Key takeaways about plaque psoriasis
• Plaque psoriasis causes itchy, painful plaques to form on the skin surface.
• Plaque psoriasis is a chronic, systemic inflammatory disease associated with a variety of comorbidities, such as obesity and cardiovascular disease.
• Getting a diagnosis of plaque psoriasis can take years, as not all healthcare professionals recognize its signs and symptoms.
• Having plaque psoriasis can lead to anxiety and depression, especially if the plaques are in highly visible areas like the hands, face and scalp.
• Many patients with plaque psoriasis are not receiving therapies that are helping them achieve their treatment goals.
• Johnson & Johnson has developed novel therapies for plaque psoriasis that target the underlying immune-system dysfunction causing the disease.
Barbra Bohannan was an active and healthy 5-year-old when large regions of her skin suddenly became painfully inflamed and itchy.
Her family doctor wasn’t sure what caused the skin lesions, but he offered her various topical ointments and creams to try to clear them. Nothing worked.
When her symptoms were at their worst, Bohannan remembers “feeling like my skin was a couple of sizes too small for my body.”
Other kids teased her about her flaky scalp, saying she was dirty and needed to wash her hair more. They joked that her “weird” fingers were due to a fungus.
“I was really ashamed,” says Bohannan, who lives in Sweden. She tried to pretend she was fine, but the plaques continued to appear, and they itched so much she often scratched her skin raw.
She was finally diagnosed with plaque psoriasis (PsO) at 12 years old and could finally begin the journey toward getting her disease under control.
What is plaque psoriasis?
Plaque psoriasis is a chronic disease caused by an overactive immune system, leading to accelerated replication of skin cells and the development of raised, inflamed, scaly plaques.
On lighter skin tones, plaques of psoriasis tend to be red with silver-white scales, while on skin of color, the plaques may appear more purple, gray or dark brown.
It is estimated that 8 million Americans and more than 125 million people worldwide live with the disease. Nearly one-quarter of all people with plaque psoriasis have cases that are considered moderate to severe.
Psoriasis plaques can develop anywhere on the body, including highly visible or sensitive areas like the face, scalp, hands, feet, skin folds and genitals, and psoriasis can also involve fingernails and toenails.
Plaque psoriasis currently has no cure. While a variety of highly effective therapies exist for achieving clear skin and improving patients’ quality of life, unmet needs remain, particularly for a highly effective orally administered therapy.
Here are five things we now know about plaque psoriasis, including how Johnson & Johnson continues to innovate to create advanced therapies that target the underlying causes of the disease.
1.
“Some people think of psoriasis as only a skin disease because that’s where its signs and symptoms are most prominently displayed,” says Steve Fakharzadeh, M.D., Ph.D., Senior Global Medical Affairs Leader, Dermatology, at Johnson & Johnson. “But it’s actually a whole-body inflammatory disease.”
One-third of people with psoriasis, including Bohannan, also develop psoriatic arthritis, a chronic immune-mediated disease that causes inflammation in and around the joints and can lead to permanent, irreversible structural damage to joints.
Bohannan wasn’t diagnosed with psoriatic arthritis until after the birth of her first child, when she experienced a full-body flare of psoriasis and debilitating joint pain. Tests done by a rheumatologist confirmed her diagnosis of psoriatic arthritis.
Psoriatic inflammation can have a ripple effect on other body systems.
“Psoriatic arthritis can result in structural changes in a patient’s joints, limit physical function and cause permanent disability,” says Dr. Fakharzadeh. “Psoriatic disease can also raise one’s risk of heart attack and stroke, as well as metabolic syndrome, obesity and diabetes. A variety of systemic considerations stem from the common drivers of inflammation in these conditions.”
2.
Dermatologists consider plaque psoriasis “a doorway diagnosis,” says Dr. Fakharzadeh. “They can see a patient across the exam room and typically know from the doorway if they have psoriasis because of the red, scaly plaques on their skin.”
