When living with psoriatic disease, every day can be a guessing game. Which body lotion will work best, especially during a flare? Should I use a special sunscreen? What moisturizer is best for my face?
Many of those with psoriasis have learned the hard way that what works well for others with normal, oily or “combination” skin doesn’t necessarily work for them. Even gentle scrubs can be too abrasive, and while some moisturizers specifically target sensitive skin, some might have a need for a moisturizer that is especially hydrating, as well.
“People with psoriasis must approach skin care very carefully — almost as carefully as you would approach skin care for a baby,” said Dr. Francesca Fusco, who practices medical and cosmetic dermatology in New York City. “There are many potential irritants and chemicals which could exacerbate psoriasis.”
Complicating matters further is that, as you age, your needs change. The issues you face in your teens and 20s, such as acne, evolve as you get older and face issues such as sun damage, age spots and the desire to dye your hair.
As a general rule, for those of all ages, Fusco suggests using creams as opposed to gels or lotions. Gels can be very drying due to their higher alcohol content, and lotions have fewer emollients in them. Look for products labeled hypoallergenic, alcohol-free, fragrance-free or for sensitive/rosacea skin, as products not labeled as such can cause irritation, she said.
Moisturizers with ceramides, lipids and hyaluronic acid often are preferable because they help keep the upper layer of the epidermis well hydrated. These components are naturally present in skin and are essential for normal function. As we age, the body decreases production of ceramides, lipids and hyaluronic acid, which makes replacing them vital to maintaining healthy skin.
Also crucial to keeping the skin hydrated is sunscreen, said Dr. Raymond Dean, a dermatologist in Traverse City, Michigan. While a good dose of vitamin D from sunshine can be beneficial to those with psoriasis, a high SPF sunscreen for the whole body is vital.
“Sunlight helps psoriasis, but sunlight also ages our skin,” Dean said. “Fortunately, with today’s formulations, many sunscreens offer adequate protection without irritating the skin.”
But while some basics are common sense, tailoring your regimen to your needs as you age can be tricky. What worked for you in your teens and 20s likely is different than how you’ll need to treat your skin in your 30s, 40s and beyond. Here’s a look at common skin issues that arise as you age, the role that psoriatic disease plays and the ingredients and products to use (and avoid) for optimal care.
Teens & 20s
Common issues: Oily scalp, face and body acne
Skin care: “The treatments for acne and psoriasis are quite different,” Fusco said.
Common acne products can be quite irritating, which can potentially worsen psoriasis. For acne, there are many great prescriptions, including topical antibiotics, sulfur agents and retinoids. Consider talking with your doctor about using formulations that are less irritating to the skin, such as those with lower concentrations of the medicine, or with a moisturizing cream, which is less likely to cause irritation.
To treat acne, one option is Finacea, a topical gel made from azelaic acid, a naturally occurring dicarboxylic acid derived from rye, wheat and barley. Sulfur-based drying lotions can reduce the size and redness of blemishes, and newer, lighter over-the-counter retinols unclog pores.
Most important, Fusco said, is scalp care. Many younger patients with psoriasis have redness and scale in their scalp and along their hairline, which can be due to active oil glands and hormonal changes.
“Using a dandruff shampoo is critical, and most young individuals don’t because those shampoos can be medicinal and smell bad,” Fusco said. She recommends Clear Scalp and Hair Complete Care Anti-Dandruff Shampoo. “It controls the dandruff and debris but smells nice and is formulated for hair beauty,” she said. “That encourages compliance — and compliance means control.”
Prescription shampoos are also available to control itching and flaking on the scalp.
Scalp psoriasis, especially along the hairline, combined with acne, can be especially frustrating for patients, said Dean. The key is to use products that don’t have a drying effect on the skin, as products that are drying can exacerbate psoriasis.
What to Avoid: Coarse scrubs,brushes, pore strips, home tools for squeezing, irritating products that can exacerbate psoriasis.
“Steer clear of over-the-counter products that are especially drying or contribute to red skin,” including some products with benzoyl peroxide, Dean said.
30s & 40s
Common issues: Sun damage, age spots and wrinkles, finding the right makeup for your skin type
Skin care: Retinoids are the single-best thing for anti-aging because they keep skin smooth, lighten brown spots and diminish wrinkles. However, prescription-strength retinols can sometimes be too harsh for patients suffering from psoriasis. Consider consulting with your dermatologist on what kind of retinol would be best for your unique skin.
“Fortunately there are many gentle over-the-counter retinoids now,” Fusco said. Her recommendations include Patricia Wexler MD Intensive Deep Wrinkle Treatment, available at Bath & Body Works, and CosMedix Serum 16 at CosMedix.com.
What to avoid: Chemical-laden sunscreens
“I recommend sticking with natural mineral sunscreens containing zinc or titanium, which are broad spectrum,” Fusco said. “Fewer chemicals mean less potential for irritation.”
50s & beyond
Common issues: Hair and scalp changes, interest in cosmetic procedures
Skin care: “Many over-50 people color their hair, but the dye is a potential irritant to the scalp and can exacerbate scalp psoriasis,” Fusco said. She recommends using Clear Scalp and Hairline (Deep Nourishing Treatment Mask). If your doctor has prescribed a scalp psoriasis solution, apply it the morning of coloring to keep your scalp calm.
In addition, this is the age at which many people begin considering cosmetic procedures. If you are considering cosmetic surgery or laser procedures, first consult with your doctor, said Dean.
“Any time you traumatize your skin, there’s a risk,” he said. “Always talk with your dermatologist and discuss whether you should have this done.
What to avoid: A dry scalp.
Don’t shampoo hair within 24 hours of coloring.
“If you are getting color on a Saturday morning, your last shampoo should be Thursday night, and you should apply a rich mask and sleep with it overnight,” Fusco said. “Doing so will nourish the scalp beautifully.”
Also, speak up when having your hair colored. “Ask the stylist to be gentle and not to use her nails while scrubbing,” she said.
No matter what your age, always consult with your dermatologist when considering new products. And don’t get stuck in a rut, staying with products you’ve used all your life just because they’re familiar. As you age, your skin ages, as well, and it’s important to find products that meet those evolving needs.
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