JASMA

Verrucous psoriasis is the skin condition equivalent of showing up to a party in hiking boots and a tuxedo: it’s still psoriasis, but it wears a very different outfit. Instead of the classic flat-ish, red plaques with silvery scale, this rare subtype can form thick, warty-looking (verrucous), hyperkeratotic plaques that fool even experienced eyes into thinking “warts,” “calluses,” or something more serious.

That confusion matters. When a rash looks like a wart and acts stubborn, people often spend months (or years) trying the wrong fixesonly to learn later that it’s psoriasis wearing a disguise. The good news: once verrucous psoriasis is recognized, there are real, evidence-based ways to calm it downoften by combining scale-thinning strategies with anti-inflammatory psoriasis treatments.

Quick note: This article is educational and not a substitute for medical care. Because verrucous lesions can mimic other conditionsincluding skin cancersget a dermatologist’s evaluation for a new, changing, painful, bleeding, or rapidly growing lesion.

What Is Verrucous Psoriasis?

Verrucous psoriasis (sometimes described as “warty” or “verrucous-appearing” psoriasis) is a rare variant of plaque psoriasis. The hallmark is an overbuilt outer layer of skinthink of it as psoriasis that decided to add a second (and third) winter coat.

Clinically, it tends to show up as:

• Very thick, rough, wart-like plaques (often with an uneven, “cobblestone” surface)
• Underlying redness typical of inflammation
• Heavy scale that can be harder to lift than in classic plaque psoriasis
• Locations that often include extensor areas (like knees, elbows) and sometimes areas exposed to friction or pressure

On a microscope slide, it still carries psoriasis features (like psoriasiform epidermal hyperplasia and neutrophils in the upper skin layers), but with added architectural changessuch as papillomatosisthat contribute to the verrucous look.

Why It Happens: Causes and Risk Factors

Like other types of psoriasis, verrucous psoriasis is driven by an immune system misfirean inflammatory process that speeds up skin-cell turnover and fuels redness, thickening, and scaling. But why do some people get the verrucous “warty” version?

1) The same psoriasis biologyturned up for thickness

Psoriasis involves immune signaling (including pathways targeted by modern biologics) that tells skin cells to grow faster than they can shed. In verrucous psoriasis, the “build-up” portion of that story can be especially dramatic, producing hyperkeratotic plaques that look more like a growth than a rash.

2) Friction, pressure, and the Koebner effect

Psoriasis can appear in areas of skin injury or irritation (the Koebner phenomenon). In verrucous psoriasis, many reports describe plaques in areas that take daily wear-and-tearplaces that get rubbed by clothing, shoes, braces, repetitive motion, or pressure points. It’s not that friction “causes” psoriasis from scratch, but it can help determine where psoriasis declares itself.

3) Common psoriasis triggers still apply

Even with this unusual appearance, people may notice flares related to classic triggers such as:

• Infections (some people flare after respiratory infections or skin infections)
• Cold, dry weather
• Skin injury (cuts, scrapes, sunburn)
• Smoking and heavy alcohol use
• Certain medications (your clinician can review these)
• Major stress (your immune system loves drama; your skin does not)

Symptoms: What Verrucous Psoriasis Looks and Feels Like

Verrucous psoriasis can be visually loud. People often describe it as “warty,” “horny,” “thick,” or “like a callus that won’t quit.” Symptoms may include:

Skin changes

• Thick, raised plaques with a rough, bumpy surface
• Redness around or beneath the thickened skin
• Heavy scaling that can look white, gray, or yellowish depending on moisture and skin tone
• Cracking or fissures, especially on weight-bearing areas
• Bleeding if the plaque cracks or is picked

Sensations

• Itching (sometimes intense)
• Burning or soreness
• Pain with walking or gripping if plaques are on soles, toes, or hands

Related psoriasis signs

Some people also have more typical psoriasis elsewhere (scalp plaques, classic elbows/knees plaques) or related features like:

• Nail changes (pitting, thickening, discoloration)
• Joint stiffness or pain that could suggest psoriatic arthritis

Verrucous Psoriasis vs. Warts (and Other Look-Alikes)

This subtype’s greatest talent is mimicry. The key issue is that verrucous plaques can resemble viral warts and, more importantly, can resemble other verrucous or thickened conditions that require different (sometimes urgent) care.

If you’ve tried “wart stuff” for weeks and the lesion is not improvingor it’s enlarging, painful, bleeding, or changingdon’t assume it’s “just stubborn.” That’s the moment for a dermatologist and, often, a skin biopsy.

