Psoriasis can be a very frustrating skin condition. With severity varying from person to person—from plaque location and medications used to flare frequency—these factors can influence how you approach in-office skin treatments. While patients with psoriasis can safely undergo aesthetic procedures, dermatologists say that timing, treatment selection and inflammation control are essential when it comes to choosing the right approach for you.
Featured experts
- Jody A. Levine, MD is a board-certified dermatologist in New York
- Jacob Beer, MD is a board-certified dermatologist in West Palm Beach, FL
Skin treatments to avoid if you have psoriasis
“Psoriasis doesn’t automatically mean you can’t have cosmetic procedures, but it does mean you need to be more selective and strategic,” explains New York dermatologist Jody A. Levine, MD. The biggest concern, says West Palm Beach, FL dermatologist Jacob Beer, MD, is patients experiencing “a clinical phenomenon called the Koebner phenomenon, which means that when someone experiences some form of injury, like microneedling, psoriasis plaques can appear in those areas.” Essentially, trauma to the skin can trigger new psoriasis plaques in previously unaffected places.
Because of this phenomenon, Dr. Levine generally advises patients to avoid skin treatments that can create significant or unnecessary injury to the skin during an active psoriasis flare. “This includes avoiding procedures such as microneedling, deep chemical peels, aggressive ablative laser resurfacing or other treatments that intentionally wound the skin,” she says.
Injectable fillers and neurotoxins should also be used with caution. “While not absolutely contraindicated, they should be avoided in areas of active inflammation or plaques,” says Dr. Levine. Additionally, intense pulsed light (IPL) and photodynamic therapy are also not recommended for psoriasis treatment. “The 2019 AAD/NPF guidelines specifically recommend against topical 5-ALA-photodynamic therapy or methyl ALA-photodynamic therapy for localized psoriasis,” she adds.
What to consider before going for a cosmetic treatment
Active vs. inactive psoriasis
Whether psoriasis is active or well controlled makes a significant difference in treatment planning. “Active psoriasis generally indicates a more acute or subacute disease process,” says Dr. Beer. Active psoriasis is characterized by inflamed, scaly or expanded plaques, which is when the skin is at its most vulnerable and at risk of triggering additional lesions as a result of skin trauma. During this time, dermatologists recommend postponing elective cosmetic procedures until the flare is adequately treated.
However, “when psoriasis is inactive or well controlled, patients often become candidates for a much broader range of aesthetic treatments. Even then, I still recommend proceeding cautiously, choosing less aggressive options or spacing treatments farther apart to minimize the risk of irritation,” says Dr. Levine. In fact, certain vascular laser treatments can actually help treat persistent redness associated with psoriasis, but again it depends on how well a patient’s psoriasis is controlled.
Seasonal timing
Timing of cosmetic treatments can also make a difference. “Many people notice their psoriasis naturally improves during the warmer months because moderate sunlight and higher humidity can be beneficial for the skin,” explains Dr. Levine. Conversely, she says that winter can be even more challenging, especially with cold temperatures, low humidity and indoor heating, which dries skin and can often contribute to flares even though there’s a lower risk of post-inflammatory pigmentation.
This doesn’t necessarily mean that cosmetic procedures should only be performed in the summer. “Seasonality matters less than if the psoriasis is well-controlled. If the patient is on a biologic or treatment that controls the psoriasis well, then many treatments can still be done, albeit cautiously,” says Dr. Beer.
