Does Psoriasis Raise Your Risk of Skin Infections?

Here’s what you should know about psoriasis and skin infections — including what to look out for, how skin infections are treated, and how to help prevent them.

Having psoriasis may increase your risk for skin infections in a few different ways, related to effects from the psoriasis itself as well as certain treatments for it.

Breaks in the Skin Barrier Caused by Psoriasis

“In psoriasis patients, if skin is inflamed or broken, it may be more prone to becoming infected,” says Melvin Chiu, MD, a dermatologist at Keck Medicine of USC in Los Angeles. This can be the case with any form of psoriasis that causes skin breakage.

A type of psoriasis called inverse psoriasis — which mainly affects skin folds in areas like your armpits, breasts, or buttocks — is more likely than other psoriasis types to be linked to skin infections, says Matt Lewis, MD, MPH, a dermatologist at Stanford Medicine in Redwood City, California. “We do look for that a lot, we swab it to check” for infections when symptoms suggest that possibility, he says.

Effects of Psoriasis on the Immune System

But the immune response seen in psoriasis isn’t known to broadly increase the risk for skin infections — in fact, it’s likely that the opposite is true. “The type of inflammation that’s present in psoriasis is actually very good at killing bacteria,” says Dr. Lewis.

Psoriasis Treatments

Both topical steroids and systemic treatments for psoriasis may increase your risk for a skin infection.

“Topical steroids can increase the risk of yeast infections, which is a type of fungus,” says Lewis. “But we tend not to see yeast infections in any part of the body except the folded areas,” so topical steroids are mostly linked to these infections in people with inverse psoriasis.

Systemic treatments for psoriasis — particularly biologic drugs that are injected or infused — work by blocking parts of the immune system involved in psoriasis flares. “Blocking parts of the immune system can make someone more susceptible to all sorts of infections, including skin infections,” says Dr. Chiu.

People with psoriasis can develop any type of skin infection, but certain types are seen more often than others. Skin infections can be caused by bacteria, fungi, or viruses.

“Bacterial infections are some of the most common, which can include pimple-like hair follicle infections or even potentially severe and progressive skin infections” such as cellulitis, says Chiu.

Commonly seen skin infections in people with psoriasis include:

• Cellulitis This type of bacterial infection affects the skin and tissues underneath, causing swelling and pain. Cellulitis tends to occur in areas where the skin is damaged, and can range from relatively mild to severe and life-threatening.

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• Shingles (Herpes Zoster) This type of viral infection causes a painful rash, typically on one side of your torso. Shingles is caused by the same virus that causes chickenpox, which becomes reactivated years later.

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• Ringworm (Tinea) This type of fungal infection can cause a red or dark ring-shaped rash on many different areas of your body — including your feet, groin, scalp, face, or hands. Ringworm is spread through skin-to-skin contact or by touching objects or surfaces an infected person has touched.

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• Oral Thrush (Oral Candida) This type of yeast (fungal) infection in your mouth causes white patches on your tongue or inner cheeks, which can spread to other areas of your mouth and throat. Thrush is more likely to occur in people who take medications that weaken their immune system, including for psoriasis.

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It’s a good idea to see your doctor if you notice any new skin symptoms, even if you’re not sure if these symptoms are signs of an infection. That's especially true if you experience itching or pain, and if your regular psoriasis treatments aren’t helping, says Chiu.

Since you’ll probably already have a dermatologist for your psoriasis, it’s a good idea to visit your regular dermatologist. For suspected infections, “The main thing to do is swab the area, and dermatology offices have those materials,” says Lewis. A skin swab collects pus or other material that can be tested to determine whether there’s an infection and what’s causing it.

• Redness, warmth, or swelling
• Pain or itching
• Visible lesions or rashes
• Fluid-filled blisters or bumps
• Fever, chills, or fatigue

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In most cases, treatment for a skin infection in a person with psoriasis won’t be any different than in someone without psoriasis.

“For most local infections, a topical therapy is totally adequate,” and will involve an antifungal or antibiotic cream or ointment, says Lewis. Treating a fungal skin infection early is important to limit its severity and extent, he says.

If you’re seeing a doctor other than your regular dermatologist, be sure to mention your psoriasis and any treatments you take for it, “So any medication your doctor recommends to treat your infection doesn’t interact with your psoriasis medications,” says Chiu.

For severe bacterial skin infections — including some cases of cellulitis — topical treatments won’t be enough. “If they have fever, chills, or redness spreading up their arm or leg from a bacterial infection, they would need oral or IV antibiotics,” says Lewis.

While it isn’t always possible to prevent skin infections, there are steps that people with psoriasis can take to reduce this risk.

“To prevent skin infections, people with psoriasis should wash their hands regularly with soap and water, avoid scratching or picking at their skin, and avoid sharing personal items such as towels or clothes,” says Chiu. These steps are especially important if your psoriasis treatment includes a biologic drug that increases your infection risk.

Keeping your psoriasis well controlled can also help limit your skin infection risk. If your psoriasis itches, “Scratching it can introduce an infection through the fingers,” says Lewis. “So by controlling the psoriasis, you’re less likely to scratch.”

• Having psoriasis can raise your risk of skin infections, particularly if your skin is broken or inflamed.
• Certain drugs used to treat psoriasis, including topical steroids and some biologic drugs, raise the risk of developing a skin infection.
• Practicing good hygiene, such as regular handwashing and avoiding sharing personal items, can help reduce the risk of skin infections when managing psoriasis, especially if your treatment plan includes immunosuppressive medications.
• If you experience signs of an infection such as redness, swelling, or fever, see your doctor promptly for diagnosis and treatment.