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RA Itching

To fully appreciate the connection between psoriasis and itching, it’s worth noting that the word psoriasis originates from the Greek word “psora,” which means to itch.

Itching affects up to 90 percent of people with psoriasis. What’s more, as many as 75 percent of psoriasis patients deal with this bothersome symptom — the condition’s primary source of discomfort — on a daily basis, according to one study in the British Journal of Dermatology.

The itching that accompanies psoriasis may be particularly bad right now since stress is a common trigger for psoriasis, and living with a chronic illness during the coronavirus pandemic can send stress levels soaring.

“I’m seeing a lot of psoriatic exacerbations due to this stress phenomenon,” says Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut.

The Vicious Cycle of Stress and Itch

To make matters worse, itching isn’t just triggered by stress — it is also associated with increased anxiety, depression, and other mood disorders. And, in turn, stress and anxiety exacerbate itch, leading to a vicious cycle that worsens psoriasis and impacts quality of life.

Indeed, for many people, the itch of psoriasis — which can be especially severe at night, disrupting sleep — has a bigger impact on their quality of life than the patches of thick raised skin covered with silvery scales that represent the visible aspect of the disease.

Treating your psoriasis is the best way to reduce itching, and there are a host of treatments, ranging from topical creams and photo (light) therapy to targeted biologics, that can help — though lack of access to treatment due to the pandemic can still be an issue.

The goal in treating psoriatic itch is to inhibit the itch-scratch cycle. Biologic drugs like etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), and ustekinumab (Stelara), are better for itch than topical treatments because they have a central effect in the brain that reduces itch activation and improves mood.

“Currently available medications don’t directly address the symptom of itching in psoriasis, however, most medications seem to improve the itch before they improve the psoriasis itself,” says Lawrence Green, MD, section editor of the Psoriasis Centers of Excellence for The Dermatologist, clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C., and a member of the medical board of the National Psoriasis Foundation. “I often hear from patients that after starting a therapy their itching has improved when the psoriasis doesn’t necessarily look that much better. But when I see them again, the psoriasis has significantly improved or cleared up and the itching stays gone.”

Managing Psoriasis Itch During COVID-19

Still, even the most effective treatments don’t always completely eradicate psoriasis symptoms like itching.  Combining prescribed medications with home remedies and lifestyle changes is often the best strategy.

Here are eight tips you can try while sheltering in place to help take the “psora” out of psoriasis.

1. Use moisturizer

With psoriasis, the skin’s inherent ability to retain moisture can be greatly reduced — up to 20 fold, compared with uninvolved skin, according to studies. There is also a correlation between disease severity and moisture loss. Since dry skin is often itchy, moisturizer is key to fighting the uncomfortable sensation.

“Since we don’t have a medication yet that directly targets the feeling of itch, we treat it by recommending topical products that can soothe the feeling,” explains Dr. Green, who prefers creams to lotions. “Creams are thicker and last longer on the skin, whereas lotions are more water and evaporate quicker, so you lose any moisturizing factor quicker than with a cream.”

2. Skip hot showers

As good as hot water can feel, it robs the skin of moisture, leading to irritation that causes itching. It also increases blood flow, which can trigger itching. To keep hot water from harming your skin, use lukewarm water and limit showers to about five minutes and baths to about 15 minutes. Keep in mind that the idea isn’t to shower less, which many people are doing in these days of more social isolation.

“When you shower less often, there’s a tendency to moisturize less or skip it altogether,” says Dr. Gohara. So stick to your regular showering schedule, which may be daily or every second or third day, depending on your activity level. Wash with a mild cleanser (Dr. Gohara recommends Dove), and moisturize afterward.

“You want your skin to be in the best condition because when we do integrate back into the world, that’s really the barrier between us and germs [that can cause infection],” says Dr. Gohara.

3. Remove scales

Psoriasis causes skin cells to divide about 10 times faster than normal and the excess cells build up into scaly thick patches of itchy, dry skin.

“Removing the scale often leads to less itchiness,” says Dr. Green. It can also improve the results you get from itch-relieving products, according to the American Academy of Dermatology (AAD).

