For Anna Lysakowska, traveling is both a passion and a profession. The 28-year-old makes her living blogging about her life on the road annaeverywhere.com, and her diagnoses of plaque and guttate psoriasis haven’t kept her from exploring more than 77 countries. She is currently based in Mexico.
Traveling with psoriatic disease, however, has its challenges. For example, there was the time the crew of an international carrier suggested removing her from the flight because they were unfamiliar with psoriasis and concerned she was contagious.
“The flight attendant asked me what was wrong with my skin in front of other passengers. As she wasn’t very discreet, other people started to look very concerned,” said Lysakowska, who was eventually allowed to stay in her seat.
Despite the humiliating experience, Lysakowska was able to prove that psoriasis isn’t contagious — but awareness is. Her explanations reassure most people, she said. In fact, some respond positively, including one woman she met on Tortuga Bay beach in the Galapagos who insisted on bringing the travel blogger home with her to try a cream her daughter had used for a skin condition.
Before finding a medication — methotrexate — that worked for her, Lysakowska often had flares while traveling. However, for her, the triggers weren’t obvious.
People with psoriasis and psoriatic arthritis (PsA) are vulnerable to flares during travel, whether the trip is for business or pleasure, said Melissa Piliang, M.D., a dermatologist at the Cleveland Clinic in Ohio.
“You encounter different weather and different humidity — it’s always drier on a plane, for example — which can dry out skin and make it more prone to flare,” she said. “People with psoriatic arthritis often have a different activity level when they travel; they may be walking more, taking more stairs, or hiking — things they don’t normally do that might flare or irritate their joints and cause fatigue.”
There’s also the stress associated with traveling. The planning it takes to pack and leave home, on top of worries about timing and delays, can be emotionally taxing, said dermatologist Stefan Weiss, M.D., MHSc, medical director of the Weiss Skin Institute in Boca Raton, Florida.
Then there’s the fact that psoriatic disease is characterized by an overactive immune system, and some of the treatments used to target the parts of the immune system that cause inflammation could suppress the immune system — not exactly the most ideal scenario for boarding a crowded flight.
“You’re (already) exposing yourself to potential infections through recirculated airplane air or being in crowds, (so) even simple colds, things that are mild for someone who’s not on an immunosuppressive medication, can be more serious for someone who is,” he said.
Preparing for your trip — physically, mentally, and logistically — can help reduce travel snags, stress, and the likelihood of flares, said Dr. Piliang. “Often people have some anxiety about the travel process, so starting to plan early and being methodical will help manage your stress,” she noted.
Create a pre-trip checklist to help plan your packing, transportation, and other details, including the timing of treatments, such as infusions or light therapy, that you can’t take with you. “If you’re going away for an extended period, for example, if you’re a snowbird headed south for the winter, ask your dermatologist for a referral at your destination,” Dr. Piliang suggested.
Whatever your treatment, it’s important that you don’t let travel disrupt it. “One key to keeping psoriatic disease under good control is not allowing travel to interfere with the regimen that’s been working for you at home,” said Dr. Weiss.
Dr. Piliang also advises getting plenty of rest and prepping skin to be in its best possible condition before you leave. “I recommend putting on a heavy, gentle moisturizer that’s free of fragrance and irritants, all over, twice a day, for a week before you go, even if it’s not your usual routine,” she said.
If you have psoriatic arthritis, Dr. Piliang recommends getting in shape “for whatever you’ve got planned, especially if it’s more active than your usual routine. It might take a few months to build up to that so you don’t flare your joints on the trip.”
John Latella, 75, who has psoriasis and PsA and travels internationally a few times a year from his home in Windsor, Connecticut, always takes with him more medication than he thinks he’ll need. “I also plan a rest day or two at the beginning and end of my trip so I’m not wiped out,” he said.
Houston native Tracy Kutch, 59, who has PsA, said she upgrades to business or first class when she can. “I like boarding and deboarding first and the extra room. The seats are big enough so I can pull my legs up and generally shift and move around,” she said.
Frequent flyers should consider signing up for TSA PreCheck, which gives prescreened passengers a faster trip through airport security within the United States. It allows them to leave laptops and liquids in carry-ons and keep on their shoes and outer clothes. If you fly internationally more than twice a year, look into Global Entry, which includes TSA PreCheck status and can expedite the customs process.
In the air
Once you’re in the air or on the road, minimize your flare risk by eating nourishing meals and getting some sleep. Don’t overdo alcohol, which can undermine your immune system, and stay hydrated, which can help prevent fatigue and achy joints, said Dr. Piliang.
Ward off infection by washing your hands frequently and using antibacterial wipes. “I wipe down the airplane seat, arm rest, seatbelt and tray table, and hotel phone, remotes and door handles,” said Kutch.
If you’re on a long flight or spending a lot of time in the car, make sure you are moving and stretching frequently and keeping calm. Latella meditates to keep stress under control. If you’re new to meditation — which Dr. Piliang also recommendeds — consider mediation apps such as Headspace and Calm.
Also be prepared for the environment you’re heading into, said Dr. Weiss. Although warm, humid beach weather often helps psoriatic skin and joints, the hot, dry atmosphere of the desert or high-altitude destinations can deplete the skin’s moisture, as can cold air.
“Both cold and hot, dry weather dry out the skin and can cause it to crack, and when the skin barrier breaks down, microbes can get in and cause a subclinical infection and skin flares,” he explained.
Travelers often run into unexpected problems in very dry environments, Dr. Piliang noted.
“Because it’s warm, they think their skin might be better, but instead, it dries out in a heartbeat, leaving itchy, irritated areas,” she said. “Use gentle soap and moisturize very well — you can’t overdo that in a dry environment.”
Likewise, protect skin from sunburn, even in winter locations and high altitudes. “The sun can be very intense in these places, so again, moisturizing is very important, as is frequent use of sunscreen and sun-blocking clothing and hats,” said Dr. Piliang.
If your skin is drawing attention from curious bystanders, consider educating those you meet about psoriasis, suggested Lysakowska, who used to disguise her skin lesions with long gloves and skirts and strategically placed wraps. But not anymore. “Now, I just wear what’s comfortable and explain what (psoriasis) is — if I want to,” she said. “Some people will never understand the reality of living with psoriasis, and educating every single person you meet isn’t always practical. If someone doesn’t understand, move on.”
A checklist for smart travel
When traveling, taking these steps can help make for a more pleasant trip.
Schedule a pre-trip consultation with your doctor.
Make sure prescriptions are current and ask for written copies just in case. Discuss a plan for coping with flares on the road. If you need to travel with syringes or sharps for an injection medication, ask for an explanatory note. When traveling internationally, check the embassy website for the country you plan to visit for any special requirements for bringing prescription medications into the country. Some foreign governments require an explanatory note from a physician about a prescription before entry into the country will be granted. If appropriate, get a flu or pneumonia shot, and if your destination is off the beaten path, particularly in the developing world, ask about preventive medications or whether it’s safe to take certain vaccinations.
However, if you are taking a biologic and need a live vaccine, such as that for yellow fever, talk to your doctor about how to proceed, as it is not recommended that those on biologics receive live vaccines, said Paul Yamauchi, M.D., assistant professor of dermatology, David Geffen School of Medicine at UCLA, Harbor-UCLA Medical Center Division of Dermatology, and adjunct associate professor, John Wayne Cancer Institute, Dermatology Institute & Skin Care Center in Santa Monica, California.
Take comfortable clothes, shoes, and other gear appropriate to your destination. If you’re headed to hot, humid areas, for example, bring light, loose, moisture-wicking or cotton clothing. If you’re going somewhere cold, take a hat, gloves, and scarf to protect as much skin as possible. Pack your own shampoo, moisturizer, and soap or cleanser, and don’t forget sunscreen and sun-blocking lip balm and clothing. Tuck whatever tools help you sleep well — a sleep mask, noise-reducing ear buds, or your favorite pillow — into your carry-on.
Organize your meds.
When flying, if possible, carry on your medications. Checking them in your luggage risks loss or damage from unregulated temperatures. Laws vary from state to state and country to country, but it’s a good idea to keep medication in its original packaging with labels attached, and even when it’s not required, doing so can speed up preflight screening. Some makers of biologic medications that need to be kept cool provide insulated travel kits, or you can purchase them online or carry a small cooler. Check in advance to see if your hotel room has a refrigerator; if not, some hotels will provide them upon request.
Understand airline security.
Let a Transportation Security Administration (TSA) officer know if you have solid or liquid medications that need special screening, and declare associated accessories, such as pumps or syringes. Medically necessary liquids, medications, and creams come with exemptions to the TSA’s 3-1-1 rule — normally no more than 3.4 ounces in clear containers in a clear quart-sized zip-top plastic bag. You can carry on more than 3.4 ounces and don’t need to put liquid meds in a plastic bag. During screening, remove them from your carry-on to be screened separately, and make sure freezer packs are at least partially frozen, or they could be confiscated. For more information on carrying on medications, visit tsa.gov/travel/special-procedures.
If you have psoriatic arthritis, consider bringing along your most helpful assistive devices, such as utensils with grips. Use wheeled luggage, airport valets, and hotel porters to combat fatigue and keep from overloading joints.
Want to know more about the latest treatments for scalp psoriasis? Check out this webcast.
By Emily Delzell for NPF
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