More Than Winter-dry Skin*
Eczema and psoriasis flare up this time of year. Here’s what you need to know.
For some people, freezing temperatures and harsh winds can cause more than chapped lips and dry skin. People with eczema or psoriasis—two inflammatory skin conditions—are most likely to experience flare-ups when the weather turns cold and dry. Though these skin conditions are often mistaken for each other (both can include itching, rashes, and redness), there are differences in how they affect the body and how they are treated.
There are several types of eczema, but the most common is atopic dermatitis (AD), an allergic skin disease. The main symptom is itching, which can be so intense that scratching leaves the skin vulnerable to infection. “Eczema is an inherited skin condition often associated with asthma or allergic rhinitis [hay fever],” says Jeffrey Weinberg, MD, associate clinical professor of dermatology with the Mount Sinai hospitals in New York City.
Eczema often starts in early childhood, and some people outgrow the symptoms as they age. In children the disease usually appears on the cheeks, elbows, knees, and scalp. In adults, eczema typically shows up in the creases of the face and neck, behind the knees, and on the wrists and ankles.
Besides itching, eczema symptoms can include dry, red, scaly, or inflamed skin; bleeding (from scratching); swelling; crusted or oozing skin; and rough, leathery, scaly patches. These symptoms can come and go, with periods of clear skin followed by flareups when the skin becomes itchy and irritated again.
Anything that might rob the skin of moisture can precipitate a flare-up, including the cold, dry air of winter; central heating; and frequent bathing without applying a moisturizer afterward. Skin that’s exposed to winter elements is particularly vulnerable, especially on the hands and face. And as people bundle up, wool and polyester clothing can also be irritants.
There is no cure for eczema, but flare-ups can be minimized and symptoms managed. The most important step is moisturizing frequently. Symptoms are usually treated with topical medications (including corticosteroids), biologic agents (drugs created
in a lab to mimic naturally occurring proteins and molecules), immunosuppressant drugs, and phototherapy.
Usually, the body grows new skin cells and sheds them every 30 days. But for people with psoriasis, the immune system goes into overdrive and produces new skin cells every three to four days. Instead of shedding the overproduced cells, the dead skin piles up as raised reddish patches with a thick, scaly, silvery-white layer. These patches, called plaques, can appear anywhere on the body but most often occur on the elbows, behind the knees, and on the scalp, lower back, and buttocks.
This condition affects an estimated eight million Americans, according to the National Psoriasis Foundation. Psoriasis can occur at any age, but it most commonly begins between the ages of 15 and 25.
As with eczema, both environmental factors and genetic predisposition play a role. While it may be difficult for most people to tell the two conditions apart, it’s actually fairly easy for dermatologists: Psoriasis usually makes the skin thicker and patchier than eczema, and it doesn’t itch as intensely.
Winter is usually a bad time for people with psoriasis, in part because of the cold, dry weather, but also because of the relative lack of ultraviolet light, which can ease the condition in
the warmer months. What’s more, just about anything that jolts the immune system can bring about a painful flare-up, including stress, colds, strep throat, or even an ear infection.
One in three people with psoriasis develop psoriatic arthritis, a disease that causes stiffness, swