Supporting psoriasis patients in aesthetic practice

Psoriasis is a chronic, immune-mediated skin disorder that affects around two in every 100 people in the UK.

While it often requires medical treatment, aesthetic practitioners have an important role to play in supporting patients' skin health, confidence and wellbeing.

From light therapies and ingredient-led skincare to advice on homecare and lifestyle factors, patients with psoriasis can benefit from a holistic, multidisciplinary approach.

Dr Maryam Zamani, oculoplastic surgeon, facial aesthetics doctor and founder of MZ Skin, says, "Psoriasis is a chronic, lifelong, immune-mediated, inflammatory skin condition with multiple phenotypes.

"Psoriasis has a major genetic component, with heritability estimated to be 60-90%. In psoriasis, T-cells become overactive, leading to inflammation and rapid skin cell growth.

"Factors like stress, infections, skin injuries, certain medications and cold weather can trigger or worsen psoriasis outbreaks."

What is psoriasis?

Psoriasis is an inflammatory skin disorder characterised by the rapid production of skin cells.

Dr Ahmed El Muntasar, a GP and aesthetic doctor, explains that, "Psoriasis results in dry skin, particularly dry raised patches with some inflammation, redness and flakiness. The skin can also be very itchy as a result of the dryness."

These patches, known as plaques, can be painful, and they are often found on the scalp, elbows, knees and lower back – although they can appear anywhere on the body, with a range of severity.

Dr Sonia Khorana, a GP with a special interest in dermatology, says, “Psoriasis is thought to be related to immune system function. Genetics play a big part and, if one of your family members has it, chances are you might too.”

"Psoriasis can be influenced by hormonal fluctuations, such as during puberty or pregnancy. And smoking, excessive alcohol consumption, and obesity may increase the risk or severity of psoriasis," adds Dr Zamani.

One of the key challenges in managing psoriasis is its cyclical nature, with symptoms often alternating between acute flare-ups and more manageable chronic phases.

During a flare-up, plaques can become inflamed, red and extremely sensitive. In contrast, during the chronic phases the skin might still be dry and flaky, but symptoms tend to be less intense. 

How to treat psoriasis

While psoriasis is a chronic condition, it can be managed through a combination of medical treatment, skincare and lifestyle adjustments.

Aesthetics professionals can support patients with treatments that can alleviate their symptoms and improve their skin health.

Treatments for psoriasis

There are several tools at their disposal to help patients with psoriasis, especially when the skin is in its chronic phase and not acutely inflamed.

Light therapy for psoriasis

One of the most promising treatments for psoriasis is light therapy.

Red light therapy has been shown to reduce inflammation and promote skin healing, making it an excellent option for clients with psoriasis.

Katie White, owner of re:lax skin school and the re:lax skin studios in London and a trained facialist and nutritionist, explains, "Red light therapy can help reduce the appearance of psoriasis plaques and calm irritated skin. It's gentle, safe and clients can see results with regular use over time."

Another option is blue light therapy, particularly for mild psoriasis. "There are FDA-approved blue light devices that can be used at home between treatments, and they offer a convenient way for clients to manage their symptoms outside of the clinic," says Dr Khorana.

It’s important to recommend patients consult a dermatologist before undergoing any form of light therapy, especially if they are on medications or topical treatments for psoriasis.

The role of skincare in psoriasis

A key aspect of managing psoriasis is maintaining skin hydration. Psoriasis causes the skin to lose moisture quickly, leading to dryness, itching and scaling.

Aesthetics professionals can incorporate hydrating treatments into their services, focusing on deeply nourishing the skin.

White advises, "Hydration is vital for psoriasis sufferers, and incorporating deeply hydrating products into beauty treatments can make a huge difference.

“Use moisturisers and serums rich in glycerin, hyaluronic acid, panthenol, ceramides and shea butter, as these ingredients help maintain the skin’s moisture barrier and soothe irritation."

During facial treatments or for homecare, practitioners can apply hydrating masks or serums that are designed to lock in moisture.

These products should be fragrance-free and hypoallergenic, as psoriasis-prone skin is often sensitive and reactive to strong ingredients.

Humectants like glycerin and hyaluronic acid work by drawing moisture from the air into the skin, making them essential in skincare treatments for psoriasis.

Occlusives, such as shea butter and petrolatum, help to seal moisture into the skin, preventing water loss and maintaining hydration for longer periods.

Dr Khorana adds, "One of the most effective strategies for clients is to layer products. Start with lighter serums and end with heavier emollients to trap moisture and protect the skin barrier."

Practitioners can also recommend thermal water sprays or hydrating mists during treatments to provide instant relief from itchiness and dryness.

These can be used throughout the day by clients to soothe their skin in between professional treatments.

Should you exfoliate with psoriasis?

Exfoliation can be beneficial for clients with psoriasis, but it requires a delicate touch. "Exfoliation helps remove the build-up of dead skin cells, which can improve the appearance of plaques and allow moisturisers to penetrate deeper," explains White.

"However, the key is to use gentle exfoliation methods that don’t cause trauma to the skin."

People should avoid mechanical exfoliants, such as scrubs with large particles, as these can cause micro-tears in the skin and trigger a psoriasis flare-up. 

Instead, opt for enzyme-based exfoliants or mild alpha hydroxy acids (AHAs) like lactic acid, which are gentle enough for sensitive skin.

These ingredients work by breaking down the bonds between dead skin cells, allowing them to slough off without damaging the skin barrier.

White recommends incorporating exfoliation only during chronic phases when the skin is not inflamed or broken. 

For those with mild psoriasis, gentle exfoliation once or twice a week can help reduce scaling and improve the texture of the skin," she adds.

