Psoriasis Unit

These include physical injury to the skin—such as friction, pressure, bruises, wounds, cuts or insect bites—which can cause patients who already have psoriasis to develop plaques in previously unaffected areas following trauma. This phenomenon, also observed in other dermatological conditions such as vitiligo, is known as the Koebner phenomenon.

The most common internal triggers include infections; treatment with certain medications such as lithium, beta-blockers or interferons; pregnancy; emotional stress; endocrine disorders; and smoking. Although smoking is not a direct trigger, it is a recognised risk factor for developing psoriasis and for worsening prognosis in patients already diagnosed.

Differential diagnosis begins at the first consultation and allows patients to receive truly comprehensive care:

Complete skin examination

Initial assessment focuses primarily on skin lesions, as these are usually the patient’s main concern and play a major role in quality-of-life impairment.

Joint assessment

A significant proportion of patients develop psoriatic arthritis following skin involvement. For this reason, screening for disease markers through specific blood tests is essential. Grupo Pedro Jaén collaborates with expert rheumatologists who act as consultants in these cases, providing added value to the unit.

Femoral arterial ultrasound

Specialists at Grupo Pedro Jaén have participated in international research showing that psoriasis increases the risk of cardiovascular disease, particularly in patients with additional risk factors such as overweight, abdominal fat, obesity, type 2 diabetes, high cholesterol or smoking. These studies demonstrate that femoral arterial ultrasound can detect arterial damage in patients with psoriasis long before clinical symptoms appear, enabling early diagnosis and timely preventive treatment to reduce the risk of serious cardiovascular events.

Liver assessment

Patients with psoriasis have an increased risk of developing fatty liver disease and liver fibrosis. For this reason, psoriasis specialists at Grupo Pedro Jaén may consider evaluating liver health during consultation.

Nail ultrasound examination

Ultrasound assessment of the nails is extremely useful for accurate diagnosis in doubtful cases and for monitoring psoriatic nail involvement. For this purpose, the Psoriasis and Inflammatory Skin Diseases Unit works in close collaboration with the Grupo Pedro Jaén Nail Unit.

Assessment of reproductive planning

Pregnancy planning is a common concern among women with psoriasis. Patients often worry about the risk of transmission to their children, potential worsening of the disease during pregnancy, or whether psoriasis treatment must be discontinued. These concerns are addressed within the unit, and therapeutic alternatives are proposed so that treatment can continue without compromising embryonic safety.

Emotional care

Psoriasis has a significant impact on self-esteem and greatly affects personal, emotional, sexual and professional relationships. Emotional assessment and support form an integral part of the specialised care provided by the unit.

There are many forms of psoriasis, mainly determined by lesion location and characteristics.

Plaque psoriasis (psoriasis vulgaris)

This is the most common form, accounting for approximately 80% of diagnosed cases. Although relatively frequent, it has a profound psychological impact and significantly impairs quality of life. Patients with psoriasis also have a higher risk of developing other medical conditions.

Plaque psoriasis presents with well-defined plaques formed by accumulations of dead skin cells that shed as whitish or greyish scales. The surrounding skin is often inflamed and reddened, and lesions may cause intense itching, cracks and skin abrasions.

Plaque psoriasis may be associated with psoriatic arthritis, which causes joint inflammation and pain similar to rheumatoid arthritis, including stiffness, swelling, loss of strength and local warmth. It most often occurs in patients with existing psoriasis or a family history of the disease, although it may also appear in individuals without a prior diagnosis, complicating detection and delaying treatment.

The joints most commonly affected include the knees, although fingers, toes, pelvis, sacrum and iliac crest (hip area) may also be involved. Psoriatic arthritis may affect a single joint or multiple joints simultaneously and typically occurs in flare-ups. Repeated joint inflammation can lead to permanent damage over time, impairing mobility and function and significantly reducing quality of life.

Inverse psoriasis

Inverse psoriasis causes red, inflamed lesions in skin folds, such as the armpits, groin, under the breasts and around the genital area. Unlike plaque psoriasis, scaling is usually minimal or absent.