Ingredients like salicylic acid, which soften skin and break down the outer layer of cells, are often used to remove scale. Gold Bond Ultimate Psoriasis Relief Cream and CeraVe Psoriasis Moisturizing Cream are two salicylic acid-containing products to try. A definite don’t: picking scales to remove them. Besides leaving the skin open to infection, pulling off scales can traumatize the skin and worsen psoriasis — what’s known as the Koebner phenomenon.

4. Keep your fingernails short and smooth

 Since it can be difficult to avoid scratching completely, keeping your fingernails short and filing them so the tips are smooth can prevent you from scratching too hard.

5. Cool the skin

Cool compresses or products that create the sensation of coolness help by reducing the perception of itch. Products like Sarna Anti-Itch Lotion that contain menthol and/or camphor tend to work best for itchy skin.

6. Maintain scalp hygiene

Scalp psoriasis, in particular, can be very itchy, and special shampoos and medications —including those that contain coal tar, salicylic acid, and steroids — are often needed to control it. Since there are fewer places to go during the pandemic, however, “a lot of people are, like, ‘I don’t need to wash my hair,’” says Dr. Gohara. “But it’s really important to keep up with your routine to avoid exacerbating the condition.”

One of the worst-case scenarios with scalp psoriasis is hair loss, a common problem that results from damage to the hair shaft or follicles that can be caused by scratching. Luckily, this hair loss is almost always temporary and hair tends to regrow once your scalp clears. To make your scalp feel less dry, the American Academy of Dermatology recommends conditioning hair after every shampoo. Bonus: Using a non-medicated conditioner can help reduce the often-unpleasant scent of a medicated shampoo.

7. Seek (a little) sun

Psoriasis is an inflammatory disease. Inflammation that starts as part of the body’s normal healing process gets out of control, leading to the development of the signature plaques that cause itching. Dermatologists often use a narrow band of ultraviolet-B rays from artificial light sources to penetrate the skin and slow the growth of affected skin cells.

Getting your own sunlight outdoors is not as effective as phototherapy, but “I love the idea of ambient sun as an anti-inflammatory right now for people suffering from psoriasis,” says Dr. Gohara. “It’s not carte blanche to lay out in the sun and get skin cancer, but 10 minutes of ambient sun exposure three times a week can really help to bring down the inflammation of psoriasis.” Besides helping with skin health, spending time in the sun helps with mental health too — it boosts levels of serotonin, the “feel-good” brain chemical, which correlates with better mood and feelings of satisfaction and calmness.

Just be sure to keep periods of sun exposure brief, since, according to the Mayo Clinic, too much sun can actually trigger or worsen psoriasis outbreaks.

8. Manage stress

“We’re living in a time of unprecedented stress, and it is really important to control it to the extent that you can,” says Dr. Gohara. Exercise is a proven stress reliever, and yoga, in particular, is an effective way to exercise your body and calm your mind in the comfort of your own home. Here is a very gentle yoga routine you can even do in bed.

Another option recommended by Richard Fried, MD, PhD, a dermatologist and clinical psychologist in Yardley, Pennsylvania, is progressive muscle relaxation, where you clench and then relax your muscles one by one starting at one end of your body and working your way up or down your body. The technique takes about 10 minutes, and when practiced at night, it can reduce physical tension and quiet the mind, helping you fall asleep faster and sleep longer.

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8 Ways to Relieve Itchy Psoriasis. American Academy of Dermatology. https://www.aad.org/public/diseases/psoriasis/skin-care/itch-relief.

Interview with Lawrence Green, MD, section editor of the Psoriasis Centers of Excellence for The Dermatologist, clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C.

Interview with Mona Gohara, MD, associate clinical professor of dermatology at Yale School of Medicine in New Haven, Connecticut

Takahashi H, et al. Defective barrier function accompanied by structural changes of psoriatic stratum corneum. The Journal of Dermatology. January 2014. doi: https://doi.org/10.1111/1346-8138.12393.

Zhu B. Itching is a significant problem and a mediator between disease severity and quality of life for patients with psoriasis: results from a randomized controlled trial. British Journal of Dermatology. April 2014. doi: https://doi.org/10.1111/bjd.13065.