Complete skin clearance refers to clearing all evidence of psoriasis from the skin. For people diagnosed with psoriasis, achieving complete skin clearance is often the goal of treatment.

“I love it — 95 percent clearance and only one shot a month,” one MyPsoriasisTeam member said of their biologic.

Another member said they started a biologic and, within five weeks, “achieved 100 percent clear skin.”

Although new treatments have made complete skin clearance possible for the first time, it may take a while to achieve this result. Additionally, no psoriasis treatments bring about total skin clearance for 100 percent of the people who try them. It’s important to keep in mind that complete clearance may not be achievable for everyone diagnosed with psoriasis, but the goal can be to clear the skin as much as possible.

What Is Complete Skin Clearance?

People with psoriasis who reach complete skin clearance no longer have psoriasis lesions — bumpy, discolored patches that itch, hurt, crack, and bleed. Other psoriasis symptoms might remain, but complete clearance indicates that the evidence of the condition on the skin is gone.

Complete skin clearance means that people with psoriasis don’t have the characteristic itching, burning, cracking, or bleeding skin and no longer require topical treatments to manage these symptoms. Typically, people who have psoriasis need to stay on medication to remain clear. These medications don’t cure psoriasis, but they can suppress it.

Here are some facts to help you better understand skin clearance and how it may be achieved.

1. Skin Clearance Can Be Measured

The severity of psoriasis is generally measured using either the Psoriasis Area and Severity Index (PASI) or the Physician Global Assessment (PGA). PASI is based on severity and the amount of body surface area that’s affected.

A PASI score under five is considered mild disease, and a score over 10 is considered severe disease. The maximum PASI score is 72.

PGA is a six-point scale that assesses severity but not specific body surface area. A PGA score of zero is clear skin, while a score of four or higher is considered severe.

Many clinical trials measure the change in PASI scores to assess the effectiveness of a drug. In this context, the term “PASI 75” means a person reduced their starting PASI score by 75 percent — a significant improvement in psoriasis symptoms. “PASI 100” would be complete skin clearance.

These perfect scores may not be achievable for everyone diagnosed with psoriasis. Because of this, it’s a good idea to discuss the topic with your dermatologist. The two of you can work together to determine whether complete clearance is a realistic goal for you.

2. Biologic Treatments May Lead to Complete Clearance

The medications that bring about complete skin clearance in some people are called biologics. These bioengineered proteins target specific cells or molecules of the immune system involved in inflammatory processes. Numerous biologic medications are on the market, and it can take some time to determine which one may work best for you without causing negative side effects.

The effectiveness of biologic medications isn’t 100 percent. One study of 846 people with psoriasis who tried biologics reported that about 25 percent achieved complete skin clearance after six months of treatment. Other studies estimate complete skin clearance in 30 percent to 45 percent of participants who try biologics.

3. Complete Skin Clearance Has Become More Possible

When biologics first became available to treat psoriasis nearly 20 years ago, 75 percent skin clearance was hailed as a great success. Luckily, health care has continued to improve for people with psoriasis. Biologics coming out today can achieve skin clearance for many people. It’s realistic to expect 90 percent clearance with these newer options.

However, complete skin clearance may not be a realistic treatment response or end point for everyone with a diagnosis of psoriasis. A few key factors seem to influence the effectiveness of biologic treatment, including the choice of drug, psoriasis severity before treatment, body weight, and a person’s overall health.

4. Disease Severity Is a Factor in Skin Clearance

Disease severity can affect how likely a person is to achieve complete skin clearance. One study of 515 people with psoriasis found that participants with severe disease saw greater changes in their PASI score when treated with biologics, up to a certain level of severity. Few individuals with a starting PASI score of 30 or above achieved complete skin clearance. Although few people with extremely severe psoriasis reached complete clearance on biologics, all participants reported a decrease in disease activity and improved quality of life.

At times, more severe skin psoriasis will be associated with psoriatic arthritis, so be sure to tell your dermatologist if you have any joint pain. Not all biologics for psoriasis treat the joints well.

5. Skin Clearance May Require Finding the Right Medication

Even if biologics work for you, it may take some time to find the one that will help you achieve clear skin. This process can take a while because there’s no test to show which biologic will work best for you, and your medical insurance may not cover all of the biologics available. If the particular medication you want to try is still in clinical trials, you may need to qualify for that study to access it.

When you try a new biologic, you can expect to wait one to four months to experience maximal effectiveness. Additionally, biologics may gradually stop working as well, perhaps due to the body making antibodies against the treatment. Even if you do achieve complete skin clearance, it may not be possible to maintain it.

6. Biologic Treatment May Become Less Effective Over Time

With some biologics, you may need to change to a different drug within five years. However, some of the newer biologics have shown sustained durability with at least five years of consistent results. The U.S. Food and Drug Administration (FDA) has approved more than a dozen biologics to treat psoriasis, so you have multiple options if a medication doesn’t work for you or stops working over time.

Biologics are systemic medications given via injection or IV infusion. Some can be self-administered at home, but others require going to a clinic or doctor’s office for an infusion every few weeks. These appointments can take time, and some people don’t feel well for a few days afterward.

It may take several weeks for you to notice any major improvement in your psoriasis. The biologics differ in the frequency of injections, so talk to your dermatologist about which medicine fits best with your lifestyle.

7. Some Biologics Work Better for People With Higher Body Weights

A review of studies assessing the impact of weight on biologic effectiveness found that some of these drugs performed less well for people with higher body weights. If you have a higher body weight, talk to your dermatologist about which biologics can be adjusted for weight and which have proven results for people regardless of body weight.

8. Biologics May Not Be Right for Everyone

Because they change the way the immune system works, biologics can increase your risk of contracting an infection and then make it harder for your body to heal. People who previously tested positive for certain infections, like hepatitis B or tuberculosis, may not be able to take biologic medications. The newest biologics are much more specific in their suppression of the immune system, so the risk of infection is lower. You may need a tuberculosis test before beginning a biologic.

In addition, some people may experience itchiness and skin discoloration, including at the injection site, especially when the biologic medication is given.

9. Communicating With Your Doctor Can Help Improve Your Outcome

It’s important to talk with your dermatologist about setting goals for your treatment and management of psoriasis. Your doctor knows the specifics of your health history and your psoriasis, and they can help you make informed decisions about treatment goals and medication options.

Be sure to tell your dermatologist about any symptoms you experience beyond the skin, such as joint pain or gastrointestinal issues. It’s important to work with your health care team to manage any comorbidities (coinciding health conditions, such as inflammatory bowel disease or cardiovascular disease) you may have in addition to psoriasis.

It’s essential to stick with your treatment plan, which may include some combination of medication, at-home skin care, and phototherapy. There’s no cure for psoriasis, but effective treatment may keep your condition in remission longer.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you wondering if complete skin clearance is possible for you? Are you considering biologics? Share your questions or experiences in the comments below or by posting on your Activities page.