Guttate psoriasis

This form is more common in childhood and is characterised by the sudden appearance of small, drop-shaped red lesions that spread across the trunk, limbs and sometimes the scalp. It is often associated with infections, particularly those caused by streptococcal bacteria, and may resolve once the infection is treated.

Pustular psoriasis

A rare form of psoriasis that presents with red patches affecting large body areas (generalised pustular psoriasis) or localised regions such as the backs of the hands or fingertips. Lesions consist of pus-filled blisters that develop hours after the skin becomes red and painful. Symptoms may include chills, intense itching, fever and gastrointestinal disturbances. Blisters typically resolve within days but may recur.

Erythrodermic psoriasis

Another rare but severe form in which the skin becomes intensely red and develops widespread scaling. Patients experience severe itching and/or burning, worsened by friction or scratching. It may affect large body areas or nearly the entire skin surface and is classified as dry or oedematous erythrodermic psoriasis, the latter being more severe.

Nail psoriasis

Approximately half of patients with psoriasis have nail involvement. Nail psoriasis can be classified into matrix psoriasis and nail bed psoriasis. Matrix psoriasis is characterised by excessive proliferation of skin cells in the nail matrix, leading to deformities and irregularities of the nail surface. Over time, the nail plate permanently loses its smooth appearance. Nail bed psoriasis presents with hyperkeratosis (keratin accumulation) and parakeratosis (disruption of the keratin formation cycle). These alterations result in yellowish or brownish discoloration beneath the nail plate, which is visible on the nail surface. In more severe cases, the nail may detach from the nail bed, leaving it exposed and unprotected. The Psoriasis and Inflammatory Skin Diseases Unit works in close collaboration with the Nail Unit to diagnose and treat nail psoriasis.

Current evidence shows that patients with psoriasis, particularly those with more severe forms of the disease, have a higher risk of myocardial infarction, ischaemic heart disease and cerebrovascular disease at younger ages. In addition, life expectancy in these patients may be reduced by approximately four to five years compared with the general population.

It has also been clearly established that cardiovascular risk increases in parallel with the severity of skin involvement.

Importantly, psoriasis itself is considered an independent risk factor for the development of coronary artery disease and acute myocardial infarction. This means that even in the absence of other traditional cardiovascular risk markers, the presence of psoriasis alone predisposes patients to cardiovascular disease.

This is because, in addition to common risk factors seen in the general population such as obesity, hypercholesterolaemia, diabetes, hypertension, smoking and depression patients with psoriasis have an additional burden: chronic systemic inflammation, which places them at a clear disadvantage from a cardiovascular perspective.

Given these findings, it is reasonable to ask whether controlling psoriasis may also help reduce cardiovascular risk. According to psoriasis specialists, the answer is yes.

Based on clinical experience accumulated over recent years, effective control of psoriasis has been shown to positively influence cardiovascular risk markers. In fact, emerging evidence suggests that treating the dermatological disease may directly improve cardiovascular prognosis. Furthermore, research is currently underway to explore the use of medications commonly prescribed for psoriasis in the treatment of cardiovascular risk factors.

At the same time, studies are investigating whether it may be appropriate to prescribe specific cardiovascular risk–reducing therapies at the time of psoriasis diagnosis, rather than waiting for overt cardiac disease to develop.

Although many of these questions are still being clarified—given the relatively recent recognition of the psoriasis–cardiovascular link—it is now clear that patients with psoriasis require close medical monitoring. Even in the absence of clinically apparent coronary disease, chronic inflammation associated with psoriasis is directly linked to thrombus formation and early endothelial damage (the inner lining of the arteries).

For this reason, specialists at the Psoriasis and Inflammatory Skin Diseases Unit of Grupo Pedro Jaén actively investigate and consider these warning signs when referring patients to cardiology, and likewise collaborate closely when referrals are made in the opposite direction.

Topical treatments for psoriasis include creams, emulsions, lotions or foams applied directly to the skin. In mild cases, these therapies may be sufficient without the need for additional options.

