A shocking number of Americans have psoriasis and eczema—39 million adults and children—which is more than four times the population of New York City, the largest city in the US. According to dermatology specialists Joshua Fox, M.D., and Robert Levine, D.O., with Advanced Dermatology, PC, (multiple locations, NY NJ) the seasonal change to cold, dry air creates difficulties for people dealing with these chronic skin disorders. "It is important to manage symptoms," says Fox, who has served on the board of the National Psoriasis Foundation. "Psoriasis and eczema can be painful. They can make everyday actions uncomfortable for adults and children, men and women, and they carry a stigma that can lead to a loss of self-esteem, depression, and other health complications."
What are the common symptoms?
Psoriasis appears on the skin as red or white, scaly patches that often itch and bleed. The patches can also look scaly or silvery in color. Nails can become yellow, ridged and separate from the nail bed. Up to 30 percent of people with the disease develop psoriatic arthritis, and recent studies indicate that patients with moderate to severe disease are also at increased risk for other associated health conditions, including heart disease, heart attack, diabetes, high blood pressure, obesity, depression and hypertension.
Eczema, a hypersensitivity disease, inflames the skin, causing pain, itching, dryness, swelling, cracking, weeping and scaling. Eczema lesions can bubble, ooze, and crust over if scratched. Skin infections can occur if bacteria invade the skin lesions.
What are treatment options?
"Once patients understand their psoriasis or eczema is not contagious, they seem to be relieved," says Fox. "They are comforted to know there is help for their symptoms." Psoraisis is an autoimmune disease apparently cause by an overactive immune system that overproduces skin cells. Eczema, on the other hand, is caused by a deficient immune system in which an imbalance of skin proteins creates skin sensitivities. "This is a significant distinction because it informs treatment," explains Dr. Fox. "A dermatologist will diagnose the condition and provide the most effective care for individual patients."
- Topical creams, such as corticosteroids, calcipotriene, anthralin, salicylic acid, and coal tars, to reduce inflammation and dissolve skin lesions
- Laser therapy with ultraviolet (UVB) light
- Systemic medications taken orally or by injection that suppress or control the immune system
- Topical creams, such as corticosteroids (severe) and hydrocortisones (mild), to reduce inflammation
- Immunomodulator creams that control inflammation and immune system reactions
- Systemic pills that suppress the immune system
- Prescription strength moisturizers that restore the skin barrier
- Oral antihistamines to relieve inflammation
- Diluted bleach baths and antibiotics to treat infection
What do you recommend patients do to manage psoriasis and eczema throughout the winter?
- Moisturize. Use a non-irritating, fragrance-free moisturizer. Thick ointments are best for locking in moisture and repairing the skin barrier.
- Limit bathing. Take warm (not hot) baths not more than once per day. Pat the skin dry with a towel (do not rub) and apply moisturizer immediately following.
- Choose a mild, non-irritating soap. Use sparingly.
- Use a humidifier indoors. The ideal range is 45-55 percent humidity.
- Wear loose, soft clothing. Choose cotton over wool, denim, or other harsh fabrics. Wear gloves and scarfs outside to protect exposed skin.
- Avoid sweating. Sweat can trigger flare-ups. Wear wicking fabrics and change out of damp or snowy clothes as soon as possible.
- Keep fingernails short. This decreases the likelihood that scratching will tear the skin and lead to infection.
- Hydrate. Drink plenty of water.
- Reduce stress. While this is easier said than done during the busy holidays, stress can trigger flares.
- Identify and eliminate possible triggers. Some common triggers include wool, soaps, fragrance, pet fur, cosmetics, and household cleaners. Some patients have found relief by altering their diets.