When the fall season approaches, this skin disorder can worsen. Here's how to cope.
By Colette Bouchez
Reviewed By Brunilda Nazario
As the hot, humid days of summer give way to cool autumn breezes, most folks breathe a sigh of relief. But this may not be the case if you suffer from psoriasis -- a chronic condition affecting the skin and joints of upwards of 4.5 million adults, as well as many children.
"The lack of humidity in the air allows the skin to retain moisture less well, and when that occurs, tiny cracks or fissures can develop on the surface of the skin," says Bruce Strober, MD, director of the Psoriasis and Psoriatic Arthritis Center at NYU Medical Center in New York City.
Psoriasis most commonly appears on the scalp, knees, elbows, and torso but can develop more readily in areas where skin is traumatized or "broken." Strober says anything that causes that to happen -- like cool, dry air -- can also exacerbate the disease.
According to the National Psoriasis Foundation, this irritating skin condition comes in several different forms with varying levels of severity. In nearly all cases, however, it begins when the normal system of cell turnover goes awry.
"Normally the top layer of skin makes itself over every 28 to 30 days -- the old cells are microscopically shed, while the new ones take their place," says Mark Lebwohl, MD, PhD, chairman of the department of dermatology at the Mt. Sinai Medical Center in New York City. In psoriasis, however, Lebwohl says that this natural process is sped up dramatically.
"In psoriasis, cells turn over as quickly as every two to three days," says Lebwohl.
The old cells don't shed off normally and new cells multiply so quickly they stick together and form lesions called patches or plaques. In the most common form of this condition, the end result can be dry, scaly, red, and sometimes itchy patches of skin. And the drier your skin gets, the worse the patches can look -- and feel.
The good news: Judicious use of moisturizer can make a huge difference -- particularly as the seasons change. Not only can this help keep tiny cracks in the skin from forming, it can also help the dry patches already there look and feel better.
"Continued use of a good penetrating moisturizer, as well a bath oil, is absolutely vital to controlling psoriasis in any weather, but particularly during dry, cold weather," says Milton Moore, MD, assistant professor of dermatology at the Baylor College of Medicine in Houston.
In fact, getting moisture deep into the skin is so important that Moore used his degrees in pharmacy and medicine to develop a patent-pending pretreatment lotion known as "Hydroglide Pre Application Lotion." When applied to psoriatic plaques first, he says, studies presented before the American Academy of Dermatology showed it can help almost any moisturizer or topical medication penetrate more deeply.
Other doctors say any bland but greasy moisturizer will work it's way into the skin as well, as long as you apply a lot of it and use it often, particularly after bathing.
Stressful Seasons for Psoriasis
Although psoriasis is believed to be the result of an immune system malfunction, Lebwohl says there have also been a number of genes identified with this condition. And like most genetic conditions, he tells WebMD that there is also a unique, genetically determined time frame in which psoriasis is triggered into action, and it's different for everybody who has it. Still, he says, something does have to act as the initial trigger, and often, that "something" is stress.
Indeed, in a study published in the Journal of the American Academy of Dermatology in 1988, doctors from the Baylor College of Medicine concluded that stress can not only trigger a psoriasis flare-up, but in some instances it may also play a significant role in the initial onset of the condition.
Since the fall season frequently kicks off an activity-packed school year -- stressful for parents as well as students -- it's not hard to see why this time of year can make psoriasis worse. Toss in a stress-filled holiday season, and some psoriasis patients can suffer well into the New Year.
But doctors say you can head off the effects of stress by engaging in some form of relaxation beginning at the start of the fall season. The Baylor research notes that several studies found hypnosis and biofeedback are effective stress reducers in some people with psoriasis.
And in at least one study published in a Swedish dermatology journal, doctors from McGill University in Quebec found that both meditation and guided imagery were effective relaxation methods in reducing psoriasis symptoms. Lebwohl reports that in another study, patients undergoing UV light therapy who practiced guided imagery -- imagining their psoriasis being healed -- experienced a quicker remission than those undergoing UV therapy alone.
Indeed, Moore tells WebMD that anything that helps you relax -- including meditative yoga, vigorous exercise, acupuncture, or even just taking time out of your day to listen to a favorite CD or drift away with a great novel -- can help keep your psoriasis under control, particularly during a stressful season. Remember that these techniques work best with traditional medical therapy instead of alone.
