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Your Top Psoriasis Questions Answered: Live Facebook Q&A

 If you prefer to read rather than watch the information, Dr Esther has written answers to your top questions too. 

1) My skin gets drier in winter - but why? And what is the best way to stay on top of it?

You might have noticed some improvements to your skin over the warmer, summer months. But now that autumn is firmly setting in, it’s important to shake up your skincare routine to minimise the risk of flare ups. This is because when weather becomes colder, humidity in the air decreases, making it much easier for moisture to leave the skin.

You skin becomes drier, thicker and more inflamed the more that moisture is able to leave the skin, which is why autumn and winter time tend to be trickier times if you have a dry skin condition like psoriasis or eczema.

When the weather changes, prevention is essential. Set yourself for the drying winter months with an emollient therapy routine. It might sound complicated, but emollient therapy is just another way of referring to a combination of products that work together to calm, soften and hydrate very dry skin.

Invest in a soap substitute, a light moisturiser for the day and a thick fatty ointment to boost your skin’s natural regeneration overnight. Through regular use of soap substitutes and bath oils, combined with cream/ointment application, each emollient will begin to complement the actions of the other to keep the skin well hydrated, flexible and comfortable.

Lots of you asked if emollients really help psoriasis. After months and sometimes years of applying a vast array of different creams, the patches may still be there - so why bother?

Emollients cannot cure psoriasis, but they are very important in managing its severity and offer considerable skin benefits, for example, boosting your skin’s protective barrier so that it can protect itself from the stresses of daily life. Whilst an emollient therapy routine is unlikely to clear up your condition, over time they will help to keep your symptoms under control and reduce the frequency and severity of flare ups.

2) How should I actually apply emollients? How much should I be using and when should I apply them?

How effective your moisturising routine is depends on how regularly you apply the emollients and how much you use.

As I mentioned before, you only need to invest in three irritant-free, psoriasis-skin-friendly products: one soap substitute, one light moisturiser and one fatty ointment to help to restore your skin’s natural moisture balance.

So when should you use your emollient products?

Soap substitutes should be used every time you wash instead of using a soap product which will dry out the skin. Using an emollient as a soap substitute will not only keep the skin clean, but actively help to lock in moisture levels.

Water dries out the skin, so it’s important to remember to moisturise immediately after bathing. You might prefer to use a light moisturiser with a quick absorption time for day use as it will help to minimise disruption to your morning.

Apply your emollient products before any topical steroids that you have prescribed. Allow the emollient to fully absorb into the skin before applying your topical medicine - this will help both products to work most effectively. As a general rule of thumb, wait 15 minutes after applying your emollient products before applying a topical steroid.

How often you will need to apply your emollients during the day varies from person to person and from time to time in the same person, depending on how dry your skin has become. A good starting point is to apply 2-3 times a day. However, some people need to increase this to up to every hour if the skin is very dry, particularly to exposed areas such as the hands.

Ointments have the highest oil-content of all moisturising products available for eczema-prone skin, making them particularly effective at sealing in moisture. However, because of their high oil-content, many people prefer to use them at night as they can leave the skin feeling quite greasy.

If you feel that your emollient therapy isn’t as effective as you would hope, try changing to an emollient with increased hydration properties; for example, one with a higher fat content or greater urea concentration.

How should I apply them?

Topical emollients should be gently smoothed into the skin in the direction of hair growth – this facilitates absorption and is preferable to application by rubbing, which introduces air bubbles into the emollient, stopping it from absorbing as effectively.

Large quantities of the product should be dispensed using a pump dispenser; if a pot of emollient is used, use a clean spoon or spatula rather than your fingers to scoop out the desired amount before it is applied to the skin. This will help to prevent contamination of the emollient.

3) Will having psoriasis affect my ability to have children?

Psoriasis won’t affect your chances of falling pregnant. However, if you are planning a baby and either you or your partner have ever had psoriasis, then it’s important to let your doctor know as soon as possible. Many of the medically prescribed treatments for psoriasis require special precautions before and during pregnancy, so speak with your doctor as early as possible to create a therapy plan that is safe for both you and the baby.

If possible, try to optimise control of your psoriasis before conception to help minimise flare-ups during pregnancy. In many cases of mild to moderate psoriasis, regular use of emollients can help you to stay symptom free for longer, and can help to prevent unexpected changes to your condition during pregnancy.

Though there is a genetic element to psoriasis, it doesn’t mean that your child will have psoriasis just because you do, so try not to worry. It's difficult to predict as psoriasis doesn't follow predictable hereditary patterns, but what we do know is that a child with one parent who has psoriasis has around a 25-28% risk of having psoriasis themselves. When both parents have psoriasis, that risk increases to roughly 50%. What to keep in mind is that Psoriasis is multifactorial, so apart from genetic factors, external factors like infections, physical and mental stress and some medication for example Lithium, antimalaria drugs, and beta blockers can provoke psoriasis.

It’s quite likely that your psoriasis will change during pregnancy, though it’s impossible to say whether that change will be for the better or worse. Happily, most women experience improvements to their condition during pregnancy (a little over 50%), however around the same amount report flare ups within six weeks of delivery.

If you experience a flare up either during or after the pregnancy then the good news is that around 6-12 weeks after you give birth your psoriasis will should go back to how it was before your baby was born.

4) Why does my psoriasis seem to flare when I’m feeling stressed? How can I get out of the cycle?

This is a very common concern and something that lots of people reached out to us about.

Put simply, when your body is under any form of physical or mental stress it responds by sending out hormones that cause inflammation. Our stress response is an evolutionary mechanism which enables us to handle acute stressors, like running from dangerous animals (it´s a flight and fight mechanism) which in the past was essential for our survival. But in people with an autoimmune disease like psoriasis, the body sends out too many stress hormones which increases the number of T-helper cells (immune cells) in the skin, which is associated with flares.

Physical and mental stress can indirectly be brought on by a number of things, for example, not getting enough sleep, smoking, or excessive alcohol intake.

Try to eat well-balanced meals; get plenty of sleep; reduce your workload; exercise regularly; and practice relaxation techniques such as meditation. And remember to reach out to those around you, or a medical professional, if the stress you are under feels unmanageable.

5) I find that my scalp psoriasis is difficult to manage. What can I do about this?

Scalp psoriasis is basically plaque psoriasis on the scalp. It is hard to treat because treatments in the form of creams and liniments often times get caught in the hair and never really reach the scalp. Treating scalp psoriasis is a two step treatment.

The first being the removal of thick scales on the scalp. This can be done by rubbing oil onto your scalp to help soften and loosen the scales. You can use olive oil or gycerol for this purpose. Do ask for help if you can't reach the hard parts. The best time to do this is before bedtime. Use a bathing cap to protect your pillow from the grease. When washing out the oil the next day, start by shampooing without water, in order to bind the oil before washing out as the opposite sequence may not be as effective in getting all the oil out. The scales may be so thick that you may need help removing them from a dermatological department, where other/stronger scale loosening products may be prescribed like salicylic acid, hormone creams or tar products.

The process of loosening the scales should be repeated daily.  Depending on how thick the scales are, the process may take up to 2 weeks before the scalp is free of scales. Most skin conditions take time to heal so do be patient.

The actual treatment can begin once the scales have been removed. Your dermatologist may have prescribed a D-vitamin liniment or a steroid liniment/mousse/gel/cream to be applied to your scalp daily. There are today different applicators that make it easier to apply products to the scalp - some with long thin spouts that reach the scalp easily through all the hair. Do reach out and ask for help from friends, family or a nurse if you are having trouble applying the treatment to your scalp. You may have to consult your dermatologist again if none of these suggestions work but remember that it may take another 4 weeks before you begin to see the effects of your efforts. So stick to your routine and give it some time. Tar shampoo can be used to prevent scalp psoriasis from returning.

6) There’s so much conflicting information - what should I listen to?

There’s no magic formula when it comes to your psoriasis. What may cause one person’s condition to worsen, may not affect another. It can be unpredictable at times , but over time you will learn to better understand what your personal triggers and controls are. Until then, take advantage of online communities, such as Flaym, which are there to help you get advice and support at the times you need it most. 

There is also a growing online community on Instagram and Twitter of people with chronic skin conditions who raise awareness by sharing pictures and life stories, but most importantly by motivating and supporting each other. Search for #eczemalife, #getyourskinout or #psoriasisawareness to join the conversation.

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