Health Tips

Topic 5: Self Care for Psoriasis Patients (General)

Welcome to DOC2US Psoriasis Health Tips Section! Hope you enjoyed our previous articles and let’s dive deeper into the topic of psoriasis today. 

In our earlier articles, we have gathered that psoriasis can be controlled and managed with the right treatment and taking your medications as instructed by your doctor. In this article, we will continue to share more tips on how to take care of yourself or your loved ones if you are the caregiver. Self-care strategies are helpful to relieve symptoms in psoriatic patients during times of psoriasis activity and also extend the time in remission.¹ 

What are some examples of self care practices for a psoriasis patient?

Here are some friendly tips that have helped many other people better manage their symptoms. 

1. Constant Skin Hydration

Maintaining skin moisture is fundamental for every psoriasis patient. It generally facilitates skin healing, reduces redness, dryness, itching, soreness as well as skin flaking which are thought to be the most troublesome among psoriatic patients.^2,3 There are many types of moisturisers that contain different ingredients to help with skin hydration. These include the ointment-based moisturiser that are thick and heavy which makes them better at retaining moisture, lotions that are thinner and get absorbed easier by the skin, or you may also choose a cream–based moisturiser that falls somewhere in between ointment or lotion types.^2,3 For psoriasis patients whose skin is very dry, oil-based moisturisers may be the preferable option as it has a stronger moisture retention effect.⁵ Look for moisturisers designed for sensitive skin that are fragrance-free or alcohol-free.^3,16 Natural compounds have also been reported to hydrate our skin. Some examples of natural compounds found in moisturising products are urea that aids in softening the outer layer of skin cells so they shed more easily or alternatively, lactic acid that eases scaly patches.⁴ Do consult your physician or visit your local pharmacies to get the most suitable moisturiser for yourself. 

The best time to apply the moisturiser is directly after bathing by patting it on your damp skin for enhanced absorption. For skins that tend to itch, moisturisers can first be refrigerated prior to use.³

Besides moisturisers, humidifier can also be used to hydrate the skin, especially if you are in a country with hot and humid weather such as Malaysia.²
 

Figure 1: Moisturising skin
Image credit to Happy Knits    
                                               
      

Figure 2: Humidifier
Image credit to Wow Skin Science
 

2.   Daily Warm Baths at least 15 mins

Daily baths can actually help relieve inflamed skin and remove scales associated with psoriasis.³ A daily warm bath of at least 15 minutes with mild soap in lukewarm water usually does the trick.^2,5 A gentle reminder to avoid using antiseptics as it may irritate the skin.⁷ Alternatively, finely ground oatmeal, Epsom salts or Dead Sea Salts can also be added to the bath water for additional comfort as studies have found them to be soothing for dry, itchy skin.^2,3,5 

Figure 3: Epsom salt bath 

Image credit to Cleveland Clinic

3. Alcohol & Smoking Cessation 

Studies have found that heavy alcohol consumption may decrease treatment response to some psoriasis treatments, or may increase the risk of liver problems.^5,7,8 In fact, higher prevalence of psoriasis has shown in men who are chronic drinkers.⁷ For women especially, reducing or avoiding alcohol intake altogether can reduce the risk of developing psoriatic arthritis.⁸ Hence, it is advised to avoid alcohol completely or to drink in moderation if required.⁵

Smoking has been described as a risk factor for psoriasis as well as a comorbid entity to which psoriatic patients are more predisposed.⁷ Through smoking cessation, studies have demonstrated that patients tend to experience fewer psoriasis flares and increased duration of remission (periods with little or no psoriasis).⁸

