Your Winter Psoriasis Questions, Answered
Solutions to all your lingering cold-weather skin worries.
As the number on the thermostat drops, the risk for psoriasis flares goes up. And that leaves many of the 7.5 million Americans who have the skin condition full of questions about how to prevent plaques from popping up—and how to treat the ones that do. Here, we tapped the experts to share some of the questions they’ve been fielding from patients that might help you, too.
Q: There’s so much advice about taking baths to soften psoriasis plaques and ease inflammation, but some folks only have a shower—any tips?
A: According to Rita Linkner, M.D., assistant clinical professor of dermatology at Mount Sinai Hospital in New York City, “If you have a sensitive skin syndrome like psoriasis, eczema, or just dry skin, then showers should be all business and no pleasure.” That means: “Short—less than five minutes—and ideally with lukewarm water.” And finally, she advises, “When you get out, towel off gently, leaving some beads of water on the skin's surface and then use ceramide-based products to lock that water back into your skin's barrier.” One of her favorites: Rodan + Fields Soothe Soothe Sensitive Skin Treatment, $87, rodanandfields.com.
Q: What should a psoriasis patient know about holding off flares while wearing a face mask?
A: It’s sad but true: Your face needs protection from your virus protection! Amy Spizuoco, M.D., clinical instructor of dermatology at The Icahn School of Medicine at Mount Sinai Hospital in New York City. Dr. Spizuoco lays out your strategy: “Keep your skin hydrated and moisturized to create a barrier between you and your mask. This will prevent and minimize any ‘break’ in your skin's natural barrier system and help decrease any risk of flares.” Also, when in doubt, look for soft breathable fabrics like cotton or paper surgical masks and stay away from scratchy extras like sequins, beads, or other embellishments.
Q: Indoor heaters and fireplaces make for very dry air, which can be both a trigger for symptoms and make existing plaques more uncomfortable. What’s the way to combat that?
A: “Moisturize, moisturize, moisturize,” insists Dr. Linkner. “It sounds redundant, but it works well if done twice a day.” She says, “Ideally using simple soaps, like Ivory bar soap as well as detergents that are free of heavy allergens should help to maintain the skin's barrier.” And, she adds, “Use a humidifier at night to provide your skin the added hydration it needs to recuperate as you sleep.”
Q: How can I prevent winter flares around my eyes?
A: Although many people may think to switch to something thicker in the winter to protect from irritating winter wind, Dr. Linker warns, that with skin already more irritated in winter, “This is not the time to try new eye products—these often times can illicit allergic reactions that can ignite a psoriasis flare.” However, if you must, she says to remember that “less is more around the eyes” and to look for hydrating formulas without fragrance. And for everyone but especially psoriasis patients who must be very wary of harsh or drying ingredients like vitamin A (a.k.a. retinol) and instead look for something with hydrating ingredients like hyaluronic acid. Try: CeraVe Eye Repair Cream, $16, ulta.com.
Q: What should you look for in a winter coat to keep from flaring around the collar and sleeves?
A: Skip anything that feels the least bit itchy as the act of scratching—and you’ll want to scratch—can trigger a flare-up and make itchy existing plaques even itchier thanks to inflammation. Dr. Linkner says that although they may seem like a good idea in freezing temps, “irritating fibers like wool and cashmere are not ideal.” Instead, she says, lean on softer fabrics like cotton fleece or opting for a smooth puffer-style coat instead.
Q: Scalp psoriasis flares can increase in the winter. What’s the best way to handle this?
A: Reach for a shampoo spiked with ingredients to treat and slough off scales like pyrithione zinc, salicylic acid, coal tar, and selenium sulfide. Although there’s no definitive research some people with scalp psoriasis report they feel their skin stops responding to medicated shampoos over time. If that’s the case, Dr. Spizuoco says, “Have two different ones—medicated and non-medicated shampoo and rotate them.” And if a flare-up is recurrent or severe, see your derm, who can prescribe a topical steroid product to calm the patches.
Q: I’ve heard that the sun is good for psoriasis. What can you do to off-set the lack of sunlight this time of year?
A: It is true, studies have shown that sunlight can help calm the immune system response that leads to psoriasis. What to do when it’s in short supply? First, ask your derm if phototherapy, which can mimic the effects of the sun indoors, is right for you. Another tactic that may help, according to Dr. Spizuoco: replacing the anti-inflammatory vitamin D you’d be getting out in the rays, which is important for skin health in general. She insists that when it comes to the nutrient, “We can't rely only sunlight, we need to get it in our diet or supplements.” Foods rich in vitamin D include salmon, egg yolks, portabella mushrooms, and vitamin D-enriched cow or almond milk. As for supplements, 600 IU is the daily amount recommended by the Mayo Clinic.
Q: Drinking water is often recommended for combating winter dryness. Do you have any tips for sneaking more in for people who don’t naturally love it?
A: Water does indeed help to prevent water loss in the top layer of the skin, but really, the goal, according to Dr. Spizuoco is preventing dehydration in general. Her recommendation is to go with something sugar-free (which is better for your health overall) like regular water or Vitamin Water. “But my personal favorite to hydrate—especially in the winter—is green or white tea. They both have tons of health benefits, including antioxidants.”
Q: Is there anything special to protect hands now that we’re all washing them so much to prevent infection?
A: Generally speaking, using soaps over sanitizer (which contains drying alcohol) is best, according to Dr. Spizuoco. When it comes to soap, think basic and skip any formulas that contain scrubbing beads. Also, keep a hand cream on the sink as well, as frequent sudsing sessions can leave skin dry. “I recommend moisturizers that have ceramides to help lock in moisture,” she says. One to try: CeraVe Therapeutic Hand Cream, $13, cvs.com.
- Sunlight and Psoriasis: British Journal of Dermatology. (2010). “Sun exposure induces rapid immunological changes in skin and peripheral blood in patients with psoriasis.” oslo-universitetssykehus.no/Documents/Behandlingsreiser/Forskning/Psoriasis%20hos%20voksne,%20barn%20og%20ungdom/PSO4_immunologi1.pdf
- Phototherapy and Psoriasis: Lasers in Medical Science. (2017). “A clinical review of phototherapy for psoriasis.” dash.harvard.edu/handle/1/34869024?show=full