Psoriasis#

Plain-language guide to psoriasis types, triggers, at-home care, prescription topical treatment, when in-person dermatology care is needed, and what TeleTest can help with.

Psoriasis is a long-term inflammatory condition where the immune system speeds up skin-cell turnover, building thick red or salmon-coloured plaques topped with silvery scale. It's not contagious. It's not an allergy. It runs in families, and the inflammation also affects the joints, heart, and metabolism in some people, so it's now treated as a whole-body condition, not just a skin issue.

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What psoriasis is

Types of psoriasis

Triggers and what makes psoriasis worse

Related conditions to know about

At-home and OTC first steps

When prescription treatment is needed

Flare-up vs maintenance treatment

Severe psoriasis - phototherapy, systemic, biologic

Pregnancy and breastfeeding

Nail psoriasis

What TeleTest can and cannot offer

Common questions

When to see in-person care urgently

Cost and coverage

What psoriasis is#

In psoriasis, your immune system signals your skin to make new cells too fast. Cells pile up at the surface before old ones have shed, building well-defined raised plaques. About 1.7% of Canadians (over 600,000 people) have psoriasis. It typically first appears in late teens to early 30s or again in the 50s and 60s, but it can start at any age.

What you'll see:

Raised plaques with silvery-white scale.
Pink-red on lighter skin tones; purple-brown on darker skin.
Often appears on elbows, knees, scalp, lower back, but can be anywhere - including nails, palms, soles, skin folds.
Tends to come and go in flares.

Psoriasis is not contagious. You cannot pass it on by touch.

Types of psoriasis#

Type	What it looks like	Notes
Plaque (vulgaris)	The classic scaly plaques	80 to 90% of cases
Guttate	Many small "dew-drop" red spots, often on the trunk	Can come on suddenly after a strep throat infection
Inverse (flexural)	Smooth, shiny red patches in skin folds (armpits, groin, under breasts)	Usually less scaly because moisture limits flake build-up
Pustular	Small white pustules on red skin, often palms and soles	Painful; can be widespread (rarely a medical emergency)
Erythrodermic	Widespread redness covering most of the body	Medical emergency - call 911 or go to the emergency department
Nail psoriasis	Pitting, thickening, yellow-brown spots, nail lifting	Often coexists with skin or joint disease

Triggers and what makes psoriasis worse#

You inherit a tendency for psoriasis; flares are usually triggered by something else:

Streptococcal throat infections (especially trigger guttate psoriasis).
Skin injury (cuts, sunburns, tight bands) - new plaques can appear at injury sites; this is called the "Koebner phenomenon."
Stress - one of the most commonly reported triggers.
Certain medications - lithium, beta-blockers, antimalarials, abrupt steroid pills, some antibiotics.
Heavy alcohol use.
Smoking - both raises risk and worsens flares.
Obesity - linked to more severe disease and less response to treatment.
Cold, dry weather.
Hormonal shifts in some women.

Quitting smoking, moderating alcohol, and weight management have measurable effects on psoriasis severity.

Psoriasis is more than a skin condition. People with psoriasis have higher rates of:

Psoriatic arthritis (joint pain, swelling, stiffness, often in fingers and toes; about 30% of people with psoriasis develop this). If you have joint pain along with psoriasis, tell your clinician - early treatment prevents joint damage.
Cardiovascular disease (heart attack, stroke). Standard heart-health screening (blood pressure, cholesterol, diabetes screen) is important.
Metabolic syndrome and diabetes.
Depression and anxiety. Visible skin disease takes a toll. Mental health support is part of complete care.
Inflammatory bowel disease and certain liver conditions in some patients.

A whole-body checkup is part of good psoriasis care.

At-home and OTC first steps#

These help mild disease and are the foundation alongside prescription treatment.

Daily skin care#

Daily moisturizer. Thick, fragrance-free creams or ointments. Petrolatum, ceramide-based moisturizers, and 10% urea creams work well.
Short, lukewarm baths or showers. Oatmeal or Epsom-salt baths can soothe.
Avoid skin injury. Don't pick at scale; gently moisturize to soften it.
Sun in moderation. Brief sun exposure (10 to 15 minutes a few times a week) helps many people with psoriasis. Don't burn - sunburn triggers flares. Use sunscreen on uninvolved skin.

