Psoriasis is a chronic autoimmune condition primarily affecting the skin, characterized by cycles of rapid skin cell growth that result in thick, red patches covered with silvery scales. While managing active psoriasis flares is a central focus of treatment, residual marks often remain on the skin after lesions clear. These lingering discolorations and textural changes, commonly called psoriasis scars, can persist long after the active disease subsides.
Understanding Psoriasis Scars
Psoriasis scars differ from active psoriasis lesions, which are inflamed patches of skin. These scars represent the skin’s healing response after inflammation and trauma from psoriasis flares. The most common type of mark left behind is post-inflammatory hyperpigmentation (PIH), appearing as dark spots ranging from brown to black, especially on darker skin tones. Conversely, some individuals may experience post-inflammatory hypopigmentation, where affected skin areas become lighter than the surrounding skin.
In some cases, the healing process can lead to changes in skin texture. Atrophic scars can form, appearing as depressed or pitted areas where skin tissue has been lost. Rarely, more significant trauma or prolonged inflammation might result in hypertrophic scars or keloids, which are raised, thickened areas of skin that extend beyond the original wound boundaries in the case of keloids.
Home and Over-the-Counter Options
Several topical ingredients and at-home strategies can help diminish the appearance of psoriasis scars, particularly hyperpigmentation. Regular application of over-the-counter retinoids, such as retinol, can promote skin cell turnover and collagen production, which may help fade dark spots and improve skin texture over time. Alpha hydroxy acids (AHAs), including glycolic and lactic acids, work by exfoliating the top layers of skin, encouraging new, less pigmented skin cells to emerge.
Vitamin C, a potent antioxidant, can brighten skin and reduce melanin production, contributing to a more even skin tone. Niacinamide, a form of vitamin B3, also helps reduce inflammation and hyperpigmentation, improving the skin’s barrier function. For raised scars, silicone sheets or gels can provide a moist, occlusive environment that may flatten and soften hypertrophic scars and keloids with consistent use. Diligent and consistent use of broad-spectrum sunscreen with an SPF of 30 or higher is also important, as sun exposure can darken existing hyperpigmented areas and impede the fading process.
Professional Treatments and Procedures
For more persistent or pronounced psoriasis scars, professional dermatological treatments offer more intensive solutions. Laser therapies are frequently employed, with fractional lasers, such as fractional non-ablative or ablative lasers, targeting textural irregularities like atrophic scars by stimulating collagen remodeling. Pulsed dye lasers are effective for reducing residual redness associated with post-inflammatory erythema, which often accompanies hyperpigmentation. These lasers work by targeting blood vessels in the skin.
Microneedling involves using fine needles to create controlled micro-injuries in the skin, which triggers the body’s natural wound healing response and stimulates collagen and elastin production, improving scar appearance. Chemical peels, using stronger concentrations of acids than over-the-counter options, exfoliate deeper layers of the skin, which can significantly reduce hyperpigmentation and improve skin texture. For raised, thickened scars like hypertrophic scars or keloids, intralesional corticosteroid injections can help flatten and soften the scar tissue by reducing inflammation and collagen synthesis within the scar itself. Consulting with a dermatologist is important to determine the most suitable treatment plan based on the specific type and severity of the scars.
Preventing Future Scars
Preventing new psoriasis scars primarily involves effectively managing the underlying psoriasis condition. Adhering to a prescribed treatment regimen for active psoriasis flares is important, as controlling inflammation and reducing lesion severity directly minimizes the potential for scarring.
Avoiding scratching or picking at psoriasis lesions is also important because this can worsen inflammation and lead to further skin trauma, increasing the likelihood of developing more pronounced scars, including pitted or raised types. Protecting the skin from sun exposure is another important preventive measure. Ultraviolet radiation can exacerbate post-inflammatory hyperpigmentation, making dark spots more prominent and slower to fade. Using sunscreen daily and seeking shade can help maintain a more even skin tone and reduce the risk of new discoloration.