The very first time I managed to completely clear my psoriasis I was in my mid twenties. A combination of prescription steroid creams and time spent in the sun temporarily did the trick. As the redness and inflammation faded and my flaky plaques disappeared, I was left with another problem, one I affectionately called my 'dalmation spots'.
In truth, I was so happy to be free of those bright red, irritated patches, the little white scars left behind just didn't bother me too much. Over the summer they seemed to grow increasingly white, whilst the skin all around them tanned. Then eventually, as I'd stopped the steroid creams and winter crept back in, so did my psoriasis. If anything, I craved seeing those little white spots again.
When I eventually permanently healed my psoriasis seven years ago, those little white dots also had chance to heal. It took time and there are days when I still notice them now. One on the back of my left hand, one on the inside of my right elbow - they tend to return when the rest of my skin gets more tanned - but they honestly don't bother me. For me, they're an important reminder of the battle I fought and won!
What Are Psoriasis Scars?
Psoriasis scars look different for everyone. For those of us with paler, white complexions, they often appear whiter than the skin around them. For those with a darker brown skin tone, psoriasis scars can sometimes manifest as hyperpigmentation - that is, they look even darker than the skin surrounding them.
Whatever your scars look like, there are a couple of important things to remember when it comes to pigmentation. Firstly, the fact that you've got rid of those inflamed, red patches of psoriasis is something to celebrate! We often forget to look at how far we've come and only focus on the negatives. It's important to realise you've come a long, long way to achieve clear skin. Be proud of yourself.
Secondly, both hypopigmentation (white patches) and hyperpigmentation (dark patches) can be treated, but the most crucial factor here is time. It's going to take time for melanin to return evenly to all areas of your skin. Skin tone can eventually even out, but it's vital to be patient. There are however some home remedies that I'll list below, backed by scientific studies, which support their impact on pigmentation.
White scars, or 'hypopigmented' scars, are due to a loss of something called 'melanocytes'. Melanocytes are melanin-producing cells that are located in the bottom layer of our skin's epidermis. They're responsible for melanin production, which gives our skin its colour pigment.
You might notice hypopigmented scars on knees and elbows from when you scraped yourself as a child. These areas of skin can appear considerably lighter than surrounding cells. There are medical treatment options available to reduce the appearance of white scars, but they're all pretty intense and certainly not 100% reliable. Scar excision, laser treatment, phototherapy and medical tattooing, tend to fall short of reliably restoring colour to closely match surrounding skin.
The above pictures are featured in my book Radiant. They demonstrate how it's possible for hypopigmentation patches to heal naturally by themselves given time.
Use a Strong Sunblock
It might be tempting to jump straight under the sun's UV rays to try to encourage melanin to return to white patches of skin, but what usually happens is that skin around these little white dots darkens, whilst the patches themselves appear whiter.
Using a factor 30 or even factor 45 sunblock can help to ensure skin around the affected patches doesn't turn even darker! Green People and Jason are both fantastic natural brands.
Gently massaging a light exfoliant into hypopigmented skin patches can encourage blood flow to the skin's surface, promoting an even skin tone.
Making your own using fine Dead Sea Salts or Coffee Grounds is a great way to ensure your treatment contains nothing but natural ingredients. Check out some ideas for natural body scrubs here.
Remember if skin is still cut or damaged, applying salts and essential oils might not be a good idea.
Massage in a Natural Scar Treatment Oil
Using a natural Scar Treatment Oil such as this one can help encourage cells to grow back smoothly evenly. For the best results apply at least twice a day.
When it comes to darker skin tones, the patches left behind once psoriasis has healed can be significantly more noticable. In some cases, where skin pigment is missing, the skin's appearance can be similar to that of a vitiligo patient (hypopigmentation). In cases where healed areas turn darker, skin can appear patchy or bruised (hyperpigmentation).
