Conditions
Psoriasis: skin plaques, treatment and refills by video
Psoriasis is a chronic condition in which an overactive immune system speeds up skin growth, causing thick, red, itchy patches with silvery scales, often on the scalp, elbows and knees. It is not contagious. By video the doctor evaluates it, helps with treatments you put on the skin, and refills what you already use, if appropriate.
Is it an emergency? Call 911.
Is this an emergency?
This is not an emergency service. Call 911 or go to the nearest emergency room if you have:
- Red skin over almost the whole body, with chills, fever or feeling very ill
- Many blisters or pus-filled bumps on the skin, with fever
- A red, warm, swollen area that spreads fast, with fever
Help lines
At a glance
Psoriasis
Common symptoms
- Patches of thick, red skin with silvery-white scales that itch or burn
- Dry, cracked skin that itches or bleeds
- Patches on the scalp, elbows and knees
- Thick, ridged or pitted nails
- Trouble sleeping because of the itch
- Other names
- Plaque psoriasis · Scalp psoriasis
- Treatment
- Skin treatment, such as corticosteroid creams, when the medical evaluation calls for it; phototherapy and systemic medicines with a specialist
- Possible complication
- Psoriatic arthritis
On this page(9)
What is psoriasis?
Psoriasis is a chronic (long-lasting) disease in which the immune system is overactive and makes skin cells multiply too fast. They build up on the surface and form plaques. It is not contagious: it doesn’t spread to other people.
It can start at any age, but it most often begins between ages 10 and 35, or later in life, and it tends to run in families. Symptoms come and go: flares can last weeks or months, followed by periods when it improves.
Some things can trigger a flare: infections (such as strep throat), dry skin, cuts or bites on the skin, stress, some medicines, and both too little sun and sunburn. In Puerto Rico, protect yourself from strong sun: a sunburn can make psoriasis worse.
How we treat psoriasis by video
You see Dr. Diana Nieves Castro, a Puerto Rico–licensed general practice physician with several years of emergency-department experience, in English or Spanish. Psoriasis is usually diagnosed by looking at the skin, scalp and nails: show the patches on camera in good light, or send photos through the secure link we send you.
By video the doctor evaluates you, helps you control mild to moderate psoriasis with treatments you put on the skin and, if appropriate, prescribes and we send your prescription to your pharmacy. If you already use a skin treatment and just need a refill, that is a follow-up visit: see prescription refills.
What a specialist handles: ultraviolet light treatment (phototherapy) is given in a skin specialist’s office, and medicines by mouth or injection that act on the whole body (including biologics) are prescribed and monitored by a specialist. If you need them, the doctor refers you. You need to be physically in Puerto Rico during the visit.
Your doctor
Dr. Diana Nieves Castro, MD
General practice physician
Several years of emergency-department experience.
Founding Executive Director of The Health Initiative.
Your visit in 3 steps
Request a visit online 24/7 — we confirm your time by email or text This is how you see a doctor online with us.
Request your visit.
Book a visit and choose "Doctor visit" for a first visit, or "Follow-up visit" if you only need a refill. You pay by card when you request it.
See the doctor by video.
We send you a secure video link. It works on your phone, tablet or computer.
Get your plan.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you need a specialist, we refer you.
What the visit costs
A first visit for psoriasis is a US$79 doctor visit. A refill of a treatment you already use is a US$49 follow-up visit. Prices are the same for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. See all prices.
Psoriasis symptoms
Symptoms vary, but the most common are:
- Patches of thick, red skin with silvery-white scales that itch or burn
- Dry, cracked skin that itches or bleeds
- Patches on the scalp, elbows and knees
- Thick, ridged or pitted nails
- Trouble sleeping because of the itch
Psoriasis treatment
Psoriasis has no cure, but symptoms can be controlled. Mild to moderate psoriasis is treated with creams, ointments, lotions, foams or solutions, especially those containing corticosteroids, and other skin treatments such as vitamin D–based medicines. For the scalp, solutions and foams are often used.
If psoriasis is widespread or doesn’t improve with skin treatment, there is phototherapy and there are medicines that act on the whole body; a specialist manages those, and the doctor refers you.
- Keep your skin moisturized.
- Learn what triggers your flares (stress, infections, dry skin, skin injuries) and avoid it.
- Protect yourself from strong sun and avoid sunburn.
- Keep a healthy weight and a nutritious diet.
Joint pain: psoriatic arthritis
Some people with psoriasis get psoriatic arthritis: joints become stiff, swollen and painful, and the neck, back or heel may hurt. Tell the doctor as soon as possible, because it can cause serious joint damage. If the doctor suspects psoriatic arthritis, she refers you to a rheumatologist.
People with psoriasis also have a higher risk of fatty liver disease, heart disease and stroke, and of anxiety and depression. The doctor can review those risks with you and, if needed, give you a lab order.
When to go to the ER
A rare, severe form of psoriasis turns almost all the skin on the body red. For your safety, go to the emergency room or call 911 if you have any of the warning signs on this page.
How we care for you
We evaluate, diagnose and treat; if needed, we give you a lab order for a lab near you.
We see adults and children of all ages. Patients under 21: a parent with patria potestad (parental authority) or a legal guardian is on camera for the whole visit and shows photo ID.
Real-time video visit. We send you a secure video link. It works on your phone, tablet or computer.
If appropriate, the doctor prescribes and we send your prescription to your pharmacy. We do not prescribe controlled substances.
You must be physically in Puerto Rico during the visit (visitors, tourists and cruise passengers are welcome).
In an emergency, call 911.
Frequently asked questions
Is psoriasis contagious?
Can I get a refill of my psoriasis cream by video?
What can I do about scalp psoriasis?
Do you prescribe biologics for psoriasis?
About this page
Author: The Health Initiative
Medical care provided by Dr. Diana Nieves Castro, MD (PR license 24027)
Disclosure: Founding Executive Director of The Health Initiative
Published: 2026-10-02 · Updated: 2026-10-02
Sources (3)
- Psoriasis (NIAMS, NIH) (opens in a new tab) (accessed 2026-10-02)
- Psoriasis (MedlinePlus, NIH) (opens in a new tab) (accessed 2026-10-02)
- Psoriasis: Diagnosis, Treatment, and Steps to Take (NIAMS, NIH) (opens in a new tab) (accessed 2026-10-02)