How to Care for Problem Skin in the Winter
Facing the enemy
As temperatures drop, heaters clank on, and the wind whips up, the battle for healthy skin begins. Dry air takes away the thin layer of oil that traps moisture in the skin, flaring itchy and painful conditions such as eczema, psoriasis, and severe dry skin.
"If we stop producing moisture or if heating sucks it out of the skin, and it's not being replaced, that will tend to cause little cracks that affect the barrier of the skin," says Alan Menter, MD, chair of psoriasis research and the division of dermatology at Baylor University Medical Center in Dallas. Any trauma to the skin, such as cracking, causes an inflammatory response, which can make skin more susceptible to flare-ups of psoriasis and eczema.
But you can minimize the toll the next few months will take on your skin by preparing now. Here's our action plan to keep you comfortable and flare-free.
1. Keep the shower as brief as possible and use lukewarm, not hot, water.
2. Switch to less aggressive, moisture-rich soaps made for sensitive skin, such as those made by Dove and Aveeno.
3. Gently pat yourself dry to avoid traumatizing or overdrying the skin.
4. Apply moisturizer while your skin is still slightly damp.
Therapeutic baths, such as oatmeal baths or sea salt baths, may help some patients, but they tend to take time, and some salt treatments can be drying, so it’s important to moisturize afterward.
Bruce Strober, MD, PhD, director of the Psoriasis and Psoriatic Arthritis Center at NYU Medical Center in New York City, understands that not everyone, especially men, will take time to do so. "I tell patients that I don't care how they moisturize, just do it regularly in a way that you like." He recommends targeting problem areas first.
"There are so many good over-the-counter products out there. Eucerin is one, and Cetaphil. They're inexpensive and work well," says Dr. Menter.
To get better results, Christine Yuan, 22, who lives with eczema and psoriasis, wraps her problem areas in plastic wrap for 30 minutes to an hour after moisturizing. "It takes time," says Yuan, "but your skin is baby soft!"
If your skin does flare up, choose soft, breathable fabrics, like cotton, instead of itchy woolens or polyester. Loose-fitting clothing will also help to keep your skin from chafing and becoming irritated by perspiration.
Change the air around you
Dr. Strober suggests that his patients use a humidifier to increase moisture levels in the home. Experts recommend keeping the humidity level between 30% and 50% (which you can measure with a hygrometer).
Dr. Strober recommends getting a flu shot, if your primary care physician agrees that it’s appropriate. "Ask your primary doctor, and then get it and any other vaccinations that might help you fight infection." And follow basic steps to keep yourself healthy, like washing your hands frequently, getting good sleep, and exercising.
A 2001 report in Archives of Dermatology measured stress levels and water loss in students without any skin disease after winter vacation, during final exams, and during spring break. The researchers found that during periods of stress, the skin's ability to retain water was reduced.
Look for wayssuch as exercise, meditation, yoga, or biofeedbackto relieve holiday-related stress.
Watch your weight
But psoriasis patients should tread carefully. There isn't conclusive research linking diet and psoriasis, but fasting periods, low-energy diets, and vegetarian diets improved psoriasis in some studies. And weight gain in general can worsen the condition.
"It does behoove a psoriasis patient to have a lower BMI. Studies do suggest that higher BMI corresponds with increased severity of psoriasis," says Dr. Strober.
Phototherapy for psoriasis
"The issue is two-fold," says Dr. Strober. "First, people wear garments that cover the skin and have a tendency to stay indoors. Second, the potency of ultraviolet light is lessened in the wintertime."
So phototherapy (in which patients are exposed to UVB or UVA rays) makes sense for patients "who are responsive to UV light," says Dr. Strober. "But you need to come in at least two to three times a week." The bonus, though, is it is covered by many insurance policies.
PUVA, a combination of UVA rays and psoralen, a medication that increases the skin's sensitivity to ultraviolet light, is another option. In a 2006 study published in Archives of Dermatology, clearance rates were roughly 80% for psoriasis patients who received PUVA and 50% for patients who received narrow-band UVB.