But not all healthcare providers are experts on skin disorders. If a provider isn’t familiar with plaque psoriasis, he or she may misdiagnose it as eczema or a fungal infection, for example.
As a child, Bohannan remembers being told that her skin plaques were “maybe atopic dermatitis, maybe psoriasis, maybe something else.”
Misdiagnoses can leave a patient “wandering from provider to provider” for answers, says Dr. Fakharzadeh. “The patient journey can be quite complex. It may take years before someone gets a correct diagnosis.”
Bohannan felt relief when she finally learned that she had plaque psoriasis. “At least I knew what I had to deal with,” she says.
3.
The thick, scaly plaques of psoriasis patients experience may also shed flakes and bleed. “That can be very off-putting and isolating for patients,” says Dr. Fakharzadeh. “Others may think, ‘Are these people contagious? Can I catch this?’”
The answer is no. Plaque psoriasis is not a communicable disease. But the stigma of having visible plaques can put a huge dent in a person’s self-perception and mental health, leaving them not wanting to socialize or always scanning a room for people’s reactions to their skin.
“As with other skin diseases, plaque psoriasis can cause people to feel abnormal and like they don’t fit in,” says Dr. Fakharzadeh.
Social isolation and low self-esteem can fuel anxiety. And the systemic inflammation that causes psoriasis may also be linked to depression, a common comorbidity associated with psoriasis.
“I always get incredibly depressed before a flare,” says Bohannan. “I wake up feeling like I’m being swallowed by a black hole.”
That can be hard to explain to others. “People think, ‘Oh, of course you’re depressed because of the way you look,’” explains Bohannan. “But there’s more to it than that.”
New research shows that psoriasis in “high impact” areas—defined as the scalp, hands, feet, fingernails, genitals and skin folds—can have a greater effect than psoriasis on lower-impact areas when it comes to quality of life, and is associated with social isolation and depression.
In conjunction with this, the International Psoriasis Council recently changed its criteria for characterizing disease severity to account for and prioritize psoriasis involving high-impact areas, even if covering just a small amount of body surface area.
4.
Options for treating psoriasis have increased in recent years, but finding the right therapy may be a challenge. No one medication may work the same for everyone, so patients often try various kinds of treatments.
Topical medications are commonly used as the first line of therapy for psoriasis. However, patients may often experience ‘‘topical churn,” or cycling through multiple creams and ointments without fully bringing signs and symptoms under control.
Further, traditional systemic therapies for psoriasis may be used in more moderate to severe psoriasis. However, efficacy may be limited and/or potential side effects leading to damage to internal organs, such as the liver, lungs and kidneys, may limit long-term use of these therapies.
Newer biologic therapies are administered by injection directly into the skin, “but a lot of patients don’t want or like needles,” says Dr. Fakharzadeh. In fact, just over half of adult psoriasis patients who are eligible for systemic therapy would prefer an oral treatment over topicals or injectables, according to research presented in 2025 at the Fall Clinical Dermatology Conference.
Over the years, Bohannan has tried multiple therapies to manage her psoriasis. Most treatments, however, only helped temporarily—a common frustration that psoriasis patients face.
Can we put the disease into long-term remission? Many researchers believe this can be done.
5.
Johnson & Johnson has a long history of developing innovative therapies for immune-mediated diseases, including plaque psoriasis.
As novel therapies that target the underlying immune-system drivers of plaque psoriasis continue to advance, expectations for treatment outcomes are changing. Dr. Fakharzadeh says a realistic goal for people who live with the disease today is not just better skin but completely clear skin.
“So what are the future goals?” asks Dr. Fakharzadeh. “Can we put the disease into long-term remission? Many researchers believe this can be done.”
When training to become a dermatologist 30 years ago, Dr. Fakharzadeh remembers that the options to treat plaque psoriasis were much more limited in terms of efficacy, safety and convenience.
“To go from there to here in 30 years is remarkable,” he says. “It’s been quite a journey so far, and it’s not over yet.”
