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Stick to your treatment plan, but keep your provider updated on any new symptoms or triggers
If you know your psoriasis triggers, avoiding them is a good first step to managing your flare-ups. But this isn’t always possible — after all, you can’t always avoid getting sick. And not every psoriasis flare has a clear-cut source, so prevention is complicated.
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But there are tried-and-true treatments and approaches that healthcare providers have found to be successful. When a flare-up strikes, it’s important to know how to act and what to avoid so you don’t make your symptoms worse.
Dermatologist Anthony Fernandez, MD, explains ways you can calm your psoriasis flare-ups and how you can prevent them from occurring in the future.
Managing psoriasis is a two-part task: You have to know how the condition works and what causes your triggers. Then, you have to respond to those triggers with the right kinds of treatments without further aggravating your skin barrier or your immune system response.
“It’s important for people to trust our knowledge about the numerous proven treatment options that are available for inflammatory diseases, but also important to realize that we don’t want to choose treatments for them but to work with them to ensure we choose treatments that align with their own goals and preferences,” states Dr. Fernandez.
“We want to work as a team. We can only do that, though, if people tell us their new problems as they arise as opposed to trying to make their own diagnoses and then trying remedies on their own. There are certainly ‘remedies’ mentioned on the internet that have been scientifically shown to cause more harm than good.”
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So, the next time you have a flare-up, here are things you should and shouldn’t do.
If your psoriasis treatment has been working and you’re doing well, but you suddenly have a flare, Dr. Fernandez says monitoring the situation is a good next step. Don’t throw caution to the wind and jump to the next best treatment you think might solve the situation.
“What we don’t want to do is panic and change the old treatment regimen because you’re flaring, especially if you’ve generally done well on a given regimen,” he says.
“With all the great medicines that we have today, we can usually control psoriasis so that a person has no more than about 1% body surface area of psoriasis on the skin — about one palm of your hand. When you’re flaring, you’ll have more of that. But this may be short-lived and we often find you’ll soon go back to having a minimal amount of psoriasis if you’ve done well on a treatment regimen for a significant amount of time.”
Information is key. Take note of new symptoms, new areas that have been affected and new potential triggers that have occurred recently. If you’ve experienced changes in your life such as stress, other environmental factors, injuries or illnesses, these are important pieces of information to share with your provider. Infections, in particular, often require specific kinds of treatment to help stop a flare-up from occurring. Sometimes, additional medications may be used for more severe flare-ups, including topical steroid creams you apply directly to the skin, oral steroids you take by mouth and other long-used psoriasis treatments like cyclosporine.
“Depending on the severity of the flare, we might add medicines that we believe are going to kick in and take control of active inflammation fast,” clarifies Dr. Fernandez.
“Usually, our goal is just to give that to you for a few weeks, and then try to taper you off and see if that flare has run its course. Then, you can go back to your baseline regimen to manage your condition.”
Moisturizer on its own isn’t necessarily a psoriasis treatment. But it can go a long way to soothe and address the side effects of the condition. “If you have psoriasis, any moisturizer usually helps your skin feel better,” notes Dr. Fernandez. “You tend to get psoriasis over joints like the elbow, so bending it stretches the skin. If the skin is really dry, it can crack and bleed and hurt. So, moisturizer will help with unpleasant symptoms.”
Moisturizer with salicylic acid is an even better choice to address psoriasis — specifically, the thick scales associated with psoriasis skin lesions.
“A moisturizer with salicylic acid can be an effective way to not only make your skin feel better, but also help topical medications work better to heal those lesions,” explains Dr. Fernandez. “If you have thick scales, topical medications have to penetrate through those and your top layer of skin before reaching the inflammatory cells causing the lesions. Salicylic acid helps dissolve those scales so that topical medicines can penetrate and work better.”
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Taking fewer lukewarm showers, using fragrance-free soaps and applying moisturizer after showering or whenever you wash your face and hands are also helpful tools for hydrating your skin.
You might be inspired to burn away the itch, but really fight the urge to reach for a bottle of rubbing alcohol. The damage and subtle burn you cause to your skin will actually end up causing a more intense immune system response because your body is trying to heal itself just in a more over-active way.
“Even though alcohol may temporarily relieve itching, the end result is it’s going to cause more irritation and promote more inflammation,” warns Dr. Fernandez.
Whenever possible, avoid picking, rubbing or scratching at affected areas of your skin. Not only can this lead to a more robust immune response, but if you introduce bacteria to the area, you could also end up with an open wound and an infection that could worsen your symptoms and psoriasis flares.
If you’re looking to calm the itch, several home remedies like oatmeal baths, baths with Epsom salt and topical ointments with coal tar can be helpful and rejuvenating.
There may not be a cure for psoriasis, but with the right treatment plan and guidance, you can prevent a flare-up from happening and reduce the likelihood that it will linger long when it does. Dr. Fernandez offers these tips.
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Stress can take a toll on your body in a whole lot of ways — and it’s one of the most common triggers for psoriasis. Finding strategies to destress and prioritize your mental and emotional health will impact your physical health, too, and help reduce the frequency of psoriasis flare-ups. To bring down your stress levels, consider:
Keeping a food journal is a good activity for anyone who’s trying to keep track of foods that may cause certain sensitivities or triggers — and that’s especially true for anyone living with psoriasis. Depending on how your body reacts to certain foods, your flare-ups might be triggered based on what you’re eating. The key is to eat a healthy, balanced diet and avoid foods that upset your symptoms or cause inflammation. And if any triggers arise, again, bring those triggers to your provider’s attention right away.
Improvements to your physical, mental and emotional health can impact your overall health. And how you sleep and the level of your physical activity is just as important as the foods you eat and what you do during the rest of your day.
“Eating well, exercising and getting good sleep are all keys to minimizing the chances of a flare and keeping your psoriasis as calm as possible,” Dr. Fernandez says. “Not getting adequate sleep is a stressor on your immune system. Exercise is also good for your immune system. Plus, it also helps promote weight loss — and keeping your weight within a normal range helps with psoriasis.”
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On average, exercising for 30 minutes a day five days a week is ideal. But even small moments of physical activity a couple of days a week can go a long way to building up your energy, improving your metabolism, maintaining a healthy immune system and reducing your stress — all things that can prevent a psoriasis flare-up over time.
It’s part of our skin care 101 regimen. Wearing sunscreen every day not only protects your skin from cancer, but it also makes sure you’re safe from sunburn and blistering — the kinds of injuries that promote psoriasis flare-ups. Even on cloudy, cold-weather days, sunscreen should be a part of your daily routine. Don’t forget it.
If your symptoms change, if you notice new triggers or if you’re concerned about the effectiveness of your treatment plan, talk to your healthcare provider about making changes.
Our bodies are so vastly different from one another and we’re constantly changing, so the goal of your provider is to make sure they get it right and adjust your treatment plan to meet your needs as elements change with your condition.
Although you’ll likely need medication to manage your psoriasis, Dr. Fernandez says they often go hand-in-hand with the lifestyle changes needed to prevent psoriasis flare-ups from happening.
“Most people with psoriasis need medicine,” he states. “The reality is, we have outstanding medications whose benefits far outweigh the risks associated with taking them.
“We believe psoriasis shouldn’t affect anyone’s quality of life with the current treatment options we have — and we can get most people to the point where they are living their life as if they don’t have psoriasis.”
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