Introduction:
Why does psoriasis keep coming back? The biggest mistake most patients make – The most common and painful thing I hear all too frequently from my patients is the following question: “Doctor, my psoriasis had completely disappeared, but after several months it came back and sometimes even worse. What is going on?”
There are a large majority of people who believe that the major cause of their psoriasis outbreaks has something to do with their diet or taking medications too soon, changing creams frequently, or finding treatment protocols on the internet. While these may all contribute to the cause of psoriasis flares, there is one factor that is even more important and it can be found in patients and health care providers alike.
As I have been treating psoriasis patients for the last thirty-nine years, I have treated over thirty-two thousand individuals who suffer from psoriasis in and outside of India. The same refrain has been repeated numerous times over the years by my patients as follows: “I thought I was cured, so after the initial clearing of my skin, I stopped medication. Then after a period of time, psoriasis returned.”
This is a cold, hard fact: the management of psoriasis cannot occur without addressing the cause of the psoriasis. Thus, in order to have an understanding of psoriasis, one must first know the individuals behind the psoriasis patches.
The biggest mistake: Treating only the skin, not the whole disease:
The biggest mistake in treating psoriasis is believing that the psoriasis is purely a skin disease when in fact it’s a disease of the entire body. Psoriasis appears as red, scaly patches on the skin, which are merely the last manifestation of a disease process that is occurring inside the body.
Additional chronic conditions related to these patches may include:
- An overactive immune system
- Chronic emotional stress
- Unresolved grief and trauma
- A family history of psoriasis
- Digestive issues
- Sleep disturbances
- Being overweight
- Smoking & alcohol
- Weather triggering factors
- Certain medications
- Individual foods that trigger reactions
If treatment focuses solely on removing the visible patches without addressing the underlying contributing factors, then a significant aspect of the Psoriasis “Story” is missing.
Psoriasis is more than just a skin disease: it is chronic, immune mediated and has multiple factors unique to each individual.
Just because skin is clear does not mean the disease is clear
While obtaining relief from having less itchy skin, lessened scale on the skin and developing more confidence through clearer skin you must ask yourself one question.
Has the tendency to develop the disease been addressed?
The answer is often no. I use a simple analogy to explain this. Imagine you are looking at a tranquil river with no ripples or waves on the surface; however, if you look deeper into the river you will see that there is quite a bit of turbulence occurring underneath the surface.
Psoriasis behaves much like this. A patient’s skin condition can look clear; if major triggers exist (ongoing emotional stress, poor quality sleep, poor lifestyles, emotional stresses or dependency on topical medications) flare-ups may still occur. Therefore, long-term treatment requires looking past the skin itself.
Each patient who has psoriasis has an individual story. One of the major myths surrounding psoriasis treatment is that the same treatment will work for all. Both of them may have psoriasis, but it is possible for their journey to be completely different.
A patient could have obtained psoriasis, because of their stress due to family problems. Another patient may have developed psoriasis as a result of an extreme amount of job-related stress. A third person might have developed psoriasis as a result of getting an infection followed by giving birth or extended use of an unsuitable medication.
Just because the patches are similar in appearance does not mean that the disease is mainly attributable to the same underlying factors. This is why psoriasis treatment should not be considered a “one size fits all” procedure. Knowing the patient is critical when evaluating the most appropriate treatment.
Identifying trigger is essential
Many patients tell me, “Doctor, my psoriasis has gotten worse all of a sudden.” However, upon reviewing the complete medical history, most flare-ups occur gradually rather than suddenly.
Frequently we have found out that:
- The amount of Stress was building up prior to onset for numerous months
- Sleep Pattern became erratic
- Emotional issues had been ongoing
- Dietary intake has dramatically changed
- Increased Alcohol Use
- Experienced an acute infection
Psoriasis typically provides prior warnings and indicators to its progression from mild to moderate.
Recognizing these causative factors can provide both physicians and their patients with information about what may be contributing to the flare-up of psoriasis and how these may be managed to interact with each other into the future.
Importance of timeline in treatment for psoriasis
One of the most beneficial parts of understanding psoriasis is creating a timeline:
For example:
- When did you develop your first episode of psoriasis?
