Depictions of the difficult locations to treat as outlined in the article. THe face, stress, scalp, nails, and foot psoriasis.

The Most Difficult Psoriasis Symptoms to Treat

Psoriasis is a long-term (chronic) skin condition that causes red, itchy, scaly patches on the body. There is no cure, and it comes and goes in cycles called flares. A psoriasis flare can last for weeks or months before going into remission.1

Which areas are the hardest to treat?

Psoriasis mostly affects the torso, arms, and legs. However, health experts are finding that other areas are also commonly affected. These sensitive areas can be harder to treat and may cause serious physical, social, and mental health challenges. Learning about treatment options can help you find relief for your symptoms.2,3


The scalp is one of the most common areas for plaque psoriasis. It affects 50 to 90 percent of all people with the condition at some point. Scalp psoriasis causes dandruff-like scales and painful sores that flare up again and again because of regular hair care like brushing or shampooing. Scratching these lesions can also cause short-term hair loss.3


One in 5 people with plaque psoriasis has it in areas such as the forehead, ears, and cheeks. It causes itching, soreness, and sensitive skin. Many times, psoriasis on the face gets worse with:3

This type of psoriasis is highly visible. Those who have it may feel embarrassed, depressed, and isolated, impacting their daily lives.


Psoriasis of the nail is also easy to spot and can cause embarrassment, especially in social settings. Symptoms include:3

  • Nail pitting
  • White, yellow, or red patches
  • Lines and ridges
  • Scaling and blood spots under the nail

Sometimes nail pain and tenderness make it hard to do everyday tasks like putting on shoes and socks.

Skin folds and genitals

Often called “hidden psoriasis,” genital and skin fold psoriasis can be uncomfortable to talk about with your doctor. Many people with the condition say this form of psoriasis hurts their body image, social and sex lives, personal hygiene, and other everyday activities. Tight-fitting clothing, sex, and bodily fluids may irritate genital sores.3

Hands and feet

Psoriasis on the hands and feet (also called palmoplantar psoriasis) creates red, dry skin and deep, painful cracks on the palms and soles. This type of psoriasis is thought to be the most crippling since it hinders movement, affecting your daily life. Having psoriasis on an easily seen area like the hands can also affect mental health.3

Which treatments work best for difficult-to-treat psoriasis?

Topical medicines (creams and ointments applied to the skin) are standard psoriasis treatments, but they have some drawbacks. They can be sticky, messy to apply, smell bad, and stain clothes and hair. As a result, you may be less likely to stick with treatment. Newer foam products are easier to use, quickly absorb into the skin, and are odorless.3

When choosing a treatment, think about one that will work best for your type of psoriasis:3

  • Scalp psoriasis: You may prefer a shampoo that washes off or a product that sticks to the scalp, like a gel
  • Face and skin folds: Doctors prescribe corticosteroids (drugs that lower inflammation), but they can cause side effects, such as skin thinning
  • Genitals: It is best to use odorless topicals that will not irritate your skin.
  • Nails, hands, and feet: Doctors usually suggest a systemic drug (one that affects your whole body), especially for severe cases. These drugs can also worsen hair loss in people with scalp psoriasis and cause other side effects.

Other remedies like light therapy do not work as well for hard-to-treat psoriasis. Meanwhile, biologics show promise in treating psoriasis of the nails, scalp, hands, and feet. These injectable drugs interrupt the disease by changing your immune system. In people with moderate to severe psoriasis, symptoms get better within weeks.1

If you have questions about which treatment is right for you, talk to your doctor.

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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