Why Is Psoriasis Itchy?

Psoriasis can cause an itchy, scaly rash on your skin. Some itchy rashes are temporary, but psoriasis is a chronic, lifelong skin condition. It can lead to changes in your skin that cause you physical and mental discomfort. People often say the itching from psoriasis feels like burning and can be very painful.

Psoriasis may not itch all the time and some types of psoriasis rarely itch. If you live with psoriasis, you might find some flare-ups itchier than others or notice that some feel worse at night.

This article covers why psoriasis itches, what triggers can make it worse, and what you can do to get relief.

Why Does Psoriasis Itch?

It’s not known why psoriasis causes itching, but it might happen the same way that other itches do.

For example, allergy itching starts in nerve receptors in the skin called nociceptors. The receptors are stimulated by a substance the immune system puts out during an allergic reaction (histamine). The substance makes the receptor misfire.

While misfiring cells explain why an allergic rash is so itchy, it is unclear why an itch happens with non-allergic conditions like psoriasis.

Scientists do know that there are a lot of nociceptors between the outer layer of skin (epidermis) and the layer of skin just below it (the dermis). This is also the place where psoriasis starts.

Psoriasis is an autoimmune disorder that happens because the immune system attacks normal cells in the skin by mistake. The skin cells in the transition place start to multiply faster than they can be shed. When they build up, you see the dry, flaky plaques of psoriasis on your skin.

What Makes Psoriasis Itching Worse?

Psoriasis may not itch all the time—or at all. Some forms of psoriasis (like plaque psoriasis) tend to be more likely to itch than others, and some flare-ups will cause worse itching than others. Psoriasis can also be mistaken for eczema, which also causes itchy skin.

Psoriasis Triggers

There are certain things in your life and environment that can trigger flare-ups of psoriasis and make itching worse.

Each person with the condition may have their own set of triggers, but common psoriasis triggers can include:

• Skin injury or irritation (e.g., scrapes, insect bites, nicks from shaving, tattoos, skin piercings)
• Getting sick with an infection (e.g., with a cold, strep throat, or the flu)
• Being under a lot of stress
• Changes in the weather (e.g., hot/cold dry air)
• Using alcohol and/or tobacco
• Certain foods and drinks (e.g., dairy, processed food, gluten)
• Taking certain medications (e.g., beta-blockers, lithium, interferons)

How to Treat Psoriasis Itch

One of the most important parts of living with psoriasis and managing your symptoms is figuring out what your triggers are and trying to avoid them. 

For example, you might find the itching from psoriasis starts up or gets worse when you’re stressed, or during the cold, dry winter months. 

There are also many over-the-counter (OTC) and prescription treatments you can try to get relief from psoriasis itching. Some are called antipruritics, meaning that they treat the itch itself. Others treat skin dryness and flakiness that can make itching worse.

Before you start using any product to treat psoriasis, make sure that your provider knows about any and all medications or supplements you are taking, whether they are oral (taken by mouth) or topical (put on your skin).

OTC and Prescription Treatments for Psoriasis Itch

Some common anti-itch remedies for psoriasis include:

• Antihistamines are medications used to treat allergies. They target nerve pathways linked to itching. Some products have a sedative effect, which can help if the itching is keeping you up at night. Benadryl (diphenhydramine) is a popular choice that you can buy OTC.
• Emollient-rich moisturizing creams have lanolin, glycerin, or petrolatum in them. These ingredients relieve dryness and lock in skin moisture for long-lasting relief. For an extra-comforting and cooling effect, try keeping your cream in the refrigerator.
• Anti-itch creams come in many OTC brands, most of which have menthol or camphor in them. Benzocaine and hydrocortisone come in both OTC and prescription strengths. Ask your provider before using an OTC product, as some contain ingredients that irritate the skin.
• Topical corticosteroids are available by prescription and OTC. They are effective treatments for itch but you should not use them too often because they can cause skin thinning (atrophy). Use the steroid only as instructed by your provider. Certain steroids are too strong for the skin of the face. Never put a topical corticosteroid on your face unless your provider tells you to.
• Aspirin may help quiet the inflammation that promotes itchiness. It can be a better choice than other nonsteroidal anti-inflammatory drugs like Aleve (naproxen), which can trigger psoriasis flares.
• Remeron (mirtazapine), a noradrenergic and specific serotonergic antidepressant (NaSSA) has been used to treat itchiness in people with moderate to severe psoriasis when nothing else has worked.
• Neurontin (gabapentin) is a prescription drug typically used to treat seizures. It can also be effective in relieving neuropathic pain. In rare cases, it's used for people with severe psoriasis if they have severe chronic pain and itching that has not been helped by other treatments.
• Retinoids. Medications made from vitamin A help some people manage psoriasis symptoms without affecting their immune systems. 
• Biologics. Some people with psoriasis are treated with special medications that are given as injections to target the cells in the immune system.
• Immunosuppressants. Drugs that tamp down the immune system, like methotrexate, are sometimes used to treat psoriasis.
• Phototherapy is a treatment using ultraviolet (UVB) radiation. It is done at a dermatologist's office. Phototherapy can be effective in relieving itchiness. It also reduces the inflammation that drives psoriasis. It is commonly used for moderate to severe cases that have not been helped by other treatments.

Home Remedies for Psoriasis Itch

You might want to try some home remedies for psoriasis itch, such as:

• Ice packs and cold compresses. These are the quickest and easiest solutions for itchiness. Ice packs and compresses numb nerve endings in the skin and cools raw, inflamed areas. Even using a washcloth dipped in ice water can be soothing. Avoid putting ice directly on your skin. To prevent frostbite, cover the ice pack in a towel and move it around constantly, icing each section of your skin for no longer than 10 to 20 minutes at a time.
• Oatmeal baths can be useful in treating widespread psoriasis plaques. An oatmeal bath helps soften and soothe the skin with a gentle exfoliating effect. Look for products made with ground colloidal oatmeal. Immediately after drying off and while your skin is still moist, put on a layer of lotion to lock moisture in.
• Time in natural sunlight can be helpful for psoriasis symptoms. Spending about 15 minutes in the sun daily is usually enough. Before getting your 15 minutes of sun, do not put sunscreen on any areas of skin affected by psoriasis. However, you should put it on the other sun-exposed areas of your body (like your face) to protect them. If you stay out in the sun for longer than 15 minutes, remember to apply sunscreen to all exposed skin.
• Short-term occlusion therapy. For this technique, apply a layer of moisturizing or medicated cream to your skin and wrap it in cling film. Cover the wrap with a sock, glove, or loose elastic bandage, and wear for several hours or overnight.
• Baths and showers. A bath can be effective for loosening psoriasis scales, but avoid taking regular hot baths or showers. Cool showers can help reduce itching and inflammation. Remember that showering and bathing actually promote skin dryness. Always apply moisturizer after drying off, while your skin is still moist, to minimize dryness and itch.
• Lifestyle changes. Along with learning about your triggers and trying to avoid them, making some changes to your diet and activity can also be beneficial for helping you manage psoriasis. You may not notice the benefits right away, but making them can help you manage the condition long-term.

When to See a Provider

If you’ve noticed that the itchiness from your psoriasis is getting worse or you have signs of a skin infection, let your provider know. You might need to change your treatment to manage the condition better.

You should also reach out to your provider if your psoriasis symptoms—including itching—are affecting your physical or mental health in any way. Having really itchy skin can keep you from getting enough quality sleep and may affect your ability to function in your day-to-day life.

Summary

It’s not clear why psoriasis itches, but many people living with it know that it does—sometimes very badly. As much as you may want to scratch, try not to. Scratching skin that’s itchy and inflamed from psoriasis can make the condition worse and lead to scarring and infections. 

If you try OTC creams, soothing oatmeal baths, and cool compresses and still itch, talk to your provider. You might need a prescription treatment to relieve the itching.