Cold Weather, Hot Flares: Winter Survival Tips for Psoriasis and PsA Transcript
“Welcome to this episode of “Psoriasis Uncovered”, a podcast series produced by the National Psoriasis Foundation, the nation’s leading organization for individuals living with psoriasis and psoriatic arthritis. Join us to hear our guest speakers uncover topics that lead to a better understanding of the disease and management, to coping and thriving with psoriasis and psoriatic arthritis.”
Corinne: My name is Corinne Rutkowski and I’m a fourth year medical student at New York Institute of Technology, College of Osteopathic Medicine. I’ll be your moderator for today’s episode, addressing management of psoriasis during cold weather. I’m here with an amazing dermatology physician assistant, Eileen Cheever, who has a clinical practice at Clearview Dermatology treating adults and children with a variety of diseases of the hair, scalp, nails, and skin, which includes psoriasis. Welcome Eileen! It’s a pleasure having you on Psoriasis Uncovered. Our discussion today is so timely. I’m not sure how cold it is where you are but where I live, it’s been pretty cold.
Eileen: My goodness, I’m in the greater Boston area and we are in the freezer. That January thaw we had earlier this month, I think was a tease. So we’re experiencing what I think is quintessential New England cold, dry winter. So thanks so much for having me. I’m excited to be here.
Corinne: Yeah, I’m in New York City and winter is here. It’s definitely cold. We know that it tends to be a time for some people when their psoriasis starts to flare. I know that my scalp has been pretty dry and itchy lately. So let’s start with a basic question. What is a psoriasis flare?
Eileen: So I think if you ask a lot of different patients their definition of a flare may differ. But as a dermatology PA, APP, when I hear a patient telling me or calling my office about a flare, it’s really that they were previously at a state in their psoriasis or psoriatic disease where they felt like their disease was at a controllable base line type of level. So, they’re not experiencing plaques or itching with our psoriasis patients, or they’re not experiencing joint pain, swelling, or aches when their disease is under control. And then that flare is really a deviation from that baseline where their skin starts to become more itchy, it becomes more dry. Some of their plaques become more evident, and it really, to me, signals that their disease is more active and we know that as we alluded to cold weather can often be a flare but there are many other sources of flares as well.
Corinne: Diving into that a bit more, why do you think cold weather prompts psoriasis?
Eileen: Sure, you know, it’s interesting. We talk about the cold and the winter, but we really don’t necessarily understand for instance, the connection between winter and flares, but it doesn’t necessarily mean that there isn’t one. We know when we look at a lot of these different surveys that ask patients, four out of 10 chose winter as the season that most aggravates their disease from a psoriasis point of view. And most of that evidence really is anecdotal, but I can tell you from our clinic, a great many of our patients are dealing with flares in the winter. We think UV light is behind that flare, a lack thereof, less UV, either less just in terms of a planetary sense or less because we’re less outside. But we think that a lack of UV plays a big role as it pertains to the winter or the season being a trigger. Cold, obviously living in the northeast, that lack of humidity, that lack of moisture in the air, that dryness. But we also know that this is a time of year where patients can be dealing with different coughs or colds or viruses or flu’s or illness. And with psoriasis being an inflammatory immune based disease, being sick or unwell or being ill or under the weather, can sometimes cause a little bit of a shift in our immune system and cause that psoriasis to flare. And we know that our patients definitely can feel oftentimes after they have an illness or they’re not feeling well that maybe there was a short amount of time where their psoriasis wasn’t under great control. And we think again with psoriasis being this pro-inflammatory immune state, there can be some connection between that.
Corinne: Great, thank you for that. It definitely is a good idea for patients to be aware of their triggers, especially because it’s not the same for everybody. And I know that you mentioned humidity previously, and in the wintertime it tends to be colder, we tend to have the heat up higher. What are some tips for improving humidity in the home?
Eileen: Yeah, the number one thing that I tell my patients is look for sources of dryness or lack of humidity in your home. And really a lot of that has to do with the primary, secondary, or ancillary ways that we heat our home. A lot of folks here, especially in New England, heat their homes with for instance, wood stoves. And that air that comes out of those wood stoves is remarkably dry. Forced hot air heat, very, very dry. And then don’t forget living in a part of the country where the humidity just by the season is lower. This can be really a recipe for low humidity, which makes sense with really my next recommendation - is trying to think about running a humidifier in the areas of your home where you spend the most time. So thinking about your bedroom or your living room or your study. Really trying to get that humidity to a point where we feel that it’s optimal and that’s usually around a 60% relative humidity. Also keep in mind too, a lot of us try to stay warm during the winter with those amazing hot, long baths or showers and unfortunately those are also very drying, and those can strip a lot of those natural oils and natural moisturizers that our skin holds and really trying to recognize that. And if it does come in line with your cultural preferences for bathing and showering practices, showering or bathing less often, and on a cooler, not cold, but cooler temperature for a lower amount of time. Really just trying to give your skin that hydration that it needs and avoiding sources of things that can strip it from it.
