Summertime Solutions for Psoriasis

Suffer from psoriasis? Summer can bring relief -- if you know how to protect against a few hidden hazards.

From the WebMD Archives

One glance at the thermometer and there's no getting around it -- summer is here!

And while scorching temperatures and high humidity can put a damper on summer fun for some, for psoriasis patients the hot, moist weather may be just what the doctor ordered!

"In general, people with psoriasis do better in summer for two main reasons -- No. 1, there's greater humidity, which helps keep the skin moist, and No. 2, there's more sunlight exposure," says Bruce Strober, MD, director of the Psoriasis and Psoriatic Arthritis Center at NYU Medical Center.

According to the National Psoriasis Foundation, psoriasis develops when the regular system of cell turnover goes awry.

Normally, skin cells are shed every 28 to 30 days and immediately replaced by new ones. In psoriasis patients, however, this process is speeded up dramatically, with cell turnover occurring as quickly as every two to three days.

This, say experts, causes a kind of biological "traffic jam," causing old, dry skin cells to literally pile up on one another, forming the characteristic plaques.

When the air is humid, Strober tells WebMD, the skin is better able to retain moisture, which is key to easing those dry plaques. Moreover, he says, since UVA is a recommended treatment for psoriasis, the natural UVA rays of summer sun can be therapeutic.

That said, experts also tell us there are some summer precautions psoriasis patients need to heed. Among them, a reminder not to overdo time in the sun no matter how much you think it can help.

"You do not need excessive sun exposure to effectively treat psoriasis -- 30 minutes per day of natural sunlight is more than adequate -- and overdoing it could cause significant problems, not only increasing your risk of skin cancer, but sometimes making your psoriasis worse," says Strober.

That's because even a slight sun burn, says Strober, can damage the skin. And that not only worsens psoriasis plaques but can also cause new ones to develop.

"Essentially, sunburn can cause normal skin to turn into psoriasis skin because of the direct damage to skin cells," says Ellen Marmur, MD, chief of dermatologic and cosmetic surgery at Mount Sinai Medical Center in New York City.

Experts say a unique aspect of psoriasis known as the Koebner phenomenon also plays a role. In this instance, any break in the skin or damage to skin cells can exacerbate that rapid cell turnover, causing new plaques to develop at the site of the damage. Experts say excessive sun exposure, which can cause sunburn, can do that kind of damage.

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Psoriasis Sun Protection Advice: What to Use

To maintain the benefits of sun exposure while preventing problems, Marmur recommends liberal use of sunscreen, or, if possible, a sunblock, for complete protection.

"A lot of people don't realize that sunscreen only offers protection from UVA rays -- to get protection from both UVA and UVB rays you need to use a sunblock, which not only reduces your risk of skin cancer, but also prevents the kind of cell damage that causes psoriasis to flare," says Marmur.

However, she does caution us to avoid heavily fragranced sun products, which, she tells WebMD, can irritate sensitive skin. Instead, choose one with minimal additives, says Marmur, who recommends the "No Add" line of products.

Joyce Fox, MD, co-director of the Psoriasis Support Group of Los Angeles, says you can also seek out a sunscreen containing avobenzone or Parsol, which is not a sunblock but does screen out UVA and UVB rays.

"Everyone should be using these products, but they are essential for those with psoriasis," says Fox, a dermatologist with the Cedar's Sinai Medical Group in Los Angeles.

If you're wondering if it's safe to use self-tanners if you have psoriasis, Fox tells WebMD that it is. However, do be aware that the bronzing coloration can make psoriasis plaques darker and more obvious to the eye.

When Sun Is Not the Answer for Psoriasis

While 90% of psoriasis suffers will see improvement in the summer, about 10% -- those who are extremely sun sensitive -- may find that their condition worsens. For these people, says Strober, the warm humid air of summer can help but staying out of the sun is a must.

Additionally, he says some of the topical as well as the oral medications used to control all types of psoriasis can increase sun sensitivity, which in turn increases the risk of burning with even minimal exposure, as well as exacerbating the risk of a flare.