How Verrucous Psoriasis Is Diagnosed

Diagnosis usually starts with what dermatologists do best: pattern recognition. They’ll examine your skin (and often nails and scalp), ask about symptoms, family history, triggers, and other psoriasis signs, and look for clues suggesting psoriasis rather than infection or tumor.

When a biopsy is especially helpful

A biopsy may be recommended when:

• The lesion looks like a wart but doesn’t behave like one
• There’s concern for verrucous carcinoma or other skin cancers
• The plaque is unusually thick, rapidly changing, ulcerated, or bleeding
• Treatments for warts or standard psoriasis aren’t working

In other words: if the skin is telling a confusing story, a biopsy provides the receipts.

Treatment: What Actually Helps (and Why “Just Moisturize” Isn’t Enough)

Verrucous psoriasis can be notoriously treatment-resistant because thick scale acts like armor. So treatment often has two jobs:

1. Thin and soften the excess keratin (so medication can penetrate)
2. Calm the underlying inflammation driving the overgrowth

1) Topical therapies (the foundation)

Dermatologists commonly start with a topical plan, often using:

• Topical corticosteroids (to reduce inflammation and itching)
• Vitamin D analogs (to slow excessive skin-cell growth)
• Topical retinoids (vitamin A–related medications that affect cell turnover)
• Coal tar or anthralin in selected cases (older, still-useful options for some people)

Pro tip your dermatologist already knows: With very thick plaques, how you apply topicals matters. Occlusion (covering with plastic wrap or medicated dressings) is sometimes used to improve absorptiononly under clinician guidance, because it can increase side effects.

2) Keratolytics (scale-lifters that make other treatments work better)

Because verrucous psoriasis is so hyperkeratotic, many care plans include a scale-softener, such as:

• Salicylic acid (a keratolytic that helps lift and loosen scale)
• Lactic acid or urea-based products (also help soften thickened skin)
• Gentle soaking + emollients (the low-tech support crew)

These agents don’t “cure” psoriasisthey help remove the barrier so anti-inflammatory medications can actually reach the target. Used incorrectly (too strong, too often, too large an area), they can irritate skin, so dosing and placement matter.

3) Phototherapy (medical light, not tanning)

Phototherapy can help moderate-to-severe psoriasis, including stubborn plaques, by reducing inflammation and slowing rapid skin-cell growth. Dermatology offices often use narrowband UVB as a go-to option; other approaches include targeted treatments (like excimer laser) or PUVA in select situations.

Important: Tanning beds are not the same thing as medical phototherapy. Medical light therapy is controlled, dosed, and supervised; tanning beds mainly emit UVA and carry significant skin-cancer risk.

4) Systemic medications (when topicals aren’t enough)

If verrucous plaques are widespread, function-limiting, or resistant, clinicians may consider systemic therapyespecially if psoriasis affects quality of life or there are signs of psoriatic arthritis.

Depending on the individual, options can include:

• Traditional systemic agents (used for decades in psoriasis care)
• Oral small-molecule therapies (for certain patients)
• Biologic therapies targeting specific immune pathways (often used for moderate-to-severe plaque psoriasis)

For verrucous psoriasis specifically, the published medical literature includes case reports and reviews describing responses to various systemic agents, including biologics that target common psoriasis pathways. Because this condition is rare, treatment is often individualizedsometimes requiring a few careful trials to find what your skin responds to best.

5) Combination strategies (often the winning move)

Many people do best with combination care, such as:

• Keratolytic + potent topical anti-inflammatory
• Phototherapy + topical regimen
• Systemic therapy + targeted topicals for the thickest plaques

Think of it less like a single “magic cream” and more like a coordinated team: one player softens, one calms, one prevents rebounds.

Self-Care That Actually Supports Medical Treatment

Self-care won’t replace prescription treatment for verrucous psoriasis, but it can make therapy more effective and reduce flares.

Reduce friction and pressure

• Choose breathable, non-rubbing fabrics
• Adjust footwear if plaques are on soles/toes (pressure can worsen thickening)
• Use protective dressings if recommended

Moisturize like it’s your side hustle

Moisturizers reduce cracking and can improve comfort. Apply after bathing, when skin is slightly damp, and consider heavier ointments for very dry areas.

Don’t pick (even if it feels productive)

Picking increases skin injury, which can trigger more psoriasis through the Koebner effect and raise infection risk.

Track triggers with curiosity, not blame

Stress, infections, weather shifts, smoking, and alcohol can all influence psoriasis. Tracking patterns can help you and your clinician build a plan that’s realisticnot punitive.