Corinne: Those are great suggestions, Eileen, thanks so much. And I agree, moisturization is very important. For our listeners, if you are looking for skincare and other products, check the National Psoriasis Foundation’s Seal of Recognition Program, which now has a new look, making it easier to find what you are looking for and this can be found at psoriasis.org/seal-of-recognition-program/. Given there are so many products available, Eileen, what are some key ingredients to look for in a lotion or cream, or even an ointment? And are there any products in particular that you like to recommend to your patients?
Eileen: I think it’s so important that you did really refer our listeners to that Seal of Recognition Program put forth by the National Psoriasis Foundation because they are such a phenomenal resource for products that really can help our patients maintain that hydration. So you know, before diving into what products I like and products that I typically find beneficial for my patients, I also talk to my patients and remind them about the ideal time to moisturize as well. So when our patients bathe or shower, we’re hoping they do so ideally less frequently on a colder temperature for a shorter duration of time. And then when they come out of their bath or shower, gently pat that skin dry. And I tell my patients that two to five minutes after you’ve gently patted your skin dry, where there’s still some water on the skin, this is an ideal time to sit by that bathtub or on your bedside and apply that moisturizer. That’s a real golden window of opportunity for us to be able to get something into the skin that can really hydrate and bring back a lot of that moisture into the skin. So there are so many great products and many names that are familiar, all of which again, you can see at that resource Corinne you mentioned. Aveeno makes some lovely fragrance-free moisturizing body lotions. They’re rich, but they’re fast absorbing and great for sensitive skin. CeraVe, another wonderful line, actually has a psoriasis skin therapy line that is specifically for those symptoms we can see in patients that have psoriasis. So it’s moisturizing, but it’s also really protecting that barrier. Curél, Dermarest, Gold Bond, a company that’s been around for a generation or so, also has a multi-symptom psoriasis relief cream that can help hydrate, but also sometimes help with some of that plaque, you know that thickness, that scale, because that Gold Bond has a salicylic acid component to it to help with some gentle exfoliation of that thickness. So again, as you mentioned, that resource has a very wide range of products to help those signs and symptoms of psoriasis.
Corinne: Thanks so much for sharing. I actually just started using a salicylic based shampoo for my scalp psoriasis and I’ve noticed really great improvement. So thanks so much for those recommendations. And I’m just curious, are there any specific products you recommend for palmoplantar psoriasis, which for our listeners, the name implies it mainly affects the hands and the feet and what can be used to help both of these areas stay moisturized?
Eileen: Always one of the most challenging areas to treat are the palms and soles. And I can even reflect back and say, I can imagine as a patient having palmar plantar psoriasis is one of the most troublesome places to experience your psoriasis. Think about how often you use your hands. Think about the role that our feet play in getting us from here to there or the shoe or sock choices we make throughout the day. These are things that we as folks who don’t have palmar plantar psoriasis, we often in the course of a busy day don’t even give a second thought. But when you have palmar plantar psoriasis, we know and the studies highly suggest very, very high quality of life impacts where these conditions can be painful, they can be itchy, and also very stubborn and difficult to treat. So when we talk about treating these areas, these areas often have a thicker skin to them - the palms and soles especially. So we wanna really keep that in mind when it comes to a product choice. A lot of the times I will talk to my patients about using something like an occlusive. So something that has a barrier to prevent your skin from losing water, but also helps on those thicker areas. So petrolatum, petroleum jelly, people know terms like Vaseline, Lanolin. People say, well those are products that tend to be thick. And yes, for a thick skin surface like a palm or sole, those can be very helpful. And a lot of times I’ll tell my patients, get a nice thick layer of petroleum jelly or petrolatum on those hands and feet and grab a big old pair of cotton tube socks and get those cotton socks on over the feet or get some cotton gloves and get them over the hands. Once you’ve applied that petroleum jelly, cover that petroleum jelly with gloves or socks and if you can sleep in it and covering that with cotton types of fabric can drive that occlusive deep through the skin of the palms and soles and really try to help some of that healing, softening, and prevent those painful cracks and fissures that our patients get. I also tell my patients, as you alluded to, so goes the scalp, often goes the feet as well. Things like salicylic acid or urea (U-R-E-A). Urea are products and ingredients you should look for areas like the palms and soles. Because not only are they hydrating for those thick areas, they also act as a keratolytic that really tries to help break down lytic kerato, thicker skin, really break down or break through that thicker skin to deliver some hydration. And good foot care is important, observing your feet for cuts or scrapes or abrasions, being gentle with the feet. It’s so tempting to be a patient with plantar psoriasis to maybe trim or cut or go after some of that skin. And we really encourage our patients to please call us and let us know if we can be a resource to help do that in a clean, sanitary way, because we don’t want our patients with psoriasis on such a tough area dealing with something such as an infection or a worse complication.