- What was going on in your life when you developed your first episode of psoriasis?
- What transpired prior to the onset of your scaling plaques?
- Which medications have provided you with relief from the scaling?
- When did your psoriasis return?
Will provide you with a wealth of information.
If the history/timeline of your psoriasis has not been considered in any treatment plan, your treatment will likely consist of nothing other than treating one scaling area of skin after another, and will not contain any attempt to understand why your psoriasis continues to return.
Do not ignore the connection between your mental and physical health.
The impact of psoriasis goes far beyond just our skin. Although many people look fine from the outside, many of them have held on to emotional pain for a long period of time. Some people still carry grief of loss. Some have chronic stress that they cannot resolve, feel angry but do not express it, have been rejected emotionally, experience humiliation, and have the weight of the world on their shoulders every day.
These feelings can impact how we respond to stress and studies show that emotional stress can impact how the immune system works in people susceptible to psoriasis.
Therefore, when a psoriasis patient has a consultation, the conversation should not be limited to questions such as:
- “How much itching do you have?”
But more importantly:
- “What is your emotional health like?”
- “How much stress are you under on a continuous basis?”
- “What life events or situations happened prior to your psoriasis being worse?”
Understanding a psoriasis patient’s emotional/mental health is just as important as understanding someone who has a chronic disease.
Beware of quick fixes
Unfortunately, many people looking for relief are exposed to promises of:
- “Cure in 7 days.”
- “One cream will clear up your psoriasis forever.”
- “Money back guarantee in 2 weeks.”
People can create unrealistic expectations based on these types of claims. Remember, psoriasis is a chronic disease and will take time to see any improvement, and will require regular follow-up and a customized approach to management.
You will not see results overnight. While the honest approach may not sound as glamorous as the miracle approach, it is ultimately the safer and more sustainable approach.
Understanding why follow-up appointments are important
The most common error is to discontinue follow-up appointments as soon as the patient’s symptoms improve. Several patients choose to stop treatment as their patches become less visible. After months when the patient returns to psoriasis status, they feel disappointed because they believe that the treatment has failed. Follow-up appointments are about more than just the routine visit.
Following up with a doctor enables them to assess:
1. The progress of the disease.
2. The need for changes in treatment.
3. If new triggers exist.
4. Should medication be discontinued, changed, or decreased over time.
Even if you have improved (temporarily) or had a worse experience with psoriasis, you should not stop having regular follow-ups before making a decision about treatment for the next event. It is similar to managing a chronic disease without follow-up; it is like trying to navigate through darkness.
The patient education component in the treatment process
Success of psoriasis management cannot depend solely upon medications. Patients also require a clear understanding of their condition. When people do not understand their psoriasis they become:
1. Anxious from lack of understanding.
2. Switching creams often.
3. Abruptly discontinuing treatment.
4. Self-diagnosing (using the Internet) after they have a flare of the skin condition.
5. Viewing all occurrences of their skin condition as treatment failures.
6. Sometimes viewing their condition is contagious or just an allergy.
Patient education will empower them to make informed choices and will help to eliminate unnecessary anxiety. Understanding that occurrence triggers vary for each patient provides them with the ability to identify that their journey of治 can differ from others.
Skin issues, not just external symptoms
From years of experience in practice, I can tell you that the best care for someone with psoriasis begins by listening. An effective consultation should include more than just information about visible symptoms. An effective consultation should focus on obtaining information about:
- Family history
- Lifestyle
- Emotional well-being
- Sleep quality
- Digestive health
- Prior treatments
- Stress levels
- Individual triggers
Although the skin is an important starting point, it should not be the only area of focus.
In ideal circumstances, the management of psoriasis not only involves making the skin look better, but is based on understanding the reasons that flare-ups happen and how to reduce the number of flare-ups over time.
Know more:
Conclusion:
The most common misconception in the care of people with psoriasis is the belief that the presence or absence of visible patches of skin is the only indication of a possible lack of understanding about the overall disease.