When to See a Dermatologist (and When to Go Sooner)

Make a dermatology appointment if you suspect verrucous psoriasis or if a “wart-like” lesion is lingering. Seek prompt evaluation if you notice:

• Rapid growth or a new lesion that looks unusual
• Bleeding, ulceration, or persistent pain
• Signs of infection (spreading redness, warmth, pus, fever)
• New joint pain or morning stiffness (possible psoriatic arthritis)

Outlook: Can Verrucous Psoriasis Go Away?

Psoriasis is typically chronicmeaning it can flare and quiet down over time. Verrucous psoriasis may be more stubborn than classic plaque psoriasis because thick scale can protect inflammation underneath. Still, many people achieve major improvement (and sometimes long periods of clear skin) with the right combination of therapies.

The realistic goal is control: less thickness, less redness, fewer cracks, less itch, and better functionso skin stops being the boss of your day.

FAQ: Quick Answers to Common Questions

Is verrucous psoriasis contagious?

No. Psoriasis is not contagious. It’s an inflammatory condition, not an infection you can “catch.”

Is verrucous psoriasis caused by HPV like warts?

Usually no. It can look like a wart, which is why diagnostic confirmation matters. If there’s uncertainty, a biopsy can help distinguish psoriasis from viral warts and other look-alikes.

Can a doctor remove it surgically?

Because psoriasis is driven by immune inflammation, simply “removing” the visible plaque doesn’t address the underlying processand skin trauma can even trigger new lesions. Treatment typically focuses on controlling inflammation and thickening rather than cutting it out.

Does sunlight help?

Some people notice improvement with careful, controlled UV exposure, and medical phototherapy can be very effective. But sunburn can trigger flares, and tanning beds are strongly discouraged due to cancer risk. Talk with a dermatologist before using UV as a strategy.

Real-Life Experiences: What Living With Verrucous Psoriasis Can Feel Like (Extra )

Medical descriptions are helpful, but they can also feel like reading your skin’s story in someone else’s handwriting. Here are experiences many people report when dealing with verrucous psoriasisespecially before they have the right diagnosis and treatment plan.

The “Is this a wart?” spiral

Because verrucous psoriasis can look so wart-like, a common first chapter is self-treatment. People try over-the-counter wart removers, freezing kits, pumice stones, foot files, or aggressive exfoliationoften for weeks. The plaque may temporarily look “flatter” after a big scrape, but then it rebounds thicker, angrier, and sometimes cracks. That cycle can be frustrating and a little insulting, like your skin is replying, “Thanks for your input; I’ve decided to ignore it.”

Misdiagnosis fatigue

Some people bounce between labels: wart, callus, eczema, fungal infection, “maybe a reaction,” “maybe a growth.” Each label comes with a new product, a new routine, and another round of hope. When nothing works, it can feel personaleven though it isn’t. Verrucous psoriasis is rare, and rare things take longer to name. Many people describe a turning point when a dermatologist says, “Let’s biopsy it,” not as a scary moment, but as a relief: finally, a clear plan.

Daily-life friction (literally)

If plaques are on the knees, ankles, soles, or hands, people often notice how much life involves rubbing something: socks, shoes, jeans, kneeling, walking, gripping. Verrucous psoriasis can make ordinary tasks feel like a negotiation. Some people change footwear, add cushioning, or avoid certain workouts. Others adapt routineslike moisturizing right after showers, wearing softer fabrics, or using protective coverings during choresto reduce irritation without feeling like they’re wrapping themselves in bubble wrap.

Embarrassment and the “public skin” problem

Thick, warty plaques can draw stares, especially if they’re on visible areas. People describe hiding legs, avoiding sandals, or keeping hands tucked awayless because of pain and more because strangers’ faces can be loud. Even when you know psoriasis isn’t contagious, it’s hard not to internalize other people’s uncertainty. Support groups (online or in-person) can be surprisingly powerful herenot for pity, but for practical tips and the simple comfort of being understood without needing a ten-minute explanation.

What “success” often looks like

For many, progress comes in layers. First the fissures heal. Then the itch quiets down. Then the plaque starts to soften. People frequently describe that keratolytics (like salicylic acid in the right dose) plus consistent anti-inflammatory treatment feels like the first time medication can actually “get in.” Others find that phototherapy or a systemic medication is the missing piece, especially when plaques are widespread or resistant. The emotional win is often as important as the clinical one: the day you realize you’re thinking about your skin less, because it finally stopped demanding to be the center of attention.

If you’re in the thick of it (sometimes literally), the most useful mindset is this: verrucous psoriasis isn’t a willpower test. It’s a diagnosis-and-treatment problem. With the right clinician and a plan that targets both scale and inflammation, many people get meaningful reliefand a lot more room in their day for things that aren’t skincare logistics.