Corinne: Thanks Eileen. And I know that you mentioned wearing gloves and socks and you know we are in the wintertime so a lot of people tend to wear a lot of layers to protect their bodies and stay warm. Maybe a sweater if they go outside, jackets, gloves, a scarf, hat. Are there any specific types of fabric that are better for individuals that have plaque psoriasis?
Eileen: I know putting on a wool sweater or a wool scarf in these cold dark months sounds so cozy and comfortable. But even as a person that doesn’t have psoriasis, those fabrics make me itch. So I can only imagine being a patient who has something such as psoriasis that those fabrics can sometimes not only feel very itchy or they can feel very irritating to the skin, they also tend to not be very breathable and can sometimes encourage overheating and feeling too warm. So we tell our patients try to stay away from things like wool or synthetic clothes like nylon or polyester because again sometimes the texture of the fabric can be agitating to your skin, but they can also unfortunately encourage overheating. So things that are breathable, 100% cotton, bamboo, silk, Tencel, and layering those things. Nobody is going to say that a cotton or bamboo shirt is going to keep you completely warm in the dead of winter. But having those products on maybe as a base layer between you and if you must or want to wear that wool sweater. Having that layer between that wool sweater and your skin will maybe give you that optimal warmth you’re asking about but minimizing that overheating and that irritation that some of those fabrics can bring.
Corinne: And in these colder months, a lot of these patients will also start to have lot of aches and pains in their joints. What do you recommend when the weather is cold to help address these aches and pains that come?
Eileen: Movement, movement, movement. And there are more and more studies that are coming out every month that talk about the benefit of even just small amounts of movement every day, correlating to improved disease trajectory in our psoriasis patients. So even if it’s just two or three minute increments spread out throughout the whole day, or getting that 15 to 20 to 25 minute session of just movement - stretching, walking around your home, getting down to the mailbox and back. Movement, movement, movement. But also we know that heat can also provide a really nice source of comfort to those joints and a moist heat can sometimes help. So if you have the ability to have that kind of moist heat on your skin, those are great options. They have a lot of those tear away type of warm packs that you can put onto your back that you can see at a local pharmacy, heating pads done safely. And again, balancing may be the benefit of a warm bath, but maybe with oatmeal in that or some type of sea salt to really try to help not over dry your skin but have that warmth really soothe your joints. But movement, a healthy weight, and then using things like heat is a responsible way to help with those joints. But also I tell folks if you are struggling with some of these basic guidelines and you still feel that your joints are not under control, I need to hear from you are your clinician because if you are experiencing a true psoriatic arthritis flare, there may be reasons during those flare times to add on emergency or rescue therapy for those flares. So always keeping your rheumatology or dermatology provider clued in with what’s going on I think is also important with some of those recommendations I suggested.
Corinne: Thanks for that and when these flares are kind of at their peak or a patient comes to you and saying that their symptoms have gotten worse, would you agree that an adjustment to management is always needed? And if it is, when should that occur?
Eileen: Yeah, you know adjustments to management, it’s tough because rescue therapy, short courses or emergency intervention therapy, and I don’t mean emergency at an emergency room, etc, But rescue therapy, think that term really more reflects what our goal is. Short bursts of rescue therapy may be an option for you. But making large overhauls to that psoriatic arthritis regiment, it’s hard because sometimes those regimens can take two to three to four months to work. And if winter is your trigger, sometimes our winters are only two to three to four months long. And then we’re really defeating the purpose of changing that regimen for the purpose of a wintertime flare because any of those real basic regimen changes outside of rescue therapy are going to take two to three months to really show any type of benefit. So really looping in that dermatology or rheumatology provider and letting them guide you about what they think the best scenario is. It doesn’t always mean bail on the whole routine. It may be adjunct therapy, rescue therapy and really having that conversation I think tailored to each patient is really important.
Corinne: I agree, and that’s great to know. It seems like the best defense to manage psoriatic disease is to try your best to maintain the treatment regimen and just take extra precautions and be very aware of what’s going on in your body. Are there any other steps that can be taken to help manage overall health in the winter?
Eileen: Winter is a time where often it’s cold and it’s dark and the holidays are within that time frame too, which can sometimes bring up a lot of different either emotional feelings or stress. And there can be some triggers that definitely come through with stress. So managing your stress, knowing any pre-existing triggers. Again, exercise is great for the joints, but exercise is great for all of us. Exercise releases endorphins which make us feel happy. They help with sleep, maintaining a healthy weight. But also recognizing that this can sometimes be a very tough time for a lot of different people across a lot of different conditions and making sure to reach out for help. Whether it be managing your stress, asking friends or family, or mental health resources, or your dermatology provider, your rheumatology provider, not being afraid to really ask for help and really trying to manage your overall health the best way that you can.
Corinne: Thank you for mentioning stress management. That is such an important thing to talk about since stress can definitely be a trigger for psoriatic disease. And I do know that during the winter months, depression and sometimes stress can be triggered. And with the winter, the darkness, the coldness, it definitely can impact our lives in more ways than one. And with inclement weather, it can sometimes take longer to travel places or for patients to get out and see their doctors at their appointments and things like that, or even get supplies to help with their condition. Do you have any tips to help address a change in mood during winter months? And is light therapy an option for patients?
Eileen: Yeah, when we talk about light therapy, I think of a couple of different types of light therapy. Having a light therapy device in terms of combating seasonal affective disorder or depression. So having a light unit in your home that you perhaps expose yourself to just to really have some of that natural light come through with a light device to really try to help boost mood. There’s a lot of evidence out there that some of those devices can certainly help counter some of the feelings or effects we may have from less daylight during this time of year. And then I always tell folks telehealth is a great option too. You mentioned inclement weather, not being able to get to your doctor’s office or supplies. We are living in an age where everybody can get a lot of things either right on their doorstep or hopefully through a quick chat and being able to reach out to your provider or professional and say, “Hey, you I need to reach you, but I’m in a position where I can’t get out during the winter months. Transportation or winter is difficult and I may have trouble getting to the pharmacy or getting the things I need. What are some options for home delivery pharmacies? Can I meet with you over telehealth?” And then I do have some patients that have done UV therapy for their actual psoriasis. So they’re having a flare and with their dermatology provider have been able to get a UV unit in their home where they’re able to treat their psoriasis with narrowband UVB light with a light box or a light device at home. So there can definitely be some creative solutions or creative ideas to try to really help manage where there may be changes in mood in the winter months, but also your skin.
Corinne: It’s great that we have so many tools in our toolbox to help given the changing weather or any other kind of accessibility hurdles that some patients might face. But I wanted to say thank you so much Eileen for providing such amazing ideas and tips for managing psoriatic disease during the winter months. This has been a great discussion, and I’m sure our listeners will really appreciate all of your input. Do you have any final comments you would like to share with our listeners today?
Eileen: Hang in there. Winter is a tough time for psoriasis for many of the reasons we talked about but when in doubt, reach out to your healthcare provider and let them know if you’re struggling in any capacity of your psoriatic disease, reach out to your provider and let us know how we can help you because we truly want to be a partner in your care.
Corinne: Thank you again Eileen for taking time to be here today. We still have some time before spring arrives, so it’s possible tips you provided can still offer help to those in need. For our listeners, a reminder to check our Seal of Recognition program for potential products you can use. If you still have questions, contact our Patient Navigation Center at education@psoriasis.org. And finally, thank you for listening to Psoriasis Uncovered where we uncover what you need to know about psoriasis and psoriatic arthritis.
We hope you enjoyed this episode of Psoriasis Uncovered for people living with psoriasis and psoriatic arthritis. If you or someone you love has ever struggled with psoriatic disease, our hope is that through our podcast you’ll gain information that inspires you to lead a healthy life and look to the future. Please share the episode link if the content in today’s episode will benefit someone you know.
You can find this or all future episodes of Psoriasis Uncovered on Apple Podcasts, Spotify, Amazon Music, Gaana, Pandora, iheart radio, and the National Psoriasis Foundation web page. To learn more about this topic or others please visit psoriasis.org or contact us with your questions or comments by email at podcast@psoriasis.org.
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