OTC products that help#

Scale-softening shampoo or lotion (an OTC beta-hydroxy acid product). Loosens thick scale so other treatments can soak in. Apply at night, gently brush or wash off softened scale in the morning, then use your prescription cream.
OTC coal-tar shampoos and ointments (1 to 6%). Have been used safely for decades for plaque and scalp psoriasis. Modern products (e.g. T/Gel, Polytar) smell less than older versions. Use 2 to 3 times a week. May stain clothing and light hair.
OTC hydrocortisone 0.5 to 1%. Mild and useful for small mild flares on the body. Don't use on the face for more than a few days without clinician input.
Coconut or mineral oil for scalp scale - apply at night, sleep in a soft cap, wash out in the morning.

Lifestyle changes that move the needle#

Stop smoking.
Cut back on alcohol.
Lose excess weight if applicable - even modest weight loss improves response.
Manage stress with whatever works for you (movement, sleep, social connection, therapy).

When prescription treatment is needed#

See a clinician if:

Plaques aren't controlled by OTC products after a few weeks.
You have plaques on the face, scalp, hands, feet, nails, or genitals.
Plaques are itching, cracking, or bleeding.
More than a small area is involved.
It's affecting sleep, work, or social activities.
You have joint pain or swelling along with psoriasis.

Prescription topical options fall into a few classes:

1. Prescription topical steroids (anti-inflammatory creams)#

The fastest way to calm a flare. As with eczema, the potency must match the body area:

Body area	Potency tier
Face, eyelids, neck, groin, armpits, under breasts	Low
Trunk, arms, legs	Medium
Hands, feet (tops), back of hands	Medium-high
Palms, soles, thick plaques	High to ultra-high, short bursts only

Used correctly, prescription topical steroids are safe. Used incorrectly (high potency on the face long-term, or daily for months on the body), they can thin the skin, cause stretch marks, or trigger a rebound flare when stopped abruptly.

Rules:

Daily during a flare for up to 2 to 4 weeks, then taper.
Weekend-only application can maintain control without continuous strong-steroid exposure.
Don't stop ultra-high potency creams cold-turkey after weeks of daily use.

2. Prescription vitamin D analogue creams#

A different class entirely - these slow the over-fast skin cell growth without thinning the skin. They take longer to work (4 to 8 weeks) but are safer for long-term use.

Often used:

Alone for mild-to-moderate plaques on the body.
In combination products with a strong steroid (one tube, faster results, less ongoing strong-steroid exposure).
As maintenance while a weekend steroid handles flare-ups.

Mild burning or redness can occur in the first 2 weeks; usually settles.

3. Prescription non-steroid anti-inflammatory creams#

The same calcineurin inhibitor ointments used for eczema can also be used "off-label" for psoriasis on sensitive areas (face, eyelids, folds, genitals) where steroids would be risky long-term. They don't thin the skin. May sting for the first few days.

4. Prescription topical retinoids#

Stronger version of the vitamin A class, used for specific areas (some body plaques, nails). Not safe in pregnancy.

5. Newer prescription non-steroid options#

A relatively new class of once-daily steroid-free anti-inflammatory creams and foams. Safe on face and folds. Often more expensive without a drug plan.

Flare-up vs maintenance treatment#

Flare-up plan#

Soften scale (an OTC scale-softening lotion/shampoo, or an OTC coal-tar product) - so creams can actually reach the skin.
Apply prescription anti-inflammatory cream matched to the body area. Daily or twice daily during the flare.
Moisturize liberally on top.
Avoid the trigger if you can identify one.

Most flares calm down within 2 to 4 weeks. If you don't see clear improvement after 4 weeks, follow up.

Maintenance plan#

Once the flare has settled, switch to a routine that keeps plaques quiet without daily strong-steroid use:

Weekday vitamin D analogue cream (Monday to Friday) + weekend steroid (Saturday-Sunday) for body plaques.
Twice-weekly non-steroid cream on face and folds.
Daily moisturizer always.
Coal-tar shampoo 2 to 3 times a week for scalp prevention.

