psoriasis, Skln Care

5 Psoriasis and Eczema Winter Skin Care Tips

I published this blog for The Itch to Best Psoriasis on Everyday Health in January this year. This reprint has a few update modifications. Great reminders for myself as I ward off rashes and try to control the dryness that heating causes in the winter cold. 

Every winter, I sense the need to adjust how I care for my skin. Freezing cold night temperatures give way to cold, shortened days. My wife likes to turn up the heater, as do my workplace and the stores I frequent. I enjoy a hot shower too. But I know that my psoriasis and eczema don’t necessarily take well to dry, heated air and long, hot showers.

It could be the stress of the holidays, it might be because my medications have lost their effectiveness, or it could just be winter. Whatever the cause, I’m needing to take extra measures to make sure my skin is well managed and cared for.

When I visited my dermatologist, Dr. Emanual Maverakis of the University of California, Davis Health System last year, I wondered what winter skincare tips he and his resident Dr. Tatyana Petukhova might have for those of us living with psoriasis and eczema.

My years of experience have helped me develop ways to manage any inevitable winter flare-ups. Here are my five recommendations with a few of my doctors’ thoughts peppered in.

1. Be Sure to Moisturize and Humidify

Without a doubt, this tip to moisturize is the one my dermatologists recommended first. Dr. Maverakis noted that  using heaters in the winter dries out the skin, so more moisturizing is needed. That’s my experience as well.

I took a couple of climatology classes in college. One professor used the analogy of two different-sized buckets to explain relative humidity. If you have a small bucket, and it’s 80 percent full of water, then you would say it’s quite full.  But if you put that same amount of water in a big bucket, it might only be 20 percent full.

Cold air is like the small bucket, and hot air is like the large bucket. When cold air is heated up, as it often is indoors in the winter, the relative humidity drops. Unless water is added back into the air, such as with a humidifier, the dry air will dry out your skin.

Dry skin will easily become itchy and irritated. In the winter, it seems to dry out even faster than usual.

I’ve noticed my skin is like a hygrometer, a device that measures humidity. I can tell when my skin is dry and needs more moisturizer. Plus, dry skin will easily become itchy and irritated. In the winter, it seems to dry out even faster than usual.

When moisturizing, I start with a layer of a lotion with ceramides (mainly for eczema) to add moisture, then lock in the moisture with a thicker, petroleum-based cream. If I am moisturizing after a bath or shower, I moisturize within a couple of minutes of getting out to trap the moisture in my skin. It took me some time experimenting with different moisturizers, and talking with my doctors, before I settled on a regimen that works for me.

Finding the Right Moisturizer for Psoriasis & Eczema

Having a humidifier in the living room, bedroom, and the office helps too — especially during those cold and dry times. Dr. Petukhova also recommended using humidifiers, noting the need to “clean them regularly” and use a humidity level “that feels comfortable.”

2. Avoid Long Hot Baths or Showers

Simply put, hot water dries out your skin, and that’s generally not good for psoriasis or eczema. My dermatologists noted this tip as second important after moisturizing. But I confess I like to bathe in hot water in the winter. When it’s cold outside, or even cool, doesn’t everyone enjoy a hot shower or bath? After seeing Dr. Maverakis, I turned back the temperature of my shower and cut down the time.

I also will take 10- to 15-minute soothing baths. I sprinkle an over-the-counter oatmeal bath packet into the water as the bath is being drawn, then I add some moisturizing oil. When I get out of the tub, I put on extra layers of moisturizer. This system seems to be working well so far, but it’s hard to give up the hot water.

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psoriasis, Psoriasis Treatments

Finding the Right Moisturizer for Psoriasis & Eczema

[This article originally posted on The Itch to Beat Psoriasis, Everyday Health on July 7, 2017.  In the article I did not mention any products. Here I’ll say that the moisturizers I use currently are CereVe Moisturizing Cream, Cetaphil Moisturizing Cream, Eucerin Creme, and Aquaphor Ointment. My use is not a product endorsement, but could be ideas to get you started if you’re looking to try something new.] 

I didn’t grasp the importance of using moisturizers on my dry skin until my mid-thirties. Back then I broke all the rules. I used my lotions and creams intermittently, not routinely. I took two showers a day, which I later learned was stripping my skin of natural oils. At every clinic appointment, my dermatologist noted the parched, dry desert that was my skin. I ignored his pleas for me to moisturize my skin.