4. Dietary and Weight Management 

Maintaining a healthy weight is important for psoriasis patients.¹¹ In fact, losing even a small amount of weight may help to relieve psoriasis symptoms like flaky, itchy and painful patches.¹¹ A 2018 study in JAMA Dermatology has shown that a low calorie diet (~800-1400 kcal/day) has a significant effect in decreasing the severity and symptoms of psoriasis, particularly among psoriasis patients who are overweight.^6,10 However, for the effects to be seen, patients need to be consistent with their low calorie diet plan for at least 16 weeks to 6 months.¹⁰ Additionally, eating a balanced diet reduces the risk of heart disease, diabetes, and other associated health conditions associated with psoriasis.⁷ 

Additionally, minimise the intake of highly processed foods whenever possible and substitute pastries and cookies with fruits instead.⁹ These should also be accompanied by healthy lifestyle habits such as getting adequate sleep and adopting routine exercises.⁹
 

Figure 4: Balanced diet

Image credit to Quarter Quarter Half diet

5. Practice Relaxation Techniques

Stress is a common psoriasis trigger.¹ Psoriasis itself can be a source of stress.⁶ Thus, it is crucial to take steps in managing your stress levels to improve psoriasis symptoms.¹ Stress reduction interventions such as yoga, meditation, group support, breathing exercises; which have been proven to be effective in managing psoriasis severity.^1,7

Figure 5: Meditation practice 

Image credit to LearnSkin Alternative Therapies for Psoriasis
 

6. Sunlight Exposure

It is reported that the ultraviolet (UV) light from the sun slows the growth of skin cells.² As a result, scaling and inflammation can be reduced.⁶ So small doses of sun can be a good way to soothe, improve, and even heal psoriasis lesions.² However, too much of sun exposure may lead to sunburn and worsen the condition of the psoriasis.⁶ It is important that you apply sunscreen with minimum sun protection factor (SPF) of 30 on the non-psoriatic areas.⁵

How do I know if I’m experiencing a psoriasis flare-up?  

A flare happens when symptoms of an existing disease suddenly worsen in severity which will eventually subside if well taken care of.¹²  A psoriasis flare-up can be caused by specific triggers such as cold and dry weather, infections, stress, skin injuries and some may be medicine-induced.¹³ Psoriasis flare-ups can be completely random and the severity of a flare-up varies from person to person.⁶ By identifying what triggers your flare, you’re one step closer to managing your flares and will have better control of your condition.¹

Depending on individuals, a psoriasis flare can happen from a few weeks to a few months, followed by periods when the symptoms subside.¹³ A psoriasis flare-up is usually identified by red, dry, and thick skin patches in which they sometimes are made up of silvery-white scales that itch or burn.¹³ As a result, psoriasis patients may experience skin cracking and bleeding.¹³ Psoriasis plaques are commonly found on the scalp, low back, knees, skinfolds such as the armpit area, under the breasts, groin and genitals.¹³ Besides, patients may also experience nail changes that include pitting, thickening, discoloration and nail bed separation, depression, anxiety or joint symptoms such as stiff, swollen joints in cases of psoriatic arthritis.¹³

Figure 6: Psoriatic flare-ups

Image credit to WebMD

When should you seek medication attention? 

Getting medical care is crucial to keep psoriasis-related pain and inflammation under control. Here are some of the signs that required medical attention:-¹⁴

1. New or worsening skin pain¹⁴

2. Uncontrolled bleeding of skin plaques¹⁴

3. New joint pain, or worsening of stiff and achy joints¹⁴
   The Psoriasis Foundation Medical Board suggests that patients should visit the doctor if they experience:¹⁵
   - swelling, pain or stiffness in one or more joints, especially the fingers or toes¹⁵
   - pain or tenderness at the lower back, feet or ankles¹⁵
   - joints that feel warm to the touch¹⁵
   - an apparent change of appearance in nails including pitting or separation from the nail bed¹⁵
   This is because it could be a sign of psoriatic arthritis, which is found to be relatively common (~30%) among psoriasis patients.¹⁵

4. New health problems, such as weight gain, dizziness, or a racing heart¹⁴
   These could be signs of other health conditions associated with psoriasis such as diabetes and heart diseases.¹⁴

Figure 7: Psoriasis red flags

Image credit to Healthline: Psoriatic Rash

How to manage flare episodes?

