Psoriasis (in German "Schuppenflechte") is a chronic inflammatory disease that shows up mainly on the skin: reddened, sharply demarcated patches of skin with silvery-white scales. The disease is not contagious. It is based on a misregulation of the immune system that leads to an accelerated renewal of skin cells.¹
In Germany, an estimated more than two million people are affected. Psoriasis can occur at any age; it often first appears between the ages of 15 and 35 or after the age of 50. The disease usually runs in flares — phases with more pronounced skin changes alternate with phases of fewer symptoms.¹,²
More than a skin disease
Psoriasis is often associated with accompanying conditions — in particular psoriatic arthritis (joint involvement), cardiovascular disease and psychological strain. Modern therapies can make the skin largely clear in many of those affected.¹
2. Forms
Psoriasis vulgaris (plaque psoriasis): the most common form. Typical sharply demarcated, raised, reddish plaques with silvery-white scaling. Preferred sites: elbows, knees, scalp, lower back, navel.
Guttate psoriasis: many small, drop-shaped lesions on the trunk and limbs. Often appears after infections (especially streptococcal sore throat), particularly in children and adolescents.
Nail psoriasis: affects the fingernails and/or toenails — pitting, oil spots, onychodystrophy. Can occur in isolation or together with skin psoriasis.
Psoriatic arthritis (PsA): inflammatory joint involvement that occurs in a relevant share of those affected by psoriasis. Joint pain, swelling, morning stiffness. Without timely treatment it can lead to joint damage. Often co-managed by rheumatology.
Sharply demarcated, raised, reddish patches of skin (plaques) with silvery-white scaling
Itching — for many of those affected the most distressing symptom
Koebner phenomenon — new lesions can appear at mechanically irritated areas of skin (e.g. scratches, sunburn, surgical scars)
Nail changes — pitting, discolouration, thickening
Scalp involvement — common, can be mistaken for dandruff
Joint pain and swelling — a sign of psoriatic arthritis
Psychological strain — shame, social withdrawal, depression
4. Causes and triggers
Psoriasis is an autoimmune disease with a genetic predisposition. The immune system triggers an excessive inflammatory reaction in the skin.¹
Genetics: familial clustering is known. Several genes are involved (including HLA-Cw6). However, psoriasis is not a classic hereditary disease — not everyone with a genetic predisposition develops it.
Immune system: T cells and certain inflammatory messengers (especially TNF-alpha, IL-17, IL-23) play a key role. Modern biologics act precisely here.
Depression and anxiety disorders — through stigmatization, itching and chronic strain
Chronic inflammatory bowel disease — Crohn's disease occurs more frequently in those affected by psoriasis
6. Diagnosis
The diagnosis is usually made clinically — the typical appearance is mostly unmistakable. In addition, the following can be used.¹
Skin biopsy: in unclear cases for histological confirmation.
Severity assessment:PASI (Psoriasis Area and Severity Index) and DLQI (Dermatology Life Quality Index) are recommended in the guideline to assess the severity and the impairment of quality of life.
Joint evaluation: with joint symptoms, psoriatic arthritis should be evaluated (rheumatology).
Screening for associated conditions: blood pressure, blood sugar, blood lipids, liver values — regularly, especially before and during systemic therapy.
For mild to moderate psoriasis, topical therapies (creams, ointments) and light therapy are at the forefront.¹
Topical corticosteroids
The most frequently used topical medications. They work quickly and effectively against inflammation and scaling. They should usually not be applied to the same area continuously (risk of skin atrophy).
Vitamin D analogues (e.g. calcipotriol)
Often combined with topical corticosteroids. Good for maintenance therapy.
Calcineurin inhibitors (tacrolimus, pimecrolimus)
For sensitive areas (face, skin folds, genital area) — no risk of skin atrophy.
UV light therapy (phototherapy)
Narrowband UVB or PUVA. Usually carried out in the dermatology practice. Effective for extensive psoriasis.
8. Treatment: systemic therapy and biologics
For moderate to severe psoriasis — or when topical therapy is not enough — systemic therapy is recommended. The current S3 guideline (DDG, version 8.0, July 2025, AWMF 013-001) defines largely clear skin as the treatment goal to aim for.¹,³
ConventionalClassic systemic therapy
Methotrexate (MTX)
One of the longest-used systemic agents. Usually taken or injected once a week. Also effective for psoriatic arthritis. Regular laboratory checks (blood count, liver values) necessary. More: Methotrexate.
Fumaric acid esters
Long established in Germany. Common side effect: gastrointestinal complaints, especially at the start.
Ciclosporin
Works quickly but is usually used only for a limited time (kidney function, blood pressure).
Acitretin
A retinoid (vitamin A derivative). Used less often, can be useful for certain forms of psoriasis.
