Psoriasis is a chronic inflammatory condition that causes skin cells to build up rapidly, resulting in thick, scaly patches. While modern treatments are effective at clearing active plaques, the healing process often leaves behind marks that linger long after inflammation subsides. These residual spots and textural changes are a normal part of the skin’s recovery. Dermatological science offers multiple approaches to address these marks and restore a more even skin tone and texture.
Understanding Psoriasis Residual Marks
The marks left by psoriasis are not typically true scars, which involve permanent changes to the skin’s structure like keloids or deep indentations. Instead, they are most often a form of post-inflammatory change—a temporary alteration in skin color. These changes fall into two primary categories: post-inflammatory hyperpigmentation (PIH) and post-inflammatory hypopigmentation.
Post-inflammatory hyperpigmentation appears as dark spots—red, pink, brown, or black—and is caused by the overproduction of melanin in response to inflammation. This type of mark is more common in individuals with darker skin tones because their melanocytes are more reactive to inflammatory triggers. Conversely, post-inflammatory hypopigmentation, sometimes referred to as Psoriasis Alba, results in lighter or white spots where inflammation has temporarily reduced or damaged the pigment-producing melanocytes. True textural scarring, such as atrophy or indentation, is a less frequent outcome, usually associated with aggressive scratching, picking, or deep, long-standing plaques.
Accessible Topical Treatments
To address hyperpigmentation, several non-prescription topical ingredients can accelerate the fading process. These compounds work primarily by increasing skin cell turnover or by inhibiting the production and transfer of melanin. Alpha hydroxy acids (AHAs), such as glycolic or lactic acid, function by gently exfoliating the top layer of skin, allowing pigmented cells to slough off quickly.
Niacinamide (Vitamin B3) is another effective ingredient that works by inhibiting the transfer of melanin pigment to surrounding skin cells. Studies suggest that concentrations of 4-5% can significantly lighten hyperpigmentation over several weeks of consistent use. Vitamin C, a powerful antioxidant, brightens the skin by neutralizing free radicals and interfering with the enzyme responsible for melanin production, contributing to a more even complexion. Since inflammation and UV exposure worsen hyperpigmentation, applying a broad-spectrum sunscreen with an SPF of at least 30 every day is mandatory to prevent new marks from forming and existing marks from darkening.
Clinical Procedures for Pigment and Texture Changes
When topical treatments are insufficient, a dermatologist can recommend in-office procedures targeting deeper pigment and textural irregularities. Chemical peels involve applying a controlled solution to the skin to cause targeted exfoliation, promoting the shedding of pigmented cells and stimulating new collagen growth. Superficial peels using agents like glycolic acid or salicylic acid are safer for all skin tones, while medium-depth peels may be reserved for less severe cases.
Microneedling uses fine needles to create controlled micro-injuries, stimulating the body’s natural wound healing response and collagen production. This process is effective for improving texture changes, such as atrophic (indented) scars. It is often safer than some lasers for individuals with darker skin tones, as the risk of subsequent post-inflammatory hyperpigmentation is lower. Combining microneedling with topical depigmenting serums, such as tranexamic acid, can enhance the fading of dark spots.
Laser treatments offer targeted solutions, with the specific type of laser depending on the mark being treated. Vascular lasers (like the pulsed dye laser, PDL) target redness and persistent pink marks left by inflammation. Fractional lasers, which create microscopic columns of injury, are used to remodel collagen and improve the depth and appearance of true textural scars. Since these procedures carry a risk of triggering new pigment changes, especially in darker skin, it is important to consult with a provider experienced in treating post-inflammatory conditions in all skin types.
Minimizing Residual Marks During Flare Management
The most effective strategy for managing residual marks involves minimizing inflammation during the active flare, as the intensity and duration of inflammation directly correlate with the severity of the resulting marks. Controlling active plaques quickly and effectively with prescribed topical or systemic medications reduces the inflammatory response. The faster the disease activity is brought under control, the lower the likelihood of significant or long-lasting pigment changes.
A preventative measure is avoiding any form of trauma to the affected skin, including scratching, picking, or aggressively scrubbing the plaques. This mechanical irritation exacerbates inflammation and can deepen the skin injury, directly increasing the risk for both hyperpigmentation and true scarring. Consistent adherence to the prescribed treatment plan and using emollients to keep the skin barrier intact are the best defense against long-term marks.