Taking medication as directed by your doctor is the first step in preventing psoriasis flare-ups. Here are some of the tips which can help to reduce symptoms and get quick relief. 

1. Keep skin moisturised throughout the day¹⁶
   Maintaining skin moisture is the key in preventing dry, itchy skin caused by a psoriasis flare-up and making flares easier to manage.¹⁶ The National Psoriasis Foundation recommends using heavy creams or ointments that lock in water. Look for moisturisers that are fragrance-free or alcohol-free. Fragrances and alcohol can actually dry out your skin.¹⁶ 

2. Resist The Temptation to Scratch¹⁶
   Try resisting the urge to scratch or rub your scalp during a flare-up as this may cause undesirable consequences such as bleeding, scabbing or even hair loss.¹⁶ It may also irritate the skin by causing wounds, slow the healing time and increase the risk of infection.¹⁷ It is also essential to note that soaps and shampoos used on a daily basis should be fragrance-free and alcohol-free as they may dry out the scalp or even be a trigger itself and result in more flare-ups.¹⁶
   
   In order to temporarily relieve from itching, you may try to gently tap or rub the area near the lesions or apply cold/warm compresses and taking cool showers.¹⁷ Alternatively, you may consider getting anti-itch products that are available over the counter such as those containing calamine, camphor or menthol.¹⁸ In terms of home management, you may also soak yourself in Epsom or Dead Sea Salts with a duration not more than 15 minutes and moisturise accordingly afterwards.¹⁶ 

3. Consult Healthcare Professionals for Over-the-counter (OTC) Products¹⁸
   There are also numerous OTC products available when it comes to relieving psoriasis flare episodes.¹⁸ They’re easily accessible as you do not need a prescription.¹⁸ However, with the wide range of products made available, it's best to consult a healthcare professional, especially a dermatologist for advice on which products to use.¹⁸
   
   Coal tar formulations can generally ease psoriasis symptoms and can be found in most community pharmacies, either in the form of medicated shampoo, bath foams, soaps or ointments.¹⁶ Coal tar has been used over the years for psoriasis as it able to lessen the itching and flaking, reduce redness, swelling and scaling as well as slow the rapidly growing skin cells.¹⁸
   
   Furthermore, salicylic acid-containing products, also known as scale softeners, are often suggested to psoriasis patients, especially those who have thick plaque-type psoriasis.^16,18 This is because salicylic acid can help soften and loosen patches of psoriasis plaque during a flare-up.¹⁶ It is important to use the salicylic acid-containing product under the advice of a healthcare professional as too much may worsen your psoriasis.¹⁸ Besides salicylic acid, lactic acid and urea can also be opted as scale softeners.¹⁸ For best outcome, psoriasis patients are encouraged to take a warm 15-minute bath prior to applying the product.¹⁸
    

Develop the right, perfect routine that works for you

Whether you’ve just been recently diagnosed with psoriasis or you’ve had it for a while, it is important to identify and create a self-care routine that helps you better manage your symptoms and not let it hinder you from living your life to the fullest. Bear in mind that what works for another person may not work for you and it is okay to continuously try new things that work best for your body. Make a list of activities that you’ve tried and worked out for you and take note of those that do not or trigger flares. That way, you’ll eventually get a grasp of things and be more comfortable with managing your psoriasis both during and after remission. 

Have you read our previous article: Biologics of Psoriasis? Click here to know more https://www.doc2us.com/topic-4-biologics-for-psoriasis

Learn more about psoriasis in the next topic in this series – Myths and Facts about Psoriasis.

