Psoriasis (Penyakit Kulit Bersisik): Causes, Treatment Options and How to Prevent Flare-Ups

By Dr Lim Tzyy Huei | Consultant Dermatologist, Pantai Hospital Batu Pahat, Johor, Malaysia

Do you have recurring red, thick, scaly patches on your skin that never seem to disappear completely? Does your scalp keep flaking despite using anti-dandruff shampoo?

These could be signs of psoriasis, a chronic inflammatory skin condition that can affect the scalp, elbows, knees, body, nails and sometimes the joints.

Psoriasis is sometimes described as penyakit kulit bersisik in Malay or 银屑病 (牛皮癣) in Chinese.

Although psoriasis can be persistent and frustrating, it is important to understand that psoriasis is not contagious, is not caused by poor hygiene, and can often be controlled effectively with appropriate treatment.

What Is Psoriasis?

Psoriasis is a long-term inflammatory condition in which the immune system becomes overactive, causing skin cells to multiply more rapidly than normal.

As a result, skin cells accumulate on the surface, forming thickened, inflamed and scaly patches.

Common symptoms include:

• Red, pink, brown or darker patches of thickened skin, often covered with silvery-white scales

• Persistent flaking or scaling of the scalp

• Itching, irritation or a burning sensation

• Dry, cracked skin that may occasionally bleed

• Nail changes such as small pits, thickening or separation from the nail bed

  
  

Psoriasis can develop at any age, and its severity varies considerably between individuals.

Some people have only a few small patches, while others experience widespread skin involvement.

Which Areas Can Psoriasis Affect?

Psoriasis can appear on different parts of the body.

Type of psoriasis	Common features
Plaque psoriasis	Thick, well-defined scaly patches, commonly on the elbows, knees and body
Scalp psoriasis	Persistent scalp flaking, thick scales and itching
Inverse psoriasis	Smooth, inflamed patches in skin folds such as the groin, armpits or beneath the breasts
Guttate psoriasis	Multiple small, drop-like scaly spots, sometimes following a throat infection
Nail psoriasis	Nail pitting, thickening, discoloration or separation
Pustular psoriasis	Pus-filled bumps caused by inflammation rather than ordinary bacterial infection

Some severe forms, including widespread pustular psoriasis and erythrodermic psoriasis, require urgent medical assessment.

What Causes Psoriasis?

Psoriasis develops through a combination of genetic predisposition and immune system dysregulation.

It is not caused by a fungal infection or poor personal hygiene.

Although psoriasis can run in families, many patients have no known family history.

Certain factors may trigger psoriasis or worsen existing symptoms.

Common psoriasis triggers

1. Emotional stress

Stress may contribute to flare-ups and sometimes makes existing psoriasis more difficult to control.

2. Skin injury or irritation

Scratching, cuts, friction, sunburn or repeated trauma may cause new psoriasis patches to appear. This is known as the Koebner phenomenon.

3. Infections

Some infections, particularly streptococcal throat infections, can trigger certain types of psoriasis.

4. Smoking and excessive alcohol consumption

These may worsen psoriasis and affect overall health.

5. Certain medications

Some medicines, including lithium and selected beta-blockers, may aggravate psoriasis in susceptible individuals. Changes to prescribed medications should always be discussed with a doctor.

6. Obesity and metabolic health

Excess body weight is associated with more severe psoriasis in some patients and may reduce treatment response.

However, triggers vary between individuals, and not every flare-up has an identifiable cause.

What Are the Treatment Options for Psoriasis?

Treatment depends on the severity of psoriasis, the affected body areas, its impact on daily activities and whether joint involvement is present.

The aim is to reduce inflammation, clear or improve skin lesions, relieve itching and maintain good long-term disease control.

1. Topical Treatments (Creams and Ointments)

For mild or localised psoriasis, topical treatment is often sufficient.

Topical corticosteroids

Steroid creams or lotions help reduce inflammation, redness, thickening and itching.

Different strengths may be prescribed depending on the affected area.