Visible patches are only one part of the much bigger picture. In order to effectively manage psoriasis, the practitioner must ask these deeper questions:
- Why did the disease start in this person?
- What caused it to come back?
- What triggered the most recent flare-up?
Have there been any changes in any area of the life of the individual since the last time that they had, or did not have, any visible patches of skin?
Asking these questions allows for more personalized, meaningful, and long-term benefits from treatment.
I tell my patients that the most important thing they should be asking is not how quickly the patches disappeared from their skin, but why they came back in the first place.
Understanding the difference between these two questions can change the entire process of how psoriasis will be managed. In fact, the care of psoriasis only begins once there is a successful long-term treatment plan.
Frequently Asked Questions (FAQs)
1. What is the biggest mistake people make in psoriasis treatment?
The biggest mistake is focusing only on clearing the visible skin patches while ignoring the underlying factors that contribute to psoriasis. Since psoriasis is a chronic immune-mediated condition, successful management often requires understanding triggers such as stress, lifestyle, sleep, infections, diet, and emotional health, not just treating the skin.
2. Why does my psoriasis keep coming back after treatment?
Psoriasis may return if the underlying triggers remain unchanged. While treatment may temporarily clear the skin, factors like stress, poor sleep, infections, smoking, alcohol, obesity, or certain medications can contribute to future flare-ups. Regular follow-up and identifying individual triggers are important for long-term management.
3. Does clear skin mean my psoriasis is cured?
Not necessarily. Clear skin is an important treatment goal, but it does not always mean the underlying tendency for psoriasis has resolved. Even after the skin improves, ongoing trigger management and regular medical follow-up remain essential.
4. Why is psoriasis treatment different for every patient?
Every person experiences psoriasis differently. While two patients may have similar-looking skin lesions, their triggers, medical history, lifestyle, emotional health, and immune responses may be completely different. This is why individualized treatment is often more effective than a one-size-fits-all approach.
5. What are the most common psoriasis triggers?
Common psoriasis triggers may include:
- Emotional stress
- Infections
- Poor sleep
- Skin injuries
- Smoking
- Alcohol consumption
- Certain medications
- Obesity
- Weather changes
- Individual food sensitivities
Triggers vary from person to person.
6. Why are regular follow-up appointments important in psoriasis?
Psoriasis is a chronic condition that requires ongoing monitoring. Regular follow-up appointments help your doctor assess disease progression, identify new triggers, adjust treatment when needed, and reduce the risk of future flare-ups. Stopping follow-up simply because the skin has improved may lead to disease recurrence.
7. Can stress make psoriasis worse?
Yes. Emotional stress is one of the most commonly reported triggers for psoriasis flare-ups. Although stress does not directly cause psoriasis, it may influence immune system activity in susceptible individuals, increasing the likelihood of symptom worsening.
8. Why shouldn’t I change psoriasis creams frequently?
Frequently changing creams or using treatments without medical guidance can make it difficult to understand how your skin is responding. Self-treatment may also delay appropriate care. It is best to follow your doctor’s advice and discuss any concerns before making changes to your treatment plan.
9. Can I manage psoriasis by using only creams?
Topical creams can help relieve symptoms such as itching, redness, and scaling, but psoriasis management often requires a broader approach. Lifestyle modification, stress management, trigger identification, proper skin care, and regular medical supervision are equally important for long-term control.
10. How can patient education improve psoriasis management?
Understanding psoriasis helps patients make informed decisions about their treatment. Learning about triggers, realistic expectations, medication adherence, and the importance of follow-up can reduce anxiety, improve treatment compliance, and support better long-term disease management.
Written by –
This article is written by Dr. R. S. Sonawane.
M.D. (Homeopathy), DI (Homeopathy), London
Psoriasis Specialist Doctor in India
Dr. R. S. Sonawane is India’s first Homeopathic Psoriasis Specialist, with over 39 years of dedicated experience in treating psoriasis and related chronic skin conditions using a holistic, patient-focused approach. He holds advanced training in homeopathy and has helped tens of thousands of patients achieve long-term relief from psoriasis through personalized, immune-balancing treatment plans designed to address the root cause of the condition rather than just symptoms.
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