What to do: "Be certain to check with your dermatologist if your treatment increases sun sensitivity and if so, reduce your exposure time and always wear sun protection," says Strober.

On the flip side, you may be able to reduce your medication in summer, substituting brief sun exposures and the more humid air for part of your treatment. But, says Strober, be sure to check with your dermatologist before cutting down on your medication.

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Bug Bites, Chlorine, and Other Summer Hazards

While the moist, humid air of summer is great for skin, it's also a happy atmosphere for an array of insects -- particularly skin nibbling mosquitoes and gnats. And that can be a problem for some psoriasis patients.

"Problems don't necessarily occur from the bite itself, but when you pick at it and scratch your skin you might start a plaque of psoriasis," Fox tells WebMD.

To help avoid problems, she suggests using an insect repellent -- as long as the percentage of the active ingredient DEET is moderately low.

"And use it only on the areas of skin that will be exposed -- and when you can, cover as much of your skin with clothing as possible, which is still the best protection," says Fox.

Marmur agrees and also suggests taking steps to control insects in your environment.

"Citronella candles or electronic bug zappers can be very helpful in keeping your direct environment clear of insects; if you still need an insect repellent always choose one for sensitive skin," says Marmur.

When it comes to fun in the sun, perhaps nothing is better than an invigorating healthy swim. Do it in ocean water and the salt content may provide some additional benefits, gently exfoliating those dead cells and helping psoriasis plaques to look and feel better.

But whether you swim in the ocean or a pool, experts say never head for the water without a moisturizer in tow.

"The single best thing you can do for psoriasis is to keep your skin moist -- winter or summer -- so if you are going to spend time in water, you must remember to add a layer of moisturizer as soon as you come out to ensure that your skin stays protected," says Marmur.

Fox says you can do double duty for your skin by finding a moisturizer with a built-in sunscreen.

"Apply it as soon as you come out of the water and you'll doubly protect your skin," says Fox.

If you've been swimming in chlorinated water, however, you might also want to consider rinsing your skin before applying the moisturizer. How can this help?

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According to the National Psoriasis Foundation, all water pulls moisture from the skin -- and water that has been heavily chlorinated or doused with other sanitizing chemicals can pull even more moisture from your cells. If left to dry on the skin's surface, say experts, drying and irritation can develop.

"A quick shower can help rinse the chemicals from your skin, but don't forget to moisturize afterwards and, if you're going back out, put on the sunscreen," says Fox.

Don't Sweat the Small Stuff

While most folks with psoriasis actually see a sharp improvement in warmer temperatures, this is not always the case. For those who suffer with a specific type of psoriasis known as seborrhea - affecting the scalp and face -- summer can actually exacerbate problems.

The reason, says Fox, has to do with sweat, which can irritate the skin and sometimes increase symptoms.

"In people who have facial psoriasis -- in the creases of the nose, in the eyebrows, or on the scalp -- the heat can provoke problems, so it's important to remain cool and to get into air conditioning if your body starts to overheat," says Fox.

Marmur agrees and adds that if you do start to perspire heavily, gently wipe the sweat from your skin using a washcloth rinsed in cool water, or a fragrance-free baby wipe used on newborns.

Most of all, our experts say using common sense in summer by being certain to protect your skin against overexposure to the sun and guarding against extreme dryness and irritation, you can enjoy the warmer weather and the health benefits of the season, without fear or worry.

"My best advice is to get outside and enjoy the summer -- don't let your psoriasis stop you!" Fox exclaims.

WebMD Feature Reviewed by Brunilda Nazario, MD on May 01, 2007

Sources

SOURCES: Bruce Strober, MD, director, Psoriasis and Psoriatic Arthritis Center, New York University Medical Center, New York. Ellen Marmur, MD, chief of dermatologic and cosmetic surgery, Mount Sinai Medical Center, New York. Joyce Fox, MD, clinical professor of dermatology, University of Southern California; dermatologist, Cedar Sinai Medical Group, Los Angeles; co-director, Psoriasis Support Group of Los Angeles. National Psoriasis Foundation.

© 2007 WebMD, Inc. All rights reserved.

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