These formulations contain active ingredients that help control the disease by reducing inflammation associated with plaques, modulating inflammatory responses and keeping flare-ups under control. Some agents also help normalise the accelerated skin cell turnover characteristic of psoriasis.

Newer-generation topical treatments offer improved safety profiles and, when used at prescribed doses and according to specialist recommendations, are effective options with minimal side effects.

Phototherapy is based on the controlled application of ultraviolet radiation to psoriatic lesions using specialised lamps. This approach reproduces the beneficial effects of sunlight while minimising potential risks.

Depending on specialist assessment and factors such as lesion type, location and extent, treatment may involve ultraviolet A radiation combined with a photosensitising agent (psoralen), broadband ultraviolet radiation or narrowband ultraviolet B radiation.

Two main types of laser are used in psoriasis management. Although they may be applied as standalone treatments, they are most commonly used as complementary therapies alongside pharmacological treatment. Laser therapy is particularly useful for small areas, thin plaques and skin that is not markedly thickened, as it allows targeted treatment without affecting surrounding skin.

Excimer laser

This laser is used for small, well-defined plaques, avoiding the need to treat large body areas. It is commonly applied to facial plaques or lesions in sensitive skin folds such as the groin or armpits. Its mechanism of action is based on plaque removal through controlled light and heat.

Vascular laser

This laser targets red pigmentation and is used to destroy the dilated blood vessels present in psoriatic lesions. As a secondary effect, it also reduces the expression of lymphocytic markers involved in psoriasis pathogenesis.

There are several treatment options for psoriasis that may be administered orally or by injection, depending on disease severity and patient needs. Some oral treatments require strict medical supervision, particularly in women planning pregnancy, as certain medications may affect the fetus. In such cases, specialist consultation is essential to adjust treatment and consider safer alternatives.

Other therapies act by modulating inflammation, helping to control immune responses and reduce excessive skin cell proliferation. These treatments may be particularly beneficial in patients with joint involvement, reducing the frequency and intensity of flare-ups. In addition, some therapies regulate immune system activity in a controlled manner, providing rapid symptom relief in specific clinical situations.

In moderate to severe psoriasis, when other treatments have been ineffective or are contraindicated, more advanced pharmacological therapies are available. These treatments act very selectively on specific molecular pathways of the immune system and generally achieve excellent results. Such next-generation therapies are usually considered second- or third-line options for patients requiring a more targeted therapeutic response.

Psoriasis doesn’t hurt

This is not true—or at least, not always. Psoriasis can cause significant joint pain, and it may also lead to itching, burning, stinging and intense pain when the skin cracks. In addition, these vulnerable areas are exposed to infections, which can be painful.

Psoriasis is only an aesthetic issue

Although the cosmetic impact is considerable for many patients, psoriasis also has cardiovascular, metabolic and emotional implications, which represent a major part of the disease’s management and prognosis.

Psoriasis is caused by poor hygiene

Psoriasis is an inflammatory condition that affects the skin cell renewal cycle and has no connection to hygiene. In fact, many patients with psoriasis are especially meticulous with personal care in order to avoid worsening their skin.

Psoriasis is contagious

Psoriasis is not contagious and is not transmitted by being near or living with someone who has it. It is also not transmitted through touching, kissing or sexual contact.

If I have psoriasis, I can’t wear make-up

Make-up can help people feel better about themselves and support self-esteem. It can also camouflage visible skin changes and, in some cases, cosmetic products contain therapeutic ingredients. However, it is important to choose high-quality, non-comedogenic cosmetics that are dermatologically tested and recommended by a specialist. It is also advisable to avoid applying make-up during flare-ups, mainly to prevent mixing it with topical medication and to avoid irritating the skin.

If I have psoriasis, my children will also have it

Psoriasis has a hereditary component, but inheritance is neither constant nor predictable. Therefore, it is not certain that children will develop the condition. In addition, if they do, the severity of psoriasis in parents does not necessarily determine the severity in their children.