Severe psoriasis - phototherapy, systemic, biologic#

If topicals aren't enough - large body areas involved, joint disease, or major impact on quality of life - the next steps are:

Phototherapy (controlled UVB light treatment) - administered at a dermatology clinic, typically 2 to 3 sessions a week for weeks to months. Effective and well-tolerated.
Oral systemic medications that calm immune over-activity (older broad-acting options and newer pills that selectively block specific inflammatory enzymes). Requires lab monitoring.
Biologic injections. Highly effective for moderate to severe psoriasis and psoriatic arthritis. Most are taken every 1 to 12 weeks depending on the agent. Require infection screening (e.g. TB, hepatitis B and C) before starting and ongoing monitoring.

TeleTest does not initiate phototherapy, systemic medications, or biologics for psoriasis, and does not arrange a dermatology or rheumatology referral. These need a dermatologist (and often a rheumatologist if joints are involved) - you would arrange those visits through your family doctor or a local clinic. What TeleTest can do:

Confirm the diagnosis and assess severity.
Optimize topical treatment to get you as much relief as possible.
Order baseline blood work or screening tests that can speed things up at the in-person visit.
Provide a clear written summary of what you've tried, what worked, and what didn't, to bring to that visit.
Help you understand what to expect.

Provincial dermatology wait times can be long. Starting that process early matters.

Pregnancy and breastfeeding#

Psoriasis can get better, worse, or stay the same during pregnancy - it varies. Treatments to know:

Generally safe:

Moisturizers and OTC products (avoid coal tar in pregnancy).
Prescription low-to-medium potency topical steroids on limited areas in short courses.
Prescription calcineurin inhibitor ointments - discuss with your clinician (data are reassuring).

Avoid:

All retinoids (topical and oral). The oral retinoid for psoriasis stays in the body for up to 3 years - women must not become pregnant during treatment or for the period afterward.
High-potency topical steroids on large areas for prolonged courses.
Coal tar in pregnancy (data are limited).
Most systemic options for psoriasis (some are absolutely unsafe in pregnancy; others vary). All require dermatology and pregnancy-care coordination.
Newer non-steroid creams (PDE-4 class) - data are limited, generally avoided.

If you have psoriasis and are pregnant, planning pregnancy, or breastfeeding, tell your TeleTest clinician so they can tailor the plan.

Nail psoriasis#

About half of people with skin psoriasis also have nail changes. Signs:

Tiny pits in the nail surface.
Yellow-brown "oil spots" under the nail.
Lifting of the nail off the nail bed (called onycholysis).
Thickening and crumbling.
Chalky debris under the nail tip.

Nail psoriasis is treated differently from skin plaques because the nail itself blocks topical creams from reaching the nail bed and matrix:

Topical treatments (prescription strong steroid solution or prescription vitamin D cream) applied to the cuticle and under the nail tip nightly, sometimes under occlusion (small bandage or fingertip cot). Improvement takes months because of how slowly nails grow.
Local injections at the base of the nail by a dermatologist.
Systemic therapy when many nails are affected or joint disease is present.

Nail psoriasis can look like a fungal nail infection (and the two can coexist). A clinician can usually tell them apart, and a nail clipping test can be sent to the lab if there's doubt.

What TeleTest can and cannot offer#

TeleTest can:

Confirm psoriasis and identify the type.
Prescribe prescription topical steroids (matched to body area).
Prescribe prescription vitamin D analogue creams and combination vitamin D + steroid products.
Prescribe prescription non-steroid anti-inflammatory creams (calcineurin inhibitor and newer PDE-4 inhibitor options).
Prescribe prescription topical retinoids for selected body and nail use (not in pregnancy).
Order baseline screening labs that may be needed for future systemic or biologic therapy.
Provide a written summary to bring to a dermatology or rheumatology visit (which you would arrange yourself through your family doctor or a local clinic).

TeleTest does not:

Initiate phototherapy (light treatment) or arrange a dermatology referral for it.
Initiate oral systemic medications for psoriasis (older broad-acting options and newer selective inhibitors), or arrange a referral for them.
Initiate biologic injections or arrange a referral for them.
Perform intralesional steroid injections for stubborn plaques or nails.

For all of those, you would seek an in-person clinician (your family doctor can refer you). TeleTest does not arrange these referrals.

Common questions#

Is psoriasis contagious?#

No. Psoriasis is driven by your own immune system. You can hug, share towels, or sleep beside someone without passing it on.

