The Challenges Of Winter And Psoriasis Flares

Psoriasis is a chronic and inflammatory multifactorial disease but for some reason, people seem to suffer more in the wintertime when flare-ups are much more common.

Jennifer Bourgeois, PharmD, a pharmacist at Market Street Pharmacy in McKinney, Texas, noted while there is no definitive answer as to why psoriasis flares up more in the winter, research speculates it’s due to drier skin that is caused by inside heat and spending less time outside in the sunshine.

Dry air can cause the skin to lose moisture, especially the upper layers, which is what results in dry, flaky skin. Studies have also found that fewer hours of sunlight in the winter seasons may trigger psoriasis flare-ups as well.

“Psoriasis is an inflammatory condition of the skin and the inflammatory cascade can be triggered by many different factors including stress, diet, and infections,” Bourgeois said. “We know that winter is often accompanied by higher stress of the holidays, increase in sugar intake, and peak season of flu—all of these may contribute to the psoriasis flares.”

Suzanne Friedler. MD, FAAD, a dermatologist at Advanced Dermatology PC in New York, noted one of the things that help psoriasis is UV light because sunlight decreases certain inflammatory mediators so it’s able to regulate the inflammatory cascade you see in psoriasis.

“Obviously in winter, there’s less UV exposure, so it causes psoriasis to be a little bit worse,” she said. “Also, people tend to take longer or hotter showers, which dries out the skin; there’s less humidly in the air in winter months; and those with dry, itchy skin can also add to winter flare-ups.”

Emily Fritchey, a holistic skin therapist at Sunshine Botanicals in Newnan, Georgia, notes as the skin gets drier, it is more likely to crack, bleed, and get infected.

“Low levels of exposure to sunlight’s ultraviolet rays likely cause psoriasis to worsen during fall and winter without proper care and precautions,” she said. “Lack of understanding when it comes to the proper skin care necessary is the biggest issue patients face.”

Psoriasis triggers vary from person to person, and some of the most common triggers include stress. Therefore, relaxation techniques, stress management and an anti-inflammatory die help tremendously to help minimize the impact stress has on this condition, Fritchey shared.

Friedler recommends moisturizing frequently to cut through the thick layer of scale and taking the correct medication helps, so communicating with your dermatologist is vital in proper care.

“There are better and better biologic therapies and lots in development,” she said. “It’s a hopeful time.”

Patients with psoriasis can keep a journal to track flares, Bourgeois said. This information can be used to help pinpoint the factors contributing to the flare, such as, is this only occurring in the winter months? Is the flare triggered by a recent illness or a change in diet?

“Awareness of the triggers can significantly help the patient and provider develop a lifestyle strategy specific for the patient,” she said. “This is often used in adjunct to a pharmaceutical medication.”

She recommends that patients use a thicker moisturizer, especially after they get their skin wet. Also covering the skin and not directly exposing it to the cold, dry air.

“This heated air in our homes and workplaces is typically drier and can steal from moisture levels in your skin,” she said. “Add a humidifier to support your skin health. Also, increase your water intake during the winter months.”

Considering lifestyle factors and natural ingredients that have science behind them is important to complement typical pharmaceutical treatments for winter flare ups. That’s why it’s important that dermatologists understand the environment their patients are in, especially for those living in cold climates.

Fred Pescatore, MD, noted that lifestyle adjustments that can help flare-ups, as well as the science behind some of the most beneficial natural ingredients for psoriasis, such as Pycnogenol French maritime pine bark extract, is an important way to best work with patients.

“Studies have found the natural antioxidant to significantly improve the painful and visible symptoms of psoriasis, including redness, flaking, thickness and total surface area of affected skin patches,” he said.

Most important, dermatologists should be providing patients with the information they need on what to do and not do daily during treatment.

“A simple handout that takes the guesswork out of the self-care they need to do at home will take the overwhelm out of what to do and not do at home and improve treatment outcome,” Friedler said.