Eat, Drink, Be Merry -- but Don't Overdo
When it comes to diet and psoriasis, most speculation has surrounded foods high in essential fatty acids, particularly omega-3s -- abundant in fish, flaxseed, and some vegetables. But while some studies have found these foods helpful for a number of inflammatory immune disorders, at least some doctors are convinced that help doesn't extend to psoriasis.
"I don't buy it," says Strober, who says there is no convincing evidence that any foods play a role in either helping or harming psoriasis.
Lebwohl agrees: "There were some preliminary data in open trials suggesting eating more fish might be effective ... but in the end it was found not to help at all," he says.
Moore is a bit more flexible. He tells WebMD that "overall, omega-3s are good for the skin, particularly dry skin, and when skin is in better condition, you're going to have easier time controlling psoriasis, so in this respect these foods might make some difference."
The National Psoriasis Foundation reports that some people have found relief using small doses of fish oil capsules -- a potent source of omega-3s.
What everyone seems to agree can help, however, is skipping that wine cocktail with your dinner, as well as any other type of alcoholic beverage."There's a group of patients who notice, a day or two after drinking alcohol in significant amounts, or even a couple of beers for that matter, that their psoriasis worsens," says Strober. If you're one of those people, experts say don't drink, especially in fall and winter.
Psoriasis and Your Environment
In addition to ushering in cooler, drier temperatures, the start of fall can also mean less sunshine. And in the case of psoriasis, that's not a good thing.
While getting too much sun -- and particularly a sunburn -- can worsen this condition, Lebwohl says getting 15 to 20 minutes of exposure daily can be beneficial, helping to keep breakouts under control. As such, experts say that as seasons change, try to spend at least a little time outdoors in direct sunlight. If that's not possible, talk to your doctor about UV light therapy -- a way of mechanically re-creating the healing effects of the sun.
"It's the treatment I use most often for psoriasis, and it's actually safer than sunlight," says Lebwohl. In use for more than 80 years, he says it also does not increase the risk of skin cancer.
You can also make your indoor space a more healing place if you use a humidifier -- a way of mechanically putting more moisture into your personal space. Doctors say it's a leading way to combat psoriasis symptoms all year round. If you can't afford an electric humidifier, try putting pots of water on or near your radiators or air vents, and leave one on a nightstand by your bed.
Psoriasis Solutions: How Your Doctor Can Help
When it comes to trying alternative remedies -- including popular treatments such as aloe vera, echinacea, or peppermint oil -- you may want to think twice. Although frequently recommended by natural medicine enthusiasts as helpful for psoriasis, the doctors we spoke to don't put much stock in these home remedies. Moore, however, says aloe vera gel does have important healing properties for the skin and might help reduce the tiny fissures that exacerbate a psoriasis flare.
"As a treatment it's not going to make or break your psoriasis, but aloe vera does have healing properties that allow skin to do what it needs to do to heal on it's own, only just a little bit better," says Moore.
In addition to whatever self-help measures you try, there are also a number of both prescription and over-the-counter topical preparations that can help. These include prescription strength moisturizers (usually in the form of heavy ointments), hydrocortisone cream to control itch and inflammation, and, one of the oldest remedies on the medical books: a preparation known as "coal tar." It treats the scaling, inflammation, and itch of psoriasis. While considered carcinogenic in high amounts, doctors say it's safe and effective in the amount used to treat psoriasis.
If you still need more help, a new class of medications known as "biologics" may be just what the doctor orders. Lebwohl says these new injectable drugs, including Enbrel, Raptiva, and Amivive, are thought to be safer than older systemic medications (like methotrexate or cyclosporine) with fewer side effects. However, Moore cautions that the treatments do require injections several times a week -- some given by your doctor -- and they are expensive, "costing up to $1,000 a month or more," he says. And, be aware that insurance, if you have it, can give you a hard time about picking up the tab.
Published Sept. 20, 2004.
SOURCES: Bruce Strober, MD, co-director, Psoriasis and Psoriatic Arthritis Center, NYU Medical Center, New York. Mark Lebwohl, MD, chairman, department of dermatology, Mt. Sinai Medical Center, New York. Milton Moore, MD, associate clinical professor of dermatology, Baylor College of Medicine, Houston. Journal of the American Academy of Dermatology, January 1988; vol 18: pp 101-104; Acta Dermato-Venereologica (Suppl), 1991; vol 156: pp 37-43.
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