4 Ways to Fade Psoriasis Scars and Discoloration
After your psoriasis plaques have gone away, you might be left with discolored patches of skin, which some people with psoriasis refer to as scars. Technically, these skin discolorations aren’t scars; they’re changes in the top layer of skin called the epidermis and tend to improve with time. True scars are due to deeper damage in the lower layer of skin called the dermis and can be permanent.
Skin discoloration is one of the most common lasting effects of a psoriasis flare and is caused by skin cell inflammation, says Tanya Nino, M.D., a board-certified dermatologist at St. Joseph Heritage Medical Group in Orange County, California. “Inflammation temporarily destroys pigment cells called melanocytes,” Nino explains.
Discoloration can occur as darkening (hyperpigmentation) or lightening (hypopigmentation), and can appear anywhere on the body where you’ve experienced psoriasis. People with darker skin can experience darkening or lightening after a psoriasis flare. People with lighter skin tend to get dark or red marks, says Susan Bard, M.D., a board-certified dermatologist in private practice in Brooklyn, New York.
The good news is that the discoloration typically resolves on its own with time, Bard says. But it can take months or even years to fully resolve, which for some people, doesn’t feel fast enough. There are a few things you can do to try to speed up the process.
Limit Sun Exposure
The most important thing to do is to prevent worsening of the discoloration by staying out of the sun and avoiding other UV light exposure. Wear sunscreen daily and cover up with protective clothing and accessories, such as hats and sunglasses. “UV light can darken discolored skin,” Nino explains. “However, the paradox is that UV light can also help psoriasis—this is why many patients will note that their psoriasis often improves in the summertime.”
If you have dark marks, you could apply a lightening cream to the affected area. The use of lightening creams can be controversial, as there have been some questions raised about their safety in the past, but Bard says they are “very safe” when prescribed and monitored by a trusted dermatologist. Just make sure you only use a lightening product your dermatologist has approved. Follow their directions for use, including how much of the product to apply and how often.
There are numerous lightening creams available both over-the-counter and with a prescription. The most common is hydroquinone, a skin-lightening agent that is sold over-the-counter (in 2-percent concentrations) and is also available by prescription in higher concentrations. Due to the risk for ochronosis, a condition where the skin can be made darker with overuse of hydroquinone, it’s generally recommended to limit its use to less than three months at a time. Other creams that may be recommended by your doctor include vitamin C, azelaic acid, kojic acid, tranexamic acid, and cysteamine.
Another option is topical retinoid (vitamin A) cream, which is available over the counter as retinol or adapalene; or, in prescription strength, as adapalene, tretinoin, tazarotene, or trifarotene. Retinoids have a very complex mechanism but have been shown in multiple studies to reduce dyspigmentation and to improve the appearance of scars. Note that retinoids shouldn’t be used if you’re pregnant, thinking of becoming pregnant, or breastfeeding.
If you have a large surface area of discolored skin, it might not be practical to try to apply a cream, Nino says. But, in her experience, most of her patients are just so thrilled to have their itchy, raised psoriasis plaques gone that they’re not bothered by the discoloration. “Remember, it fades on its own over time,” she adds.
Treat Flares Early
Bard’s best advice to minimize the likelihood of hyperpigmentation is to treat psoriatic plaques as soon as they appear. By working with your dermatologist, you can figure out the right treatment plan for your psoriasis. Some topical treatments that help psoriasis that can also reduce skin discoloration include prescription topical steroids, such as hydrocortisone, triamcinolone, and clobetasol. Each steroid cream has a different potency, so doctors may prescribe several creams depending on the location, thickness, and extent of the psoriasis plaques.
If someone with psoriasis has severe itch, and scratches the area to the extent that it’s seriously damaged, scars may occur. Scars form when the dermis is damaged. In response to the injury, the body produces new collagen fibers, and this creates new tissue that has a different texture and appearance than the surrounding tissue. This is what we call “scar tissue.”
Although true scars can never be completely removed, different cosmetic treatments are available to minimize their appearance, such as dermabrasion, lasers, and microneedling. However, some methods aren’t recommended for people with psoriasis, as they could trigger a flare due to the Koebner phenomenon—this is where skin damage in psoriasis can create new psoriasis plaques. So, it’s important you speak to your dermatologist for advice before you apply any products or have any treatments to reduce the scars on your skin.
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