Will my children get psoriasis?#

Genetics matter. If one parent has psoriasis, children have a higher chance (roughly 10 to 25%) of developing it. If both parents have it, that climbs to around 50%. But genes alone don't cause psoriasis - triggers like infections, stress, or skin injury usually need to set it off.

How is psoriasis different from eczema?#

Feature	Psoriasis	Eczema
Edges	Sharp, well-defined	Less defined, blurrier
Scale	Thick, silvery-white	Light, dry, sometimes weepy
Distribution	Elbows, knees, scalp, lower back	Folds (kids); hands, eyelids, neck (adults)
Itch	Usually milder	Often intense
Onset	Often gradual; flare with triggers	Often chronic with frequent flares

The two can look similar in some cases; a clinician can usually tell them apart and the treatments overlap.

How is psoriasis different from a fungal rash (ringworm)?#

Ringworm typically has a clearer centre with an active red ring around the edge and tends to spread outward. Psoriasis plaques are filled in, not ring-shaped, and tend to appear symmetrically (both knees, both elbows). When it isn't obvious, a clinician can scrape and test for fungus.

Why does my scalp psoriasis feel worse than my body?#

The scalp has thicker skin and more hair, so scale builds up and traps shed cells, making it itchier and harder to treat. Specific scalp treatments include:

OTC scale-softening shampoos to loosen scale.
Coal-tar shampoos.
Prescription steroid solutions, foams, and shampoos.
Vitamin D analogue gels or foams.

Apply, leave on for the time specified, then wash out. Pulling at the scale damages hair follicles - soften and rinse instead.

What about my nails?#

See the Nail psoriasis section above. Topical treatment is slow (months) because nails grow slowly. When many nails are affected or there's joint pain, systemic treatment is more effective and requires a dermatologist.

Does sun help or hurt psoriasis?#

Moderate sun helps most people with psoriasis - UVB light slows the over-active skin cell growth. Sunburn hurts. Aim for 10 to 15 minutes of sun a few times a week on involved skin, use sunscreen on uninvolved areas, and never tan or burn.

Tanning beds aren't recommended - they emit mostly UVA, which doesn't help psoriasis and raises skin cancer risk.

Can I dye my hair if I have scalp psoriasis?#

Yes, but plan around flares. Dye during a calm period rather than an active flare. Patch-test new dyes (apply a small amount behind the ear for 48 hours). Avoid permanent dyes on actively inflamed scalp.

What about diet?#

There's no specific psoriasis diet that clears everyone. What does help in some patients:

Weight loss in overweight patients (consistent benefit across studies).
Reducing alcohol.
Mediterranean-style eating (vegetables, fish, olive oil) - modest benefit in studies.
Vitamin D if deficient.

Cutting out gluten only helps the small minority of patients with proven celiac disease. Get tested before going gluten-free.

Should I get tested for psoriatic arthritis?#

If you have psoriasis and any of:

Joint pain or stiffness, especially in fingers or toes
Swelling of a finger or toe (looks like a "sausage")
Lower back pain or stiffness lasting more than 30 minutes after waking
Heel or elbow tendon pain

...mention it to your TeleTest clinician. Early treatment of psoriatic arthritis prevents permanent joint damage. We can order baseline blood work and provide a written summary to bring to an in-person clinician; your family doctor can arrange a rheumatology referral.

Can I drink alcohol?#

Moderation matters. Heavy alcohol use worsens psoriasis and can interfere with several systemic treatments. Light to moderate use is generally fine but if you're flaring, try cutting back for a few weeks to see if it helps.

Are steroid creams safe long-term?#

Short bursts (up to 2 to 4 weeks of daily use) followed by tapering or weekend-only use is safe. Continuous daily use of strong steroids on the same area for months at a time isn't - that's when skin thinning, stretch marks, and rebound flares happen. The vitamin D analogue and non-steroid options were designed precisely to fill the long-term maintenance slot without continuous strong-steroid use.

How do I taper off a strong steroid?#

Never stop a strong steroid cold turkey after weeks of daily use. Step down gradually:

Week 1: once daily instead of twice
Week 2: every other day
Week 3: weekends only

At the same time, start a non-steroid option (vitamin D analogue or calcineurin inhibitor) on weekdays. This hand-off keeps inflammation low while the skin recovers.

