Psoriasis is a chronic autoimmune condition where the immune system triggers an accelerated growth cycle in skin cells, leading to thick, scaly patches on the skin’s surface. The condition is caused by an underlying state of inflammation that drives this rapid cell buildup, resulting in the characteristic plaques. While the visible symptoms manifest on the skin, psoriasis is recognized as a systemic, body-wide disease. Untreated, the persistent inflammation can progressively worsen the disease, contribute to other serious health complications, and significantly diminish a person’s quality of life.
Progression of Skin Disease
Failing to treat psoriasis allows the inflammatory process to continue, directly causing the dermatological symptoms to intensify. A mild presentation, which may cover less than 3% of the body surface area (BSA), can advance into moderate or severe disease, affecting 10% or more of the skin. The existing plaques tend to become thicker, more resistant to simple topical care, and expand to cover a larger area of the body. This expansion increases the patient’s discomfort with more intense itching and pain, often leading to cracked skin that may bleed.
Chronic inflammation compromises the skin’s natural barrier function, making the affected areas more susceptible to secondary bacterial or fungal infections. In severe cases, unchecked inflammation can lead to the development of rare, life-threatening forms of the disease, such as erythrodermic or generalized pustular psoriasis. Erythrodermic psoriasis covers nearly the entire body with a generalized redness and peeling, disrupting the body’s ability to regulate temperature and fluid balance.
Development of Psoriatic Arthritis
One of the most concerning complications of untreated psoriasis is the development of Psoriatic Arthritis (PsA), an inflammatory disease affecting the joints and connective tissues. Approximately 30% of people with psoriasis will develop PsA, often 7 to 10 years after the initial skin diagnosis. The systemic inflammation causing skin plaques targets the musculoskeletal system, specifically the joints and the entheses (where tendons and ligaments attach to bone).
PsA manifests as stiffness, swelling, and pain in or around the joints, sometimes involving the spine or leading to dactylitis, the severe, sausage-like swelling of an entire finger or toe. If the joint inflammation remains uncontrolled, it will lead to irreversible structural damage, including erosions of the bone and joint destruction. A diagnostic delay of even six months is associated with radiographic progression and impaired function. Early diagnosis and treatment are therefore paramount to preventing permanent physical disability and preserving joint function.
Increased Risk of Systemic Comorbidities
Untreated psoriasis maintains chronic, low-grade inflammation throughout the body. This sustained inflammatory environment is often referred to as the “psoriatic march.” Inflammatory cytokines, such as TNF-α and IL-17, circulate systemically and can compromise the integrity of blood vessels. This can accelerate the process of atherosclerosis, where plaque builds up in the arteries, significantly elevating the risk for severe cardiovascular events like heart attack and stroke.
Chronic inflammation also interferes with metabolic processes, increasing the risk of developing metabolic syndrome, a cluster of conditions that includes high blood pressure, abdominal obesity, and abnormal cholesterol levels. Patients with psoriasis have an increased incidence of Type 2 Diabetes, as the systemic inflammation can drive insulin resistance. Untreated psoriasis is also associated with a higher likelihood of developing other immune-mediated conditions, including inflammatory bowel diseases, such as Crohn’s disease. The severity of the skin disease is directly correlated with the risk of these systemic comorbidities.
Impact on Mental Health and Daily Function
The physical symptoms of untreated psoriasis, including persistent itching, pain, and visible plaques, severely reduce a person’s quality of life. Chronic discomfort and unpredictability of flares interfere with basic daily activities like sleeping, dressing, and maintaining personal relationships. Visibility of the lesions, particularly on the hands or face, often leads to feelings of shame and fear of stigmatization.
Living with a highly visible, painful, and unmanaged chronic condition places a substantial emotional burden on patients. Rates of depression and anxiety are significantly higher in people with psoriasis compared to the general population. This psychological distress can create a negative feedback loop, as stress is a known trigger for psoriasis flares, further worsening the symptoms. The combination of physical discomfort and psychosocial distress can lead to social isolation and reduced vocational opportunities.