After exfoliation, it’s crucial to immediately follow with a hydrating serum or moisturiser to replenish the skin barrier.

Homecare for psoriasis clients

In addition to in-clinic treatments, it’s important to guide patients on how to manage their psoriasis at home.

White advises that patients with psoriasis should focus on keeping their skincare routine minimal and avoiding potentially irritating ingredients.

"I recommend a gentle cleanser, followed by a hydrating serum and a thick, occlusive moisturiser," she says. 

Dr Khorana recommends encouraging patients to use fragrance-free, hypoallergenic products.

"Avoiding fragrance and harsh chemicals is key for managing psoriasis, as the skin is highly sensitive to irritants. Stick to proven ingredients like ceramides, glycerin and colloidal oatmeal," she says.

Treatments to avoid for patients with psoriasis

While some treatments can soothe the symptoms of psoriasis, there are others to avoid, especially during active flare-ups.

Dr El Muntasar advises against microneedling and microdermabrasion during flare-ups, as these treatments can cause skin trauma and worsen the condition.

Similarly, Dr Khorana cautions against the use of tanning beds, which, though once considered a psoriasis treatment, are now known to increase the risk of skin cancer.

Professionals should also avoid using overly aggressive exfoliating treatments or chemical peels, which could trigger the Koebner phenomenon, where trauma to the skin can lead to new psoriasis lesions.

Medical treatments for psoriasis

While aesthetic therapists can offer support, psoriasis does sometimes require medical intervention.

Emollients and steroids

Emollients are an important part of psoriasis treatment. Dr El Muntasar explains, “There’s something called the emollient ladder which tells you how thick the emollient is. A lot of these creams are prescribed, not just over-the-counter products.”

Steroids may also be required to reduce inflammation, and there’s a ‘steroid ladder’ to follow based on the severity of the condition.

Dr Zamani explains, "There is no inherent problem with topical steroids in relation to psoriasis. They are a common and effective treatment option when used correctly under medical supervision.

"For moderate to severe psoriasis, other treatments may be more appropriate for long-term management.

"Steroid use for the face or genitalia should be low potency and limited to short-term use due to the risk of skin atrophy."

Phototherapy and other treatments

For more severe cases, clients may need referral to a dermatologist for advanced treatments such as phototherapy, which uses UV light to reduce inflammation.

Dr Khorana notes, “Treatment options include prescribed light treatments (phototherapy), tablets which suppress the immune system, and injections.”

She also highlights a 2020 study where botulinum toxin injections showed improvement in psoriasis symptoms. However, more research is needed in this area, and this treatment may still be in the experimental stage.

Dr Zamani adds, "Therapeutic options include topical treatments, phototherapy or systemic treatment. Second-line therapy includes phototherapy and PUVA.

"Targeted biologics or oral small molecule inhibitors can be used depending on the severity and patient needs. Different treatment modalities can be combined for enhanced efficacy."

Gut health and nutrition in psoriasis

An emerging area of psoriasis management is the role of gut health.

The connection between the gut and skin, often referred to as the gut-skin axis, suggests that gut inflammation can play a role in the development and severity of psoriasis symptoms.

Emma Gould, a registered nutritional therapist specialising in psoriasis, explains, "Nutritional therapy is about finding out where imbalances may be in the body and correcting them with nutrition and lifestyle measures.

“In the case of psoriasis, supporting the gut and liver is key. These organs are heavily involved in skin health, and by improving gut bacteria, digestion and decreasing potential pathogens, we can help alleviate symptoms."

White adds, "The gut can play a role in all inflammatory skin conditions, including psoriasis. Dysbiosis of the gut may increase the risk of psoriasis occurrence and development by influencing the immune system."

She recommends patients incorporate probiotics into their diets and maintain a healthy balance of nutrients to support gut health.

Gould advises professionals to consider recommending a comprehensive stool test to assess their client's gut health. "Test, don’t guess," she says.

Dietary recommendations for psoriasis

Diet can have an impact on psoriasis. Foods that trigger inflammation, such as processed foods, sugary snacks and alcohol, can worsen symptoms, while anti-inflammatory foods can help manage them.

White advises patients to eat a balanced diet rich in lean protein, whole grains, healthy fats and nutrient-dense vegetables.

She suggests that a diet high in omega-3 fatty acids (found in oily fish, like salmon and mackerel) can be particularly beneficial due to their anti-inflammatory properties.

Gould emphasises the importance of eating a varied diet rich in plant-based foods.

"I recommend aiming for around 30 different plants per week," she says, as a diverse diet helps maintain a healthy gut microbiome.

Leafy greens, berries and seeds are particularly beneficial for reducing inflammation.

Both Gould and White agree that while supplements such as omega-3 or multivitamins can be helpful, they should be taken under the guidance of a qualified practitioner. Some supplements can interact with medications or exacerbate symptoms if not used correctly.

How can aesthetics professionals help with psoriasis?

Psoriasis can significantly impact a patient’s physical comfort, emotional wellbeing and skin confidence.

While further medical intervention is sometimes necessary, aesthetic professionals can offer safe, supportive treatments and holistic advice that complement dermatological care.

"Each treatment plan should be personalised to the individual based on severity, location and impact on quality of life," says Dr Zamani.

"It’s important to ensure patients understand the benefits and potential side effects of treatments. Follow-ups are essential to monitor effectiveness and adjust as needed."

As the experts emphasise, effective management involves personalised skincare, lifestyle adjustments and a compassionate, informed approach.

With the right guidance, patients can feel more in control of their condition and achieve healthier, calmer skin.