Jennifer Soung, M.D., a board-certified dermatologist at Southern California Dermatology in Santa Ana, offers tips on managing psoriasis when the temperature drops and the risk of flares rises.
My scalp psoriasis can be unbearable in winter. It’s hard to find a shampoo that works for a long period of time. What can I do?
It is common for shampoo treatments to lose their beneficial effects after a while. To counter this, choose two or three shampoos you like and alternate between them. We don’t understand why a shampoo can seem to lose its effect, but if this happens, you should alternate between shampoos with different ingredients: pyrithione zinc, salicylic acid (in Neutrogena T/Sal) and coal tar (in Neutrogena T/Gel). And then, of course, see your doctor. If you have severe scalp psoriasis, you will need more than shampoo, which treats only from the outside. You should also treat with vitamin D and/or steroid topicals, which reduce the inflammation from the inside after being absorbed into the skin.
I’ve heard vitamin D may help reduce flares. Can vitamin D supplements replace the benefits of exposure to natural sunlight?
Scientific evidence supports the idea that vitamin D topicals applied directly on the skin can help treat psoriasis. However, the evidence for an association between oral vitamin D supplementation or even the vitamin D levels in the body and psoriasis flares and severity is not so clear. Some studies suggest that vitamin D deficiency is associated with more severe psoriasis, so we generally tell our patients to be sure they are vitamin D sufficient. If you are deficient (according to standard laboratory testing), you should definitely supplement, but beyond that, there is no evidence to suggest that additional supplementation will be helpful.
It is very difficult to say whether vitamin D levels in the body are associated with flares, but normal vitamin D levels are important for skin health.
My sensitive skin makes it hard to find a moisturizer that doesn’t irritate it. What advice do you have?
A few of my favorite moisturizers for sensitive skin are Vanicream, Cetaphil and CeraVe. But whatever you do, you definitely want to find something that is fragrance-free like these are.
Will drinking more water help to keep my skin moisturized?
There’s not a lot of evidence that drinking extra water improves skin hydration. In terms of maintaining skin hydration, it is important to avoid excessively hot water when bathing, use a humidifier and use skin moisturizer, especially after a shower.
How should I care for my child’s skin in winter?
There is actually no difference between adult and child winter skin care for psoriasis. The key to helping with chronic skin disease is moisturization. When the skin is dry, the basic skin function as a barrier is compromised. Irritation can occur, triggering a psoriatic flare.
Flares happen. What should I do if I experience a bad flare and need relief?
You really need to see a dermatologist who understands systemic medications. Topicals are not going to be enough for a bad flare-up. A dermatologist who is familiar with treating severe psoriasis will likely prescribe a biologic drug or an oral systemic medication like methotrexate or cyclosporine.
Editor’s note: Answers have been edited for length and clarity.
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