Psoriasis medications are not safe

Several of the drugs used to treat psoriasis are also prescribed for other serious conditions, which can lead patients to perceive them as dangerous or associated with excessive side effects. However, these medications have a high safety profile, and the benefits of treatment generally outweigh the risks of leaving the disease uncontrolled. It is essential to follow the dermatologist’s guidance in order to maximise benefits and minimise risks.

With psoriasis, it’s better not to use sunscreen

Because phototherapy is commonly used to treat psoriasis and many patients improve in the summer, the myth has developed that people with psoriasis can sunbathe freely and even skip sunscreen.

It is true that psoriasis specialists may recommend controlled sun exposure, as ultraviolet rays can have a beneficial effect on plaques and other skin symptoms. Many patients report significant improvement in summer, particularly when spending time in coastal environments, where higher humidity may also help relieve symptoms.

However, this does not mean that patients can sunbathe without limits or without sunscreen. Solar radiation accelerates photoageing (dark spots, wrinkles and loss of radiance) and increases the risk of skin cancer.

Excessive sun exposure can also cause sunburn and trigger a rebound effect, leading to worsening psoriasis.

In practice, the goal is short, controlled exposures to obtain potential benefits without the risks—always according to the psoriasis specialist’s advice.

In addition, some psoriasis medications are not compatible with sun exposure. For example, topical vitamin D derivatives—such as calcipotriol, tacalcitol and their combinations—may lose effectiveness with sunlight, which is why they are typically recommended for evening use.

Some systemic drugs can also increase sun sensitivity, so starting these therapies in summer may be discouraged or, if treatment is already underway, sun exposure should be limited and photoprotection should be intensified.

Finally, medications such as cyclosporine and methotrexate may interact with sun exposure by increasing skin cancer risk, so additional precautions are also required.

Regardless of the treatment being followed, patients with psoriasis should pay close attention to daily skincare in order to relieve itching, help remove accumulated scaling, prevent cracking and reduce the risk of infection in affected areas. General recommendations include:

Hydration

This is the key principle for patients with psoriasis. Keeping the skin well moisturised helps reduce dryness, scaling, itching and stinging, and also helps prevent cracking. Highly emollient products should be chosen to reduce water loss, strengthen the skin barrier and keep the skin soft and supple. These moisturisers should be formulated without volatile ingredients or fragrances.

Gentle cleansing

Use daily hygiene products formulated with oat-based ingredients and a pH as close as possible to healthy skin (between 4.5 and 5.5). Apply preferably with the hands, avoiding washcloths, exfoliating gloves or sponges. Dry the skin by patting gently rather than rubbing, to avoid triggering flare-ups. For the scalp, use a shampoo specifically formulated for psoriatic skin.

Colognes and perfumes

Patients with psoriasis should choose hygiene and cosmetic products that are fragrance-free and alcohol-free, and avoid applying these products directly to the skin.

Fabrics

Wear clothing made preferably from natural fabrics such as cotton. Wool is natural, but it may cause itching and worsen psoriatic skin.

Nail care

Keep nails short and well filed, avoiding sharp edges or splinters, as scratching can injure skin that is already highly vulnerable.

Healthy habits

Maintaining a healthy lifestyle in general—avoiding smoking and alcohol, as well as overweight and obesity—can have a very positive effect on psoriasis.

Managing stress

Anxiety and stress are among the main triggers for psoriasis flare-ups. Physical activity and relaxation techniques can help improve emotional wellbeing and reduce flare-ups or disease worsening.

Prevention

Try to avoid skin trauma and infections, and keep in mind that many medications can worsen psoriasis—such as certain anti-inflammatory drugs, antihypertensives, antimalarials and iodine-containing medications, for example.

Sun exposure

Sun exposure, together with the higher humidity typical of coastal climates, often leads to noticeable improvement in psoriatic lesions. However, excessive sun exposure can have the opposite effect and significantly worsen psoriasis.

The content of this page has been prepared by the Communication Department and the Medical Team of Grupo Pedro Jaén, in line with our editorial commitment to ensuring the accuracy and up-to-date nature of the information provided.

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