Stronger preparations may be required for thick plaques on the elbows or knees, while delicate areas such as the face and skin folds require more cautious treatment.

Vitamin D analogues

Medications such as calcipotriol help regulate excessive skin cell production.

They may be used alone or combined with topical corticosteroids.

Other topical treatments

Selected patients may benefit from salicylic acid, coal tar preparations or non-steroidal anti-inflammatory creams.

Moisturisers are also important for reducing dryness and scaling.

Important: Psoriasis treatment should not be stopped or changed abruptly without understanding the maintenance plan. Some patients benefit from intermittent treatment to previously affected areas after improvement.

2. Phototherapy (Medical Light Treatment)

Narrowband ultraviolet B (NB-UVB) phototherapy may be considered for patients with more widespread psoriasis or those who do not respond adequately to topical treatment.

It uses controlled ultraviolet light to reduce skin inflammation.

Treatment usually requires repeated sessions over several weeks.

Phototherapy should be performed under appropriate medical supervision. It is different from using tanning beds or attempting to treat psoriasis through excessive sun exposure.

3. Oral Medications

Patients with moderate to severe psoriasis, extensive lesions or significant impairment of daily activities may require systemic medication.

Common options include:

Methotrexate

Methotrexate helps suppress excessive immune activity and is commonly used for moderate to severe psoriasis.

It is generally taken once weekly and requires regular blood monitoring, particularly for liver function and blood cell counts.

Cyclosporine

Cyclosporine is a relatively fast-acting medication that may be useful when rapid control is required.

It requires monitoring of blood pressure and kidney function and is generally used for a limited period.

Acitretin

Acitretin is an oral retinoid that can be useful for selected types of psoriasis, including thick or pustular disease.

It requires monitoring and has important pregnancy-related restrictions.

Other oral targeted treatments, such as apremilast or deucravacitinib, may be considered depending on the patient’s suitability, clinical circumstances and local availability.

4. Biologic Injections

Biologic therapies have significantly improved the treatment of moderate to severe psoriasis.

These medications target specific inflammatory pathways involved in psoriasis, allowing more selective control of the disease.

Examples include:

Biologic group	Examples
TNF-alpha inhibitors	Adalimumab, infliximab
IL-12/23 inhibitor	Ustekinumab
IL-17 inhibitors	Secukinumab, ixekizumab
IL-23 inhibitors	Guselkumab, risankizumab

Biologic injections can achieve substantial skin clearance in many patients, including those with psoriasis that has not responded adequately to conventional treatment.

Some patients achieve almost completely clear skin.

However, not every treatment works equally well for everyone.

Before starting biologic therapy, patients generally require assessment for infections such as tuberculosis and hepatitis, along with other relevant medical conditions.

The selection of treatment depends on several factors, including psoriasis severity, joint symptoms, other medical conditions, medication safety, patient preference and affordability.

How Long Does Psoriasis Treatment Take to Work?

Improvement is usually gradual, although the response varies depending on the treatment used.

Treatment	General expectation
Topical treatment	Early improvement often within 2–4 weeks
Phototherapy	Gradual improvement over several weeks
Methotrexate	Improvement may become noticeable after 4–8 weeks
Cyclosporine	Often improves within a few weeks
Biologic injections	Some improve within the first few weeks, with fuller responses often assessed after 3–4 months

These are general estimates rather than guaranteed timelines. Some patients may need longer treatment or adjustments before satisfactory control is achieved.

Can Psoriasis Be Cured Permanently?

Currently, there is no permanent cure for psoriasis.

However, many patients can achieve excellent long-term control, and some can remain almost completely free of visible skin lesions with appropriate treatment.

Psoriasis tends to follow a relapsing and remitting course.

This means symptoms may improve or disappear for a period of time before returning.

Recurrence does not necessarily mean treatment has failed.

The frequency and severity of flare-ups vary between patients. Some require only intermittent topical treatment, while others benefit from ongoing systemic or biologic treatment.

How Can I Reduce Psoriasis Flare-Ups?