Biologics are biotechnologically produced medications that specifically block certain inflammatory messengers. They have fundamentally changed the treatment of psoriasis in recent years.¹,³
Anti-TNF: adalimumab, infliximab, certolizumab
Inhibit the inflammatory messenger TNF-alpha. Long established. Biosimilars available.
Anti-IL-17: secukinumab, ixekizumab, bimekizumab
Inhibit interleukin-17, a key inflammatory messenger in psoriasis. High efficacy. Bimekizumab (new in the 2025 guideline) additionally inhibits IL-17F.³
Inhibit interleukin-23. Advantage: longer injection intervals (in some cases only every few weeks or months).
Anti-IL-12/23: ustekinumab
Inhibits interleukin-12 and 23. Long established.
New 2025Small molecules (oral)
Apremilast (PDE4 inhibitor)
A PDE4 inhibitor as a tablet. More moderate efficacy than biologics, but taken orally.
Deucravacitinib (TYK2 inhibitor)
A TYK2 inhibitor as a tablet. New in the 2025 guideline. It specifically inhibits tyrosine kinase 2 and thereby differs from the classic JAK inhibitors.³
No one has to live with severe psoriasis today
The treatment of psoriasis has fundamentally improved in recent years. If the current treatment is not working satisfactorily, it is usually worth talking to dermatology about modern alternatives.
9. Everyday life with psoriasis
Skin care: regular emollient basic care — even during clear phases. Often the single most important measure in everyday life.
Avoid triggers: stress, alcohol, smoking and excess weight can promote flares. A healthy lifestyle can have a positive effect on the course.
Medications: regular and punctual intake/application. With biologics: observe the cold chain, keep to injection appointments. More: Medications when travelling.
Psychological strain: visible skin changes, itching and stigmatization can considerably impair quality of life. Psychological support and self-help groups (in Germany, Deutscher Psoriasis Bund e. V.) can help.
Joint symptoms: with new joint pain or swelling, psoriatic arthritis should be evaluated — early treatment can prevent joint damage.
How brite helps you with psoriasis
MTX once a week (always the same day), the biologic every few weeks with the cold chain, plus daily emollient basic care — psoriasis treatment has a clear rhythm. brite helps you keep it and not mix anything up.
Medication reminder — MTX weekly (a day error can be dangerous), biologic injection appointments every few weeks, fumaric acid ester dose escalation over weeks, apremilast or deucravacitinib daily: brite reminds you on time about every component. Set up a reminder
Interaction check — MTX plus NSAIDs (kidney risk)? MTX plus trimethoprim/co-trimoxazole (can raise levels)? Biologics plus a live vaccine (contraindicated)? Recognize trigger medications (beta blockers, lithium, ACE inhibitors)? brite shows the critical combinations. Check now
Health history — document the skin picture, PASI values from your practice appointments, flares, joint symptoms and quality of life (DLQI) over time. At your next dermatology appointment, show objectively how the treatment is really working. Track your history
Digital medication plan — all your medications clearly laid out for dermatology, rheumatology (with PsA) and your family doctor. Important before operations or vaccinations: biologics and MTX have to be taken into account. Go to medication plan
No. Psoriasis is an autoimmune disease and is not transmissible — neither by touch nor by sharing towels or the like.
Biologics are biotechnologically produced medications that specifically block certain inflammatory messengers (TNF-alpha, IL-17, IL-23). They are usually given as an injection or infusion and can achieve largely clear skin in many of those affected.¹,³
Not according to current knowledge. Psoriasis is a chronic disease. With modern therapies, however, the symptoms can be largely controlled in many of those affected — the treatment goal is the greatest possible clearance of the skin.¹
An inflammatory joint involvement that occurs in a relevant share of those affected by psoriasis. Symptoms: joint pain, swelling, morning stiffness. Without timely treatment, joint damage can develop. It is usually co-managed by rheumatology.
Not necessarily — but psoriasis is a chronic disease, and after stopping there are often relapses. The decision about the duration of treatment is made individually with dermatology.
Stress does not cause psoriasis, but it can trigger or intensify flares. Stress management (relaxation techniques, exercise, psychotherapy) can have a positive effect on the course.
Regular emollient skin care, avoiding triggers (stress, alcohol, smoking), a healthy diet, regular exercise and weight control. With excess weight, weight loss can improve the course.
Usually yes — when there is an indication and conventional therapies are not sufficiently effective or are not tolerated. The exact requirements are set by the guideline; the prescription is issued by dermatology.
Medical disclaimer: This article is for general information and does not replace medical advice, diagnosis or treatment. Psoriasis medications (especially systemic therapies and biologics) require regular medical monitoring. The choice of treatment is always determined individually by the treating dermatology. Last updated: April 2026.
