Louise Chang, MD
Winter brings dry air, colder temperatures, and reduced exposure to sunlight – all of which can worsen the symptoms of psoriasis. What can the 7.5 million Americans who suffer from psoriasis due to prevent a flare-up of symptoms? Are there winter tips for psoriasis treatment?
Yes, and good self-care for your psoriasis in winter isn't difficult once you know what to do.
For tips from psoriasis experts, WebMD turned to:
Along with taking your psoriasis medication, they say, follow these six psoriasis treatment tips to keep inflammation, patches, and itchy skin in check.
Make your showers short, sweet, and lukewarm, says Abel, who cares for many psoriasis patients. "Avoid hot water," she says. "Hot water feels good at the time, but the itching can rebound when you get out."
Cutting down on showers is best in winter, when indoor air tends to be dryer. "No more than one a day," Abel says. "And no scrubbing. It can be irritating, and when skin is irritated, psoriasis gets worse." Also, she recommends that you pick soaps for sensitive skin.
Dermatologists and other health professionals who care for psoriasis patients can't say it often enough: Moisturize, moisturize, moisturize. One of the best times is after a shower.
"Put moisturizer on your skin 3 to 5 minutes after you towel off after a shower," Aldredge says. Doing it quickly makes a difference, she says. "It helps seal in moisture so the skin doesn't get as dry."
What kind? "Lotions are easiest to apply all over," Abel says. "But creams and ointments are more moisturizing than lotions."
"Plain old petroleum jelly is one of the best moisturizers in the world," Aldredge says. But people are often reluctant to use it, she knows, because of its "greasiness." She suggests: "Use it at night or after a shower, and wear old sweats or pajamas. It will soak in after an hour or two."
The use of light therapy can help clear up patchy, scaly skin, Abel says, although the time commitment can be a problem, as most people with psoriasis need multiple sessions. Also called phototherapy, light therapy has been a standard of psoriasis treatment for a long time. The premise is simple: ultraviolet light slows the rapid growth of skin cells that occurs in psoriasis and can clear the symptoms for a period of time (while normal skin typically replaces itself every month or so, in psoriasis that process can speed up to three or four days).
One option is called psoralen UVA, or PUVA. "It is a type of photo chemotherapy, in which the patient takes a light-sensitizing medication, psoralen, by mouth, then an hour and a half later is exposed to long-wave, ultraviolet light in the office," Abel says. PUVA requires about 25 treatments, according to the National Psoriasis Foundation, and there are long-term risks of skin cancers with light therapy, so that risk must be weighed. PUVA has been in use since the last 1970s but is less common now, Abel says, due to a newer type of phototherapy called narrowband UVB or ultraviolet B. This type emits the part of the UV light spectrum most helpful for psoriasis.
About 30 treatments are needed for UVB to clear the skin, according to the National Psoriasis Foundation.
If your psoriasis is getting worse, or usually does in the winter, it is a great time to check-in with your physician for a medication tune-up. Your doctor can assess whether the psoriasis medications you are using -- topical, systemic, or a combination -- are working as well as possible.
Common topical psoriasis treatments that you rub on your skin include over-the-counter products such as salicylic acid and coal tar such as Psorent, and prescription topical creams such as Dovonex (synthetic vitamin D3), Tazorac, and corticosteroid medications.
Systemic psoriasis medications include methotrexate, which you can take as a pill, and new injected drugs called "biologics," such as Enbrel and Humira. Remicade another biologic, must be infused at the doctor's office.
By adjusting doses or medicine types, you may get more psoriasis relief in winter.
"Stress plays a big part in making any skin condition worse," says Aldredge. The stress can be emotional or physical, such as having to have surgery. She tells patients: "Control the things you can. Take time to eat healthy, exercise, and do whatever you think is stress-reducing." She's had psoriasis patients tell her they reduce stress by prayer, singing in a group or exercising, among other options.
Most people who have lived with psoriasis for a long time are aware, Aldredge says, of the role stress in their lives plays in making the condition worse.
Because stress can trigger or worsen psoriasis, the National Psoriasis Foundation suggests relaxation and stress-reduction techniques -- meditation and yoga in particular -- to help people manage their disease.
Few research studies have found proven benefit to alternative therapies for psoriasis, according to Abel and Aldredge, but that doesn't mean they wouldn't help you. Aldredge says some patients have told her that yoga, acupressure, and acupuncture all have helped relieve their psoriasis to an extent.
"If it works [for you], and it's legal and it's harmless, use it," says Aldredge.
But, remember, always discuss alternative approaches with your doctor first.
SOURCES: Lakshi Aldredge, MSN, RN, ANP-C, adult nurse practitioner, Portland VA Medical Center, Portland, Ore. Elizabeth A. Abel, MD, dermatologist, Mountain View, Calif.; and adjunct clinical professor of dermatology, Stanford University School of Medicine, Stanford, Calif. American Academy of Dermatology web site, "Psoriasis & Psoriatic Arthritis." National Psoriasis Foundation.
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