CP-339166 September 2022

A WORD FROM DOC2US
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REFERENCES

1. Lovering C. (2022) 8 Self-Care Strategies to Incorporate Into Your Psoriasis Management Routine. Available at https://www.healthline.com/health/psoriasis/self-care Website Accessed: 4th May 2022 

2. Fries, W. (2022).  7 Tips for Psoriasis Skin Care. Available at https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-skin-care-tips Website Accessed: 3rd May 2022

3. Kowalczyk, J. (2022). 6 Psoriasis Self-Care Tips You Should Try. Available at https://www.sharecare.com/skin-health/psoriasis/psoriasis-self-care-tips#slide-2 Website Accessed: 3rd May 2022 

4. Beauty Hacks for Psoriasis: Start Your Day Right (2022). Available at https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-beauty-hacks Website Accessed: 3rd May 2022

5. Mayo Clinic. Psoriasis Lifestyle and Home Remedies. (May, 2020). Available at https://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/drc-20355845#:~:text=Try%20these%20self%2Dcare%20measures,for%20at%20least%2015%20minutes. Website Accessed: 3rd May 2022 

6. Lindberg, S. (2021).  Psoriasis Getting Worse? Here’s What You Can Do About It. Available at  https://www.healthline.com/health/psoriasis/why-psoriasis-worsening#causes Website Accessed: 3rd May 2022

7. Sarkar, R., Chugh, S., & Bansal, S. (2016). General measures and quality of life issues in psoriasis. Indian Dermatology Online Journal, 7(6), 481. https://doi.org/10.4103/2229-5178.193908 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134161/ Website Accessed: 4th May 2022

8. American Academy of Dermatology Association. Healthy Diet and Other Lifestyle Changes That Can Improve Psoriasis. Available at https://www.aad.org/public/diseases/psoriasis/insider/diet Website Accessed: 4th May 2022

9. Wesdock, Margaret. Psoriasis Diet: Foods to Eat and Avoid If You Have Psoriasis. Available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/psoriasis-diet-foods-to-eat-and-avoid-if-you-have-psoriasis Website Accessed: 4th May 2022

10. Ford, A. et al. (2018) Dietary Recommendations for Adults with Psoriasis or Psoriatic Arthritis From the Medical Board of the National Psoriasis Foundation: A Systematic Review. Available at https://jamanetwork.com/journals/jamadermatology/article-abstract/2684587

11. Pagan, C,N. (2021). Psoriasis and Your Weight. Available at https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-weight-link#:~:text=Losing%20even%20a%20few%20pounds,almost%2050%25%20in%2020%20weeks. Website Accessed: 12th August 2022

12. Medicinenet.com. Medical Definition of Flare. Available at https://www.medicinenet.com/flare/definition.htm Website Accessed: 1st June 2022

13. Barhum, L. (2022). How Long Does Psoriasis Last? Available at https://www.verywellhealth.com/how-long-does-psoriasis-last-5219760 Website Accessed: 4th May 2022

14. Pagan, C,N. (2020). Psoriasis: When You Need an In-Person Visit. Available at https://www.webmd.com/skin-problems-and-treatments/psoriasis/psoriasis-covid-doctor-visit Website Accessed: 4th May 2022

15. Baucom, M. (2020) Treating Psoriasis: 6 Important Reasons to See Your Dermatologist. Available at https://www.healthline.com/health/psoriasis/moderate-to-severe/treating-psoriasis-important-reasons-to-see-your-dermatologist#new-symptoms Website Accessed: 4th May 2022

16. Santos-Longhurst, A. & Ledbetter, S. (2020). 10 Tips for Managing a Psoriasis Flare https://www.healthline.com/health/psoriasis/managing-severe-psoriasis-flare-ups Website Accessed: 1st June 2022

17. Villines, Z. (2019). Why Psoriasis Itches and How to Stop It. Available at https://www.medicalnewstoday.com/articles/319585#how-to-stop-itching Website Accessed: 5th May 2022

18. American Academy of Dermatology Association. What Psoriasis Treatments Are Available Without A Prescription? Available at https://www.aad.org/public/diseases/psoriasis/treatment/medications/non-prescription Website Accessed: 2nd June 2022

Written by

Janelle Leong