Then I endured the worst stretch of skin health in my life. Psoriasis covered more than 95 percent of my body, and I was overwhelmed by feelings of depression. My dermatologist referred me to the Psoriasis Treatment Center at the University of California in San Francisco.

One nurse told me that their patients moisturize every two hours. I just nodded my head in agreement, not mentioning how my lotions and creams sit idle most days. Even though I didn’t end up receiving treatment there, I learned a valuable lesson that stays with me to this day: Moisturize your skin regularly.

Why Moisturize?

Since I have both psoriasis and eczema, I have double the reason to moisturize my skin.

On its website, the National Psoriasis Foundation (NPF) states that “keeping the skin lubricated on a daily basis is an important part of psoriasis care because it reduces redness and itching and helps the skin heal.”

Vivian Shi, MD, assistant professor of dermatology and director of the Eczema and Skin Barrier Clinic at The University of Arizona in Tuscon, has written that moisturizers work by “directly hydrating the skin,” and “bolstering the skin barrier to prevent the skin from losing water.”

I first met Dr. Shi when she was a resident at the University of California in Davis dermatology clinic in Sacramento, and I came to know her work better when I volunteered for an eczema study she conducted. I enjoyed catching up with her over the phone recently about skin moisturizers. On the call, she reinforced the importance of finding an effective moisturizer, as well as adhering to a skin moisturizing plan.

Narrowing Your Search

I asked Shi what was the right moisturizer to use on my skin. “Find the one that you will use,” she says. “At the end of the day, you have to pick one that you will use.” She cautioned me to avoid parabens, dyes, fragrances, and other allergens since I have sensitive skin.

Skin-care products dominate entire stores shelves. so how do you narrow your search for a moisturizer? One way is to look for stamps of approval from organizations such as the National Eczema Association (NEA). I also read articles like the NPF’s blog post, 10 Must-Have Lotions for Under $10, to get ideas. Physicians will often provide free samples to try at home, and I also enjoy sharing moisturizer and treatment ideas with friends and acquaintances.

Part of searching for a moisturizer is learning more about them. For example, Shi’s article taught me the difference between “fragrance-free” (no substances are used to impart an odor) and “unscented” (the product may have a fragrance that’s masked by another substance). She recommends fragrance-free products.

What about the difference between ointment, cream, and lotion? Ointments are the thickest moisturizers and do a great job of preventing water loss. Creams are less greasy than ointments, as they mix greases with a liquid, such as water. But according to the NEA, creams may “contain stabilizers and preservatives to prevent separation of their main ingredients, and these additives can cause skin irritation or even allergic reactions for some people.” Shi notes that lotions contain more liquid or water than grease. Since this liquid evaporates quickly, lotions generally don’t moisturize dry skin as well as ointments and creams.

I’ve used many ointments and creams over the years. Personally, I don’t mind a moisturizer that’s greasier, but I don’t like the feel of something like pure petroleum jelly. I tolerate thicker creams best. Cost and availability are also considerations. By weighing my needs and preferences, I’ve settled on products that I will use routinely.

Developing a Routine

Finding the right moisturizer is only half the battle. As Shi says, “the moisturizer is only good when applied on the skin.” I can certainly relate when she says that about 50 percent of people forget their doctor’s moisturizing directions as soon as they leave the office.

Over the last decade, I’ve refined a routine that works for my skin and lifestyle — a process that begins with a discussion with my doctor about my skin needs. I set aside time to moisturize at least twice a day. After I shower at night, I apply moisturizing cream within minutes of patting my skin dry. Then I apply topical prescription medication on affected skin lesions. When the weather is dry, I apply another layer of moisturizer after the topical medication.

I have the same routine in the morning, but without the shower. And keeping moisturizers in my backpack and at the office gives me the opportunity to moisturize outside of my two regular times if I feel the need.

Your routine will no doubt vary from mine. Some people, for example, set alarms on their phones to remind them to moisturize. Whatever you decide, stick to a routine that works. If you need to, modify your routine so that the moisturizers you’ve carefully chosen and paid for don’t sit idly on the shelf.