It happens all the time: Good-meaning folks ask, “Can’t you just exfoliate it off?”
No, friend, psoriasis is a different breed from your dry skin in winter. Search Amazon and you’ll find scores of scrubs, brushes, and other tools marketed to people living with psoriasis. But according to George Martin, M.D., a dermatologist in Kihei, HI, and a medical board member of the National Psoriasis Foundation, these products could cause more harm than good.
Here, Dr. Martin answers questions about five common beauty treatments for general skincare and if they work for sensitive psoriatic skin.
Q: Should psoriasis patients exfoliate with scrubs or brushes?
George Martin, M.D. (GM): The buildup of unsightly or thick, uncomfortable scale is a problem for psoriasis patients. Scale buildup also acts as a barrier to topical medications used to treat psoriasis. There are two basic ways to exfoliate: mechanical and chemical. Mechanical exfoliation includes treatments such as scrubbing, brushing, or abrading with nylon towels or sponges. This is generally irritating and can lead to discomfort and at times even bleeding. If mechanical exfoliation is done, it should be done gently.
Q: What about chemical exfoliation?
GM: Chemical exfoliation uses ingredients such as salicylic acid, lactic acid, urea, and others that help remove the thick adherent scale of psoriasis lesion. They are often referred to as keratolytics because they break up and dissolve adherent or thick psoriatic scale that is made up of keratin. These keratolytic agents are often included in moisturizing lotions or creams that hydrate the skin at the same time they remove scale.
Salicylic acid has been used for decades as a treatment to remove psoriasis scale. It is a very effective keratolytic agent in removing surface scale found on psoriasis plaques on the body trunk or extremities. Be careful, though, as salicylic acid can be very irritating when used on the facial skin affected by psoriasis or in skin folds such as armpits, groin or underneath breasts.
Q: How about hot baths for psoriasis?
GM: Psoriasis lesions of the skin are generally inflamed and often itchy or painful. Hot water can cause a temporary relief of symptoms such as itch, burning, or stinging of psoriasis lesions. The temperature of the bath should not be too hot and should allow for extended soaking and hydration of inflamed psoriasis skin lesions. Application of topical medications and moisturizers immediately following baths is an excellent way of trapping water in the skin as well as facilitating penetration of topical medications into psoriasis plaques.
Q: Face masks are extremely popular. Could they work for psoriasis patients? Are there ingredients to avoid?
GM: There are a wide array of face masks containing a broad range of ingredients, some of which can be irritating to “sensitive skin” psoriasis individuals. In general, masks that are marketed as “calming” or “hydrating" to the skin and non-irritating are acceptable for use in psoriasis patients. Be careful of “exfoliating” masks or “anti-aging” masks that contain harsh or irritating chemicals or “acids” which could flare already inflamed psoriasis facial skin.
Q: What about other facial treatments, like anti-aging products with alpha-hydroxy acids?
GM: Facial treatments that might help hydrate and soothe dry, irritated psoriasis skin are helpful. So terms such as “calming," “soothing" and "hydrating” are key buzzwords to look for in a facial menu or when purchasing a product. Vigorous scrubs, micro-dermabrasion, and “anti-aging” chemical peeling agents should in general be avoided and could cause significant irritation and facial psoriasis to flare.
There are a wide range of alpha-hydroxy acids (AHAs) that come in varying strengths. Be sure that if you choose to purchase or be treated with an AHA, start with the least irritating formulation available. When in question, begin with a AHA on a non-facial area such as the chest or arm and if there is no sign of irritation then apply it to a small area of the neck or behind the ear to judge its potential for irritation. If no irritation occurs, apply an anti-aging product to a small area on the side of the face before applying to the rest of your face.
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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.