Although not every flare-up can be prevented, several measures may help maintain healthier skin and improve long-term disease control.

1. Moisturise regularly

Apply a fragrance-free moisturiser at least once or twice daily, especially after bathing.

2. Avoid scratching or picking scales

Repeated injury can worsen inflammation and sometimes trigger new lesions.

3. Use gentle skin care products

Avoid harsh soaps, aggressive scrubbing and unnecessary irritating products.

4. Manage stress and maintain adequate sleep

Stress management may help some patients reduce flare-ups and improve their quality of life.

5. Maintain a healthy body weight

Weight management, regular physical activity and a balanced diet are beneficial for overall health and may improve psoriasis outcomes.

6. Avoid smoking and limit alcohol intake

These are particularly important because psoriasis is associated with other long-term health conditions.

7. Follow the prescribed treatment and maintenance plan

Continuing appropriate treatment and attending scheduled reviews may help maintain disease control.

There is no single diet proven to cure psoriasis. Patients generally do not need to avoid entire food groups unless there is a separate medical reason.

Can Psoriasis Affect the Joints?

Yes. Some people with psoriasis develop psoriatic arthritis, an inflammatory condition affecting the joints, tendons or spine.

Warning signs include:

• Persistent joint pain or swelling

• Morning joint stiffness

• Swollen fingers or toes

• Heel pain

• Persistent inflammatory back pain

  
  

Early recognition and treatment are important because untreated psoriatic arthritis may lead to permanent joint damage.

Patients with psoriasis should inform their doctor if these symptoms develop, even if their skin condition is relatively mild.

Is Psoriasis Associated With Other Health Conditions?

Psoriasis is more than a skin condition.

People with psoriasis, particularly those with more severe disease, may have an increased risk of certain associated conditions, including:

• Obesity and metabolic syndrome

• Diabetes

• High blood pressure and cardiovascular disease

• Fatty liver disease

• Anxiety and depression

• Psoriatic arthritis

  
  

This does not mean every patient will develop these conditions.

However, appropriate health screening and management of cardiovascular risk factors are important parts of long-term care.

When Should You See a Dermatologist?

Consider seeking dermatological assessment if:

• Your scaly skin patches persist or keep recurring.

• Your scalp does not improve with ordinary anti-dandruff treatment.

• Your psoriasis affects the face, hands, feet, nails or genital area.

• Your skin condition interferes with sleep, work or daily activities.

• You develop joint pain, stiffness or swelling.

• Your psoriasis remains poorly controlled despite treatment.

  
  

Sudden widespread skin redness, extensive pustules, fever or feeling very unwell requires urgent medical assessment.

Living With Psoriasis

Living with psoriasis can sometimes be physically uncomfortable and emotionally exhausting.

Visible patches, persistent scaling and repeated flare-ups may affect confidence, social activities, sleep and quality of life.

It is important to remember that psoriasis is not caused by being unclean, and it cannot be passed to others through touching, sharing meals or ordinary daily contact.

With an accurate diagnosis, suitable treatment and consistent long-term care, many people with psoriasis can maintain good skin control and continue their usual activities comfortably.

Final Thoughts

Psoriasis is a chronic inflammatory condition, but it does not have to remain uncontrolled.

Modern treatment options range from medicated creams and phototherapy to oral medications and targeted biologic injections.

The most suitable approach depends not only on the amount of skin involved, but also on the affected areas, associated symptoms and how much psoriasis affects your daily life.

Early assessment and an individualised treatment plan can help improve symptoms, reduce flare-ups and maintain better long-term control.

Dermatology Consultation in Batu Pahat

If you are experiencing persistent scaly patches, recurrent scalp psoriasis, nail changes or psoriasis that is difficult to control, a dermatological assessment can help confirm the diagnosis and guide appropriate treatment.

Dr Lim Tzyy Huei Consultant Dermatologist Pantai Hospital Batu Pahat, Johor, Malaysia

This article is intended for general patient education and does not replace an individual medical consultation.