Family Doctor logo

Will the psoriasis come back?

Psoriasis tends to be a chronic condition that comes and goes. There may be long gaps when you have little or no skin problems at all. The best outlook seems to be after an episode of guttate psoriasis following streptococcal tonsillitis. A short course of UVB phototherapy with or without vitamin D ana­logues will often lead to remission that lasts for many years.
The pattern with typical plaque psoriasis is much more variable. The treatments most likely to induce a remission, rather than just suppress the psoriasis, are dithranol, UVB phototherapy and PUVA. With other treatments, psoriasis tends to return quite quickly. Topical corticoster­oids and vitamin D analogues, for example, may suppress your psoriasis but are unlikely to induce a lasting remission.
In some people, after their psoriasis has been completely cleared they have many months or even years free from symptoms; in others, their psoriasis returns almost immediately and needs another course of treatment. If their psoriasis is severe enough, these people tend to require continuous systemic treatment such as methotrexate, hydroxyurea, retinoids or ciclosporin A. In one study, three out of 260 patients were clear of their psoriasis for more than five years after successful treatment, but most patients were not clear for more than six months.
Usually, the same treatment that previously caused the remission will do so again. But, sometimes, treatments lose their efficacy after several courses. This is particularly common with the Ingram regimen using dithranol and UVB photother­apy. The Ingram regimen can work well for many years giving remis­sions of several months, then either it suddenly stops clearing a patient or the remission becomes increas­ingly short, indicating that systemic treatment should be started.