In my experience chatting with psoriasis patients, hyperpigmentation patches can be just as troublesome for some as the original skin condition they were treating. Some people turn to bleaching creams to try to achieve an even skin tone. As desperate as it can feel to want an even complexion, these creams can be dangerous and I wouldn't recommend them. There are however several science backed options for treating hyperpigmentation at home.
According to this 2012 study, aloe vera contains something called aloin, a natural depigmenting compound that has been shown to lighten skin. I would recommend applying a pure aloe vera gel each night before bed. Search out a brand like this one which doesn't contain a ton of ingredients. The purer the better.
Research shows that green tea may offer a depigmenting effect when applied to hyperpigmented areas of skin.
Making a soothing green tea compress is a fantastic option for treating both rosacea and hyperpigmentation. Brew a pot of green tea using organic tea bags or loose leaf tea. Allow to cool, then add to a bowl along with a handful of ice cubes. Soak a flannel in the cooled solution and apply to affected areas.
Alternatively, you might like to apply the tea bags themselves directly to particularly dark patches.
Liquorice Extract contains active compounds that have been shown to lighten hyperpigmentation. This tincture can be taken orally or applied directly to hyperpigmented skin patches. Liquorice is also very good at reducing inflammation, so in that sense giving this natural option a try is definitely win-win. It's not however recommended internally if you suffer from high blood pressure.
Vitamin C is scientifically proven to help reduce dark spots. It works by inhibiting the enzyme 'tyrosinase', which in turn works to prevent melanin production. The additional good news is, it significantly lightens pigmentation, but does not impact normal skin.
A vitamin C serum such as this one would be a good option if you're looking to apply a treatment topically. It can also prevent sun damage and boost collagen production as a bonus! Alternatively this website explains how to make your own using a few simple ingredients.
Apple Cider Vinegar
Often revered for a myriad of home remedy treatments, apple cider vinegar is another stand-out option for treating hyperpigmentation. ACV contains acetic acid, which can act as a mild chemical peel in some cases. A study in the journal
Dilute one part apple cider vinegar in an equal amount of water and use a cotton wool pad to apply to affected patches of skin.
Another natural remedy for treating hyperpigmentation is mulberry leaf. The active ingredient in mulberry disperses melanin and blocks factors that can cause pigmentation, as highlighted in this study published in the Journal of Clinical and Aesthetic Dermatology.
Mulberry tinctures are hard to come by in the UK, so I'm going to recommend this tea to make a compress, as per the Green Tea compress above.
Living with Pigment Change Vitiligo
Scarring affects us all in different ways. Some people are so delighted to be free from psoriasis, the little white or brown patches left behind pale into insignificance in comparison to dealing with the condition itself.
That said, for some, hypo or hyper pigmentation can be just as devastating as psoriasis. It might feel as though you've accomplished so much in getting rid of this skin condition, only to be faced with what feel like permanent reminders.
If you're finding it a struggle to cope with the impact of pigmentation marks, there are a couple of podcast episodes I would really urge you to listen to. Firstly my interview with That Vitiligo Guy. James McLeods attitude to his skin is eye opening. He completely transformed the way I view my own imperfections and I would highly recommend his infectious positivity. This guy is truly amazing.
I'd also like to recommend Iomikoe Woods. This goddess is setting Tik Tok on fire!! And I learned so much from my conversation with her.
For James and Iomikoe there are no treatment options. Vitiligo is irreversible, so where their skin pigment has changed, it will be changed forever*. The positivity with which each of them embrace their differences however, is nothing short of humbling.
*I'll hold my hands up and say Vitiligo is a skin condition I have the least personal experience with. Since writing this article a lovely lady called Jodie pinged me on Instagram and directed me to Kerensa's amazing account! Check out her pictures ..
Kerensa follows a very similar protocol to mine. Anti inflammatory, Autoimmune and Gut nourishing. She has managed not only to put her vitiligo into remission, but to encourage the pigment to return to her skin. You'll find her account here.