Minimizing Flare-ups

These no-nonsense tips from dermatologists can help people living with psoriasis ease their discomfort and maximize the effectiveness of treatment.

1. Follow the basics of good health. Eating a balanced diet, drinking plenty of water, and getting enough sleep are all steps patients can take to avoid feeling tired and overstressed. This also can help the body fight off infections that can aggravate the skin.
    

2. Learn the triggers. Research shows there are known triggers for psoriasis — certain infections, some medications, skin injury, stress, and winter weather. Smoking also may trigger psoriasis. While it is not always possible to avoid every trigger, knowing what triggers psoriasis can help you make informed decisions. To learn more, see Psoriasis Triggers.
    

3. Keep track of flares. This can be an especially helpful technique for managing psoriasis. When a flare-up strikes, write down when it occurred and include information about what was happening at the time that may have triggered the psoriasis. Was there a stressful event in your life? Did spending a summer evening outdoors result in numerous mosquito bites? Keep in mind that psoriasis may not flare for 10 to 14 days after the skin is injured. This information can reveal facts about how psoriasis affects you and offer insight to help you and your dermatologist better manage the condition.
    

4. Quit Smoking. If you have psoriasis or a family history of psoriasis, don’t start smoking. If you do smoke, here’s another good reason to quit. Research continues to suggest that smoking may trigger psoriasis. It appears that localized pustular psoriasis, which occurs on the palms and soles, can be aggravated by smoking and that in some cases, quitting smoking clears the skin. Research also suggests that severe psoriasis may be linked to smoking.
   
   If you are trying to quit, do not use a nicotine patch before consulting a dermatologist. Nicotine patches can aggravate psoriasis.
    

5. Limit alcohol consumption. Research indicates that heavy drinking may trigger psoriasis and even prevent treatment from being effective. Studies also are finding that there may be a link between severe psoriasis and heavy drinking. Dermatologists recommend that their patients who drink should do so in moderation. However, people taking methotrexate, a medication used to treat moderate to severe psoriasis, should not drink alcohol. Mixing methotrexate and alcohol can have serious side effects.
    

6. Reduce Stress. Many people with psoriasis say they experience flare-ups during stressful times. While stress cannot be prevented, there are a number of healthy ways to reduce stress. Some people find that joining a psoriasis support group helps. Others find comfort in psychological counseling. Exercise and a number of relaxation techniques also can effectively reduce stress.
   
   According to the National Psoriasis Foundation, stress reduction works best when combined with medical treatment.
    

7. Take good care of your skin:

• Apply emollients and moisturizers. Emollients soften the skin. Moisturizers lock in the skin’s own moisture to prevent dryness and cracking. One of the best ways to lock in moisture is to apply moisturizer after bathing. Regular use of moisturizers can help prevent the itch and pain of dry skin and reduce scaling and inflammation. People often get good results by applying a lotion during the day and a cream or ointment, which are thicker than lotion, at night.
   

• Avoid scratching. There is no doubt about it, psoriasis itches. In fact, the word “psoriasis” derives from the Greek word for itch, “psora” The thought of not scratching can seem maddening. However, scratching can puncture the skin, allowing bacteria to enter and cause an infection. Scratching also causes the skin to bleed and worsens psoriasis. After scratching, lesions can appear on previously clear skin. To alleviate the itch, dermatologists recommend:

Treat the psoriasis. Dermatologists say that one of the most effective ways to stop the itch is to treat the psoriasis. When the psoriasis clears, the itch usually disappears. In the interim, these can curb the itch:

• Apply a cold compress. Applying a cold compress can reduce inflammation and lessen the desire to scratch.
   

• Apply a menthol-based ointment or topical steroid. These can help manage the itch until the psoriasis clears.
   

• Moisturize. Moisturizing, especially after bathing, can help relieve the dry skin that causes itching.
   

• Soak in a warm oatmeal bath. This relieves itching for some people. A dermatologist can recommend an appropriate oatmeal-bath preparation.

Once lesions clear, it is important to continue using emollients and moisturizers. Regular use can help soften skin and prevent the dryness that causes the skin to itch.

• Bathe in warm, not hot water. Dermatologists recommend that patients with psoriasis take short, warm showers and use fragrance-free cleansers.

• Never pick at lesions. Like scratching, picking at lesions can cause bleeding, infection, and a worsening of the psoriasis. Dermatologists recommend treatment to clear the psoriasis and regular use of emollients and moisturizers to help soften skin and prevent dryness.
   

• Pat your skin dry; rubbing can irritate it. Rubbing, or irritating the skin in any way, can cause psoriasis lesions to form. Developing a habit of gently patting your skin dry can alleviate this problem.
   

• Use sunscreen. While sunlight can help treat psoriasis, many treatments make the skin sun-sensitive. Anyone using a topical or systemic retinoid or PUVA therapy must protect their skin from the sun. Patients using retinoids should apply sunscreen 15 to 20 minutes before going outdoors and wear protective clothing. Additionally, sun exposure can cause sunburn, which can trigger psoriasis.
   

• Wear cotton clothing next to your skin. Cotton is less likely than other fabrics to irritate the skin or cause overheating.

An educational program brought to you by the American Academy of Dermatology.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.

Supported by an educational donation provided by Amgen and Wyeth.