What is "rebound" and how do I avoid it?#

A "rebound" flare happens when strong systemic steroids (pills or injections) are stopped abruptly, or sometimes after very prolonged daily use of high-potency creams. The plaques come back worse than before. Avoid by:

Never asking for oral or injected steroids as "a quick fix" for psoriasis - they're rarely a good idea long-term and rebound is common.
Tapering topical strong steroids rather than stopping cold.
Using vitamin D analogues or non-steroid options for maintenance.

What about coal tar - is it safe and worth it?#

Modern coal tar products are safe in adults and have been used for decades for plaque and scalp psoriasis. They:

Slow the rapid skin-cell growth.
Reduce itch.
Don't thin the skin.

Drawbacks: they smell (less in modern formulations), can stain clothes and light hair, and shouldn't be used in pregnancy or breastfeeding. Worth trying for scalp psoriasis especially.

What about aloe vera and other natural remedies?#

Pure aloe vera gel (99%+) can soothe and moisturize. Evidence on actual plaque clearance is mixed - some studies show benefit, others don't. Use it as part of comfort, not as your only treatment. Watch for fragranced aloe products (they can irritate).

Avoid:

Tea tree oil (common cause of contact dermatitis)
Apple cider vinegar (irritates open skin)
"Steroid-free" creams from unregulated sources - some have been found to contain unlabelled steroids.

Do vitamin D supplements (pills) help my psoriasis?#

Oral vitamin D doesn't clear plaques at safe daily doses. It's worth taking 1,000 to 2,000 IU/day for general bone, muscle, and immune health, especially through Canadian winters, but don't expect the pill alone to do anything for your skin. The topical prescription vitamin D analogue creams work on the skin, which is different.

I'm planning pregnancy. What do I need to change?#

If you're on topicals only, mostly nothing - just keep to low-medium potency steroids in short bursts on limited areas, avoid coal tar, and avoid topical retinoids. If you're on a systemic or biologic, you must plan with your dermatologist well before conception - some drugs require months off before pregnancy is safe.

How long until I see results from treatment?#

Strong topical steroids: 1 to 2 weeks for visible improvement.
Vitamin D analogue creams: 4 to 8 weeks for clearance.
Non-steroid creams (calcineurin inhibitors, newer options): 2 to 4 weeks.
Phototherapy: 4 to 8 weeks of regular sessions.
Systemic medications and biologics: 4 to 16 weeks depending on the agent.

If you don't see clear improvement on a topical after 4 weeks of correct use, follow up.

What about the stigma - how do I handle it?#

Psoriasis is visible, and it's emotionally hard. Tell-it-like-it-is points to share with friends or partners:

It's not contagious.
It's not from poor hygiene.
It's an immune condition, not an allergy.
I'm managing it.

If psoriasis is affecting your mood, ask your TeleTest clinician about mental-health support. Treating the skin and the mood together gives the best result.

When to see in-person care urgently#

Go to a walk-in or emergency department for:

Widespread redness covering most of the body with shivering, fever, or feeling unwell - this can be erythrodermic psoriasis (a medical emergency).
Sudden onset of widespread pus-filled bumps with fever - this can be generalized pustular psoriasis (also an emergency).
A joint that's hot, red, and severely painful - could be septic arthritis, especially if you're on immune-modulating treatment.
Skin infection signs (oozing yellow crust, spreading redness, warmth, fever).
An allergic reaction to a new product (widespread rash, swelling of lips or face, trouble breathing) - call 911 if breathing is affected.

For routine flares, a TeleTest consultation is the right step.

Cost and coverage#

Consultations: Self-pay. See the intake page for current pricing.
OTC products (moisturizers, scale-softening lotions/shampoos, coal tar): Pay at the pharmacy.
Prescription topical steroids and many vitamin D analogue creams: Often covered by provincial drug plans, especially the generic options.
Combination products and newer non-steroid creams: Variable coverage - some need private insurance.
Phototherapy, biologic injections, and systemic medications (if you go on to need them): Often have special-access pathways through provincial plans and manufacturer support programs. A dermatologist's clinic can usually help with paperwork.

You can have any prescription sent to the pharmacy of your choice; we encourage price-shopping.

Eczema - sometimes confused with psoriasis
Acne
Cosmetic dermatology - for pigment changes after long-term psoriasis
Fungal toenail infections - which can look like or coexist with nail psoriasis