Psoriasis is a chronic, hereditary immune disease where T cells in the skin are wrongly activated and set off an inflammation that makes the skin cells divide ten times faster than normal: the skin doesn't have time to mature and shed, but piles up in thick, scaly plaques with dilated vessels beneath (hence the redness, and hence the small bleeding points if you pick off the scales). The same inflammation can affect joints and tendon attachments (psoriatic arthritis in one in three), eyes, vessels (increased risk of cardiovascular disease) and mood (depression is more common). About one in three has a parent or sibling with psoriasis; onset is most common in the 20s and around 55. What triggers flares in those with the predisposition: streptococcal throat infection (often gives guttate psoriasis, small drop-shaped patches all over the body), stress, alcohol, smoking, overweight, certain medicines (beta-blockers, lithium, antimalarials, anti-inflammatories, rapid tapering of steroid tablets), cold and dry air in winter, and mechanical skin injury: wounds, grazes, sunburn, tattoos, scratching, friction from clothes, and, relevant here, hard massage and cupping, which can produce a new patch exactly where the skin was irritated (the Koebner phenomenon, which affects about one in four). Psoriasis is not contagious, is not caused by hygiene or diet, and can't be cured, but it can be treated so well that most can become almost completely clear, and it should be treated for more reasons than the skin.
The types, and how psoriasis differs from what resembles it
| Type | Where and how | Share |
|---|---|---|
| Plaque psoriasis (vulgaris) | Well-defined red plaques with silvery-white scales on elbows, knees, lower back, scalp, navel; symmetrical; itches in half | 8 in 10 |
| Scalp psoriasis | Thick scales and redness in the scalp, often over the hairline, behind the ears and on the neck; confused with dandruff and seborrhoeic dermatitis (which is thinner, yellower and greasier) | Half of all with psoriasis |
| Nail psoriasis | Pits in the nails, yellow-brown "oil spots", thickening, nail lifting from the bed; confused with nail fungus | Half; strongly linked to psoriatic arthritis |
| Guttate psoriasis | Hundreds of small drop-shaped patches over trunk and arms, often two weeks after tonsillitis in young people; can clear by itself | 1 in 10, mostly young |
| Inverse psoriasis | Smooth, red, shiny patches without scales in skin folds: armpits, groins, under the breasts, the buttock cleft; confused with fungus | More common with overweight |
| Pustular psoriasis | Pustules on palms and soles (localised) or over the whole body with fever (generalised, acute) | Uncommon; generalised is an emergency |
| Psoriatic arthritis | Swollen, stiff joints (fingers, toes like "sausages", knees, back), tender tendon attachments (heel, elbow), morning stiffness over 30 minutes; can come before the skin | 1 in 3 with skin psoriasis |
Eczema sits in the creases, is more vaguely defined, itches more and scales more thinly; fungus in skin folds is often one-sided with an active edge and responds to antifungals; seborrhoeic dermatitis in the scalp is thinner and yellowish. A dermatologist makes the diagnosis on appearance, sometimes with a skin biopsy. Seek care for diagnosis and treatment with suspected psoriasis; soon with swollen or stiff joints, tender heels or "sausage fingers" (arthritis should be treated early to avoid joint damage); urgently with widespread redness over the whole body with fever and chills or spreading pustules.
Treatment that works, step by step
- Emollients daily on the whole body, preferably with urea 5–10% or salicylic acid 2–5% on thick plaques (dissolves the scales so the treatment reaches the skin). The foundation at all stages.
- Topical treatment for limited psoriasis: the combination steroid + vitamin D analogue (calcipotriol/betamethasone as gel, ointment or foam) once a day for four weeks, then twice a week as maintenance, is first choice and well tolerated; calcineurin inhibitors on the face and in skin folds; tar and dithranol in individual cases. Steroid tablets should be avoided in psoriasis: they cause severe flares when stopped.
- Scalp: soften the scales overnight with salicylic acid in oil or a descaling treatment, wash out with tar or mild shampoo, and treat with steroid solution, foam or calcipotriol/betamethasone gel in the scalp twice a week as maintenance. Don't pick off the scales, comb gently.
- Light treatment (UVB) at a skin clinic two to three times a week for eight to twelve weeks for widespread psoriasis; a sunny holiday helps many, but sunburn triggers.
- Systemic treatment for moderate to severe psoriasis or psoriatic arthritis: methotrexate (first choice, once a week), apremilast, ciclosporin, acitretin, and the biologics (TNF, IL-17, IL-23 inhibitors) which give 80–100 per cent clear skin in most and treat the joints at the same time. They are expensive but subsidised and given via a skin clinic; anyone with moderate psoriasis that affects life should ask for a referral.
- Treat the rest: blood pressure, blood lipids, blood sugar and weight (psoriasis doubles the risk of heart attack in severe disease), depression and anxiety (common, treatable), and joints via a rheumatologist.
Self-care and triggers
- Alcohol and smoking are the strongest lifestyle factors: both worsen it and make treatment less effective; stopping smoking and moderate drinking give fewer flares.
- Weight: five to ten per cent weight loss with overweight reduces psoriasis measurably and improves the response to biologics.
- Stress and sleep: flares often follow a stressful period with a few weeks' delay; sleep, movement, relaxation and, when needed, counselling are treatment. See stress.
- Infections: treat tonsillitis, and mention psoriasis when you get new medicines (beta-blockers, lithium, NSAIDs and antimalarials can worsen it).
- The skin: lukewarm showers, fragrance-free, emollient straight after, cotton next to the skin, don't scratch or pick at plaques (Koebner), sun protection against burning but moderate sun is welcome, bath salts and sea bathing relieve in many.
- Diet: no specific diet cures; a Mediterranean diet and less sugar reduce inflammation and weight; gluten-free only with proven coeliac disease (more common with psoriasis, ask for a test with gut symptoms). Omega-3 has weak support. Vitamin D if deficient.
- Joints: movement and strength training adapted to the joints; heat in the morning for stiffness; see rheumatism and joint pain.
Massage, oil and cupping with psoriasis: the rules
Psoriasis skin responds to mechanical irritation with new plaques (the Koebner phenomenon), and that is the rule that governs everything here. Oil: emollient fragrance-free oil (mineral oil, paraffin, jojoba, almond) on damp skin after showering is good for the dryness and scales, and salicylic acid in oil overnight under a shower cap is classic descaling for the scalp; avoid essential oils and fragrance (contact allergy is more common on inflamed skin) and tea tree products marketed for psoriasis. Massage: on healthy skin, by all means, and especially as stress management: regular massage lowers stress hormones and improves sleep, and those are two of the most important flare factors. Over plaques: light application without pressure, never rubbing, never with knuckles or tools, and never so that scales are torn off. Cupping: never over plaques or within a hand's width of them, never over recently healed spots (the skin there is thin and Koebner-prone for weeks), not at all during a spreading flare or with guttate psoriasis (new patches appear anywhere), not over skin folds with inverse psoriasis, and not on a joint with active psoriatic arthritis. With stable, well-treated psoriasis with occasional plaques it is fine to cup healthy skin on back, buttocks, thighs and calves with light suction and plenty of oil, and it can be valuable for the muscles around stiff joints in psoriatic arthritis between flares and for the stress that drives the disease; start on a small area, look at the skin after two days (Koebner patches come after one to two weeks, so evaluate after two weeks before expanding), and stop if a new patch appears where the cup has been. Strong suction, fast strokes and dry skin are what damage; light, slow and oily is what works. Face cupping with psoriasis on the face or hairline: no. This is also in when to avoid cupping. More on the skin in eczema and massage oil.
Read more
Eczema in adults, rheumatism and joint pain, rosacea, scalp massage, stress, inflammation in the body, massage oil and when to avoid cupping.
Frequently asked questions
What does psoriasis look like?
Well-defined red patches with silvery-white scales on elbows, knees, lower back and scalp, often symmetrical; pitted, thickened nails; small drop-shaped patches over the body after tonsillitis (guttate); or smooth red patches without scales in skin folds (inverse). One in three also gets swollen, stiff joints or tender heels (psoriatic arthritis). Eczema sits in the creases, itches more and is more vaguely defined; fungus in skin folds is one-sided with an active edge. A dermatologist makes the diagnosis.
What triggers psoriasis?
Tonsillitis and other infections, stress, alcohol, smoking, overweight, certain medicines (beta-blockers, lithium, anti-inflammatories, antimalarials, rapid tapering of steroid tablets), cold and dry winter air, and mechanical skin injury: wounds, sunburn, tattoos, scratching, friction, hard massage and cupping, which can produce a new patch where the skin was irritated (the Koebner phenomenon). Find your own triggers with a diary.
Which treatment helps psoriasis?
Emollients daily; for limited psoriasis steroid + vitamin D analogue once a day for four weeks, then twice a week; the scalp is descaled with salicylic acid in oil and treated with solution or gel; light treatment for widespread psoriasis; and for moderate to severe disease or joint involvement methotrexate or biologics via a skin clinic, which give almost completely clear skin in most. Steroid tablets should be avoided. Also treat blood pressure, weight, mood and joints.
Does oil help psoriasis?
Fragrance-free emollient oil on damp skin relieves dryness and scales and helps the treatment reach the skin; salicylic acid in oil overnight softens scalp scales. Oil doesn't cure psoriasis and doesn't replace treatment. Avoid essential oils, fragrance and tea tree products: contact allergy is more common on inflamed skin. Apply without rubbing; scales shouldn't be torn off.
Can you cup if you have psoriasis?
Never over plaques or within a hand's width, never over recently healed spots, not during a spreading flare or with guttate psoriasis, not in skin folds with inverse psoriasis and not on joints with active arthritis: mechanical irritation can cause new patches (Koebner). With stable, well-treated psoriasis it is fine to cup healthy skin on back, buttocks, thighs and calves with light suction and plenty of oil; test a small area, evaluate after two weeks, and stop if a new patch appears where the cup has been. Face cupping with psoriasis on the face: no.
Related guides
Written by Curam. Last updated 17 October 2026. This is general self-care information and does not replace medical care. For sudden, severe or unusual symptoms, contact your doctor. Talk to your doctor before cupping if you are pregnant, take blood thinners or have a condition affecting skin, blood vessels or blood.
