How Top Docs & Real Patients Keep Psoriasis in Check
We've got 10 proven strategies that can help stretch the time between your psoriasis flares.by Beth Shapouri Health Writer
When you have a chronic skin condition like psoriasis you know that flares (and the accompanying redness, itching, and plaques) are par for the course. Coincidentally, your goal is to go as long as possible in between each one. With the right mix of tips and medications you can hold off the inflammatory—and downright annoying—symptoms. Scroll through for some expert-approved strategies and power-playing meds to keep flare episodes at bay for a good chunk of time.
Start a Symptom Journal
Relying on recall isn’t the most effective way to fully understand your triggers and stave off future psoriasis episodes. Instead, start documenting! “I recommend that you journal daily for a minimum of 12 weeks to see patterns,” says Robyn Gmyrek, M.D., a clinical instructor of dermatology at Mt. Sinai Hospital in New York City. Include specifics on your skin condition that day (mild or severe) as well as what you ate, the medications you took, what and how much exercise you did, any allergies or infections, and your overall stress level. “You might not only identify things that trigger flare-ups, but also things that improve your condition,” she says.
Practice Good Sleep Hygiene
Ah, the Sandman. He’s good for so much, including keeping chiropractor Laura DeCesaris, 32, of Scottsdale, AZ, free of psoriasis symptoms for longer. DeCesaris’ go-tos: wearing blue-light-blocking glasses to help filter out computer light when she’s working in the evening and avoiding sugar and caffeine late in the day. And to quiet her mind, “I keep a little notebook by my bed so if my mind is churning at night,” she says, “I can write down whatever is on my mind and ‘let it go’ until the morning.”
Ask About a Biologic
There are many prescription options for treating psoriasis, but to reduce the overall frequency of outbreaks, doctors often turn to immune-modulating drugs called “biologics,” explains Dr. Gmyrek, who is also a dermatologist at Park View Laser Dermatology in New York City. These injections, including methotrexate and cyclosporine, decrease the immune-system-provoking inflammation that brings on flare-ups—but in a very direct way. “Unlike drugs that work on your whole immune system, biologics used for psoriasis block specific cells,” Dr. Gmyrek says. “Since [they] are so targeted, they can be safer than medications that broadly suppress the immune system.”
Watch What You Wear
Fabric matters! “I stay away from nylon and rayon,” says Jon Quigley, 58, of Lexington, NC, who has psoriasis. “They irritate my skin.” Dermatologist Michelle Henry, M.D., a clinical instructor of dermatology at Weill Cornell Medical College in New York City, backs him up: Certain materials can cause friction that can lead to a plaque outbreak. She suggests cotton over synthetic clothes, and using detergent without harsh chemicals. “The Environmental Working Group has a database called SkinDeep, where you can search for detergents and see how ‘clean’ they really are,” Dr. Henry says. “Choose one with a rating of 1 or 2.”
Consider Light Therapy
It’s a common recommendation with scientific backing—it was found highly effective in treating and holding off flare-ups, per a 2017 review by the Institute for Quality and Efficiency in Health Care in Cologne, Germany—and real-world fans. “I ended up purchasing a [Joovv] red-light unit for home use,” says DeCesaris, who uses it daily. Quigley goes the sunlight route, which Dr. Gmyrek’s patients have found beneficial, as well. So much so, she suggests patients exercise outdoors for their daily dose of rays. Just make sure to talk to your doctor to head off risk factors like skin cancer.
Apply Moisturizer Liberally
Every day! Potentially multiple times a day! Doing so can be helpful in preventing episodes, says Dr. Henry, who recommends a mild lotion. “Moisturizing between flares is a good idea, because if your skin is more moist, it’s less likely to become aggravated,” she explains. If you can, buy multiples and stash a bottle in your bedroom, bathroom, and gym bag to help you remember to slather it on.
Talk to Your Doctor—a Lot
Dr. Gmyrek regularly reminds her clients of two truths: There is no one best way to treat psoriasis, and treatment varies from patient to patient. That means working with your doctor to find the exact combination of lifestyle changes, medications, and other strategies most effective for you. While this can take some time, staying in communication with your care team and alerting them to any skin changes can help ensure you’re on the right track.
We all know that stress is bad for us, but it’s downright evil for psoriasis. “Stress and the nervous system have an impact on inflammatory conditions, including psoriasis,” says Dr. Gmyrek. Taking steps to find inner zen can stop the response that causes the itchy skin and red lesions. Anything that helps you relax is fair game, but Dr. Gmyrek suggests exercising outdoors (sunshine helps your bod release more of the calming hormone serotonin) and soothing activities like meditation or knitting.
Don’t Forget Fitness
Another reason to exercise, beyond its stress-reducing effects: A 2018 meta-analysis in Medicine showed that vigorous exercise can help keep psoriasis symptoms away. Don’t let the word “vigorous” deter you from starting a plan. “Choose an activity that is comfortable for you,” says Dr. Henry. “Running, swimming, walking—all of these are great for reducing inflammation.” But, she emphasizes, “the best kind of exercise is the one that doesn’t aggravate symptoms for you. If biking [causes] friction against the seat, try a calming yoga class.”
Please, give it up! Smoking is a major trigger for psoriasis (among a zillion other issues): Puffing nicotine is highly correlated with both the onset and severity of outbreaks, according to one review of research. Ending your relationship with cigarettes is especially important for people with psoriatic arthritis. A 2015 study in the journal Annals of Rheumatic Diseases found that those who smoked showed poorer responses to treatment once plaques did occur.
Phototherapy Review: Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG). “Does light therapy (phototherapy) help reduce psoriasis symptoms?” ncbi.nlm.nih.gov/books/NBK435696/
Link Between Exercise and Psoriasis Management: Medicine. (2018) “Association between physical activity and risk of prevalent psoriasis: A MOOSE-compliant meta-analysis. ncbi.nlm.nih.gov/pmc/articles/PMC6076093/
Association Between Smoking and Psoriasis: Arch Dermatol. (2005) “Relationship Between Smoking and the Clinical Severity of Psoriasis.” jamanetwork.com/journals/jamadermatology/fullarticle/401096
Psoriatic Arthritis and Smoking: Ann Rheum Dis. (2015) “Association between tobacco smoking and response to tumour necrosis factor α inhibitor treatment in psoriatic arthritis: results from the DANBIO registry.” pubmed.ncbi.nlm.nih.gov/25063827/