriasis lesions subside are often post-inflammatory discoloration, a result of the skin’s natural healing process. These discolorations typically do not involve changes in skin texture.
One common type is post-inflammatory hyperpigmentation (PIH), which manifests as flat, darkened areas. These spots can range from light brown to deep black, depending on skin tone and prior inflammation severity. PIH is more frequently observed in individuals with darker skin complexions.
Another form is post-inflammatory erythema (PIE), characterized by flat, reddish or purplish marks. PIE is more prevalent in individuals with lighter skin tones, reflecting lingering dilated blood vessels. Neither PIH nor PIE represents true scarring, as they do not involve permanent alterations to skin structure.
True scarring, involving textural changes like depressions or raised areas, is less common after psoriasis. However, it can occur if lesions are severely scratched, picked, or if a secondary skin infection develops. These instances can disrupt normal collagen structure, leading to more permanent marks.
Why Some Marks Linger
The duration and persistence of post-psoriasis marks vary significantly, influenced by several factors. The severity and duration of the initial psoriasis flare play a substantial role; more intense and prolonged inflammation can lead to more lasting discoloration. Individual skin type and genetic predisposition also affect how skin responds to inflammation and heals.
Sun exposure can significantly worsen existing discoloration, causing marks to darken and become more resistant to fading. Ultraviolet radiation stimulates melanin production, which can deepen hyperpigmented areas.
Mechanical trauma, such as scratching or picking at lesions, further contributes to mark persistence. This physical irritation can prolong the inflammatory process and disrupt healing, potentially leading to stubborn discoloration or true scarring. Protecting the skin from sun and physical irritation is important for mark resolution.
Strategies for Fading Marks
Several approaches can help reduce the appearance of existing psoriasis marks, ranging from topical applications to in-office procedures. Topical treatments often include ingredients designed to promote skin renewal and even out skin tone. Retinoids, such as tretinoin, accelerate cell turnover, while alpha hydroxy acids (AHAs) like glycolic acid gently exfoliate the skin’s surface.
Vitamin C and niacinamide are also beneficial, as they possess antioxidant properties and can help inhibit melanin production, thereby reducing hyperpigmentation. Certain prescription creams, including corticosteroids or calcineurin inhibitors, may be used under medical supervision to address lingering inflammation and discoloration. These specific applications for marks should be guided by a healthcare professional.
For more stubborn marks, in-office procedures performed by a dermatologist can be considered. Laser therapies, such as pulsed dye lasers, are effective for addressing persistent redness from post-inflammatory erythema. Fractional lasers, which create microscopic channels in the skin, can improve both texture and discoloration. Chemical peels, using various concentrations of acids, remove superficial layers of skin to reveal a more even tone.
Microneedling, a procedure that creates controlled micro-injuries, stimulates collagen production and can enhance the penetration of topical agents. Consistent general skincare, including diligent moisturizing, helps maintain skin barrier integrity. Daily broad-spectrum sun protection with an SPF of 30 or higher is crucial to prevent existing marks from darkening further and to support the fading process.
Minimizing New Marks
Preventing new psoriasis-related marks largely depends on effective management of the underlying skin condition. Consistent adherence to prescribed psoriasis treatments is paramount, as controlling flares reduces inflammatory burden on the skin. By minimizing the duration and severity of active lesions, the likelihood of developing significant post-inflammatory discoloration decreases.
Avoiding physical trauma to the skin is another crucial step in preventing new marks. Scratching, picking, or aggressively rubbing psoriasis lesions can exacerbate inflammation and increase the risk of both discoloration and true textural scarring. Gentle handling of the affected areas allows the skin to heal more effectively without additional irritation.
Maintaining a healthy skin barrier through a gentle skincare routine also supports prevention. Using mild cleansers and moisturizers helps keep the skin hydrated and resilient, which can mitigate the impact of inflammation. A well-maintained skin barrier is better equipped to recover from psoriasis flares with fewer lasting effects.
Consistent sun protection remains a vital measure for preventing new post-inflammatory hyperpigmentation. Regular use of sunscreen on affected and exposed areas helps shield the skin from ultraviolet radiation, which can stimulate melanin production and darken any emerging marks. Proactive measures are essential for reducing the long-term visual impact of psoriasis.