If you’re living with psoriasis, you might think anti-aging treatments — from microdermabrasion to chemical peels — are off-limits. And there is some truth to that concern: Psoriasis and skin trauma don’t mix, thanks to the Koebner phenomenon, which occurs when new lesions form in areas where skin has been injured — even if psoriasis has never appeared in that area before.
We spoke with Dr. Bruce Brod, co-director of the Occupational and Contact Dermatitis Program at Penn Dermatology, to get a sense of the safety and efficacy of anti-aging treatments for people living with psoriasis.
HealthCentral: Could you tell us a little about the Koebner phenomenon for people with psoriasis?
Dr. Bruce Brod: With certain skin conditions — psoriasis being one of them, lichen planus being another — it’s a condition where the skin is traumatized, and it has the potential to cause the skin disease to come up in that area. I think the history goes back to somebody who was injured on a horse way back when, and when their skin was injured they developed psoriasis.
HC: Is there a chance that regenerative skin treatments, such as microdermabrasion and chemical peels, could initiate a Koebner-type flare on the face?
Dr. Brod: A peel that penetrates more deeply into the skin could have the potential. But I think for superficial peels like microdermabrasion, causing enough trauma to result in the Koebner phenomenon is relatively low risk. It’s something that should be discussed with patients, but the risk is not super high. With superficial treatments on the face, I think it’s more trial and error — proceeding conservatively, maybe testing it in small areas.
HC: For people with psoriasis on their face or neck, what types of anti-aging skin treatments, if any, do you recommend?
Dr. Brod: The problem is, if they have active psoriasis on their face or neck, then their skin barrier may be impaired. So some of the anti-aging products that have topical retinoids in them, that have topical vitamin C, that have alpha hydroxy acids, could potentially irritate or inflame the skin. These are people who might be more limited in what they can use. They might have to use products that are gentler in nature and test in small areas of the skin. So it could potentially be a limiting factor.
Fortunately, psoriasis on the face is relatively uncommon. It does occur there, but it is uncommon. Those are folks who might want to use anti-aging products like low-strength retinol products, which are over-the-counter, and gluconolactone-type products that are larger-molecule alpha hydroxy acids. They might be tolerable. They can also benefit from tips and techniques to camouflage it at times with cosmetics that can blend to the color of the skin.
HC: For people with psoriasis that is not on their face or neck, what types of anti-aging skin treatments do you recommend?
Dr. Brod: I think it really depends on their skin type — whether they have more oily skin, more sensitive skin, and the level of need their skin has, what they’re trying to achieve. With any regimen that I have a patient on, the important thing is trying to set goals with a patient — what are they trying to achieve. Do they want to fade dark spots, improve fine lines, add luster to their skin, camouflage blood vessels? Sometimes using peels with salicylic acid can actually be therapeutic and anti-inflammatory.
HC: You mentioned powerful retinoids as something to watch out for. Are there treatments you would caution your patients against trying?
Dr. Brod: I think they may need to be more cautious with the prescription retinoid products. Products that have a lower pH tend to inflame the skin. But it doesn’t necessarily exclude them, either. Resurfacing or lasers could potentially pose a risk.
They shouldn’t be limited in terms of fillers or Botox. I don’t think there’s too much of a distinction between psoriasis and non-psoriasis patients in that regard. You want to avoid a procedure in a skin area that’s affected by psoriasis because there is more potential to introduce infection.
HC: What anti-aging ingredients should people with psoriasis look for in products for home use?
Dr. Brod: There are certain products that have retinol in them. There are certain products that are formulated more reliably with vitamin C, which can be a powerful antioxidant in the morning. Usually I like to have patients on a regimen that includes sunscreen, sometimes in the formulation of a moisturizer.
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Casey Nilsson writes about psoriasis and autoimmune diseases for HealthCentral. Casey is an award-winning magazine writer based in Providence, Rhode Island. She’s a 2017 Association of Health Care Journalists fellow and her story on unfair labor conditions for people with disabilities was a finalist for the 2016 City and Regional Magazine Association Awards. Follow her on Twitter @casey_nilsson.