Managing Wintertime Psoriasis Flares

This article originally appeared in the Drug Topics® sister publication, Dermatology Times®.

Psoriasis is a chronic and inflammatory multifactorial disease but for some reason, people seem to suffer more in the wintertime when flare-ups are much more common.

Jennifer Bourgeois, PharmD, a pharmacist at Market Street Pharmacy in McKinney, Texas, noted that while there is no definitive answer why psoriasis flares up more in the winter, research suggests it’s due to drier skin caused by inside heat and spending less time outside in the sunshine. Dry air can cause the skin, especially the upper layers, to lose moisture, resulting in dry, flaky skin. Studies have found that fewer hours of sunlight in the winter seasons may trigger psoriasis flare-ups as well.

“Psoriasis is an inflammatory condition of the skin; the inflammatory cascade can be triggered by many different factors including stress, diet, and infections,” Bourgeois said. “We know that winter is often accompanied by higher stress of the holidays, increase in sugar intake, and peak season of flu. All of these may contribute to the psoriasis flares.”

Suzanne Friedler, MD, FAAD, a dermatologist at Advanced Dermatology PC in New York, explained that 1 thing that helps psoriasis is UV light because sunlight decreases certain inflammatory mediators, so it’s able to regulate the inflammatory cascade you see in psoriasis. “Obviously in winter, there’s less UV exposure, so it causes psoriasis to be a little bit worse,” she said. “Also, people tend to take longer or hotter showers, which dries out the skin; there’s less humidly in the air in winter months, and those with dry, itchy skin can also add to winter flare-ups.”

Emily Fritchey, a holistic skin therapist at Sunshine Botanicals in Newnan, Georgia, notes that as the skin gets drier, it is more likely to crack, bleed, and get infected. “Low levels of exposure to sunlight’s ultraviolet rays likely cause psoriasis to worsen during fall and winter without proper care and precautions,” she said. “Lack of understanding when it comes to the proper skin care necessary is the biggest issue patients face.”

Psoriasis triggers vary from person to person and stress is one of the most common triggers. Relaxation techniques, stress management, and an anti-inflammatory can help tremendously to minimize the impact of stress on the condition, Fritchey shared.

Friedler said moisturizing frequently to cut through the thick layer of scale and taking the correct medication helps, so communicating with your dermatologist is vital in proper care. “There are better and better biologic therapies and lots in development,” she said. “It’s a hopeful time.”

Patients with psoriasis can keep a journal to track flares, Bourgeois said. This information can be used to help pinpoint the factors contributing to the flare, such as,is this occurring only in the winter months? Is the flare triggered by a recent illness or a change in diet? “Awareness of the triggers can significantly help the patient and provider develop a lifestyle strategy specific for the patient,” Friedler said. “This is often used in adjunct to a pharmaceutical medication.”

She also recommended that patients use a thicker moisturizer especially after they get their skin wet; also,covering the skin and not directly exposing it to the cold, dry air. "This heated air in our homes and workplaces is typically drier and can steal from moisture levels in your skin,” she said. “Add a humidifier to support your skin health. Also, increase your water intake during the winter months.”

Considering lifestyle factors and natural ingredients that have science behind them is important to complement typical pharmaceutical treatments for winter flare-ups. That’s why it’s important that dermatologists understand the environment their patients are in, especially for those living in cold climates.

Fred Pescatore, MD, said lifestyle adjustments that can help flare-ups and discussed the science behind some of the most beneficial natural ingredients for psoriasis, such as Pycnogenol French maritime pine bark extract. “Studies have found the natural antioxidant to significantly improve the painful and visible symptoms of psoriasis, including redness, flaking, thickness, and total surface area of affected skin patches,” he said.

Most important, health care providers should provide patients with the information they need on what to do and not do daily during treatment. “A simple handout that takes the guesswork out of the self-care they need to do at home will take the overwhelm out of what to do and not do at home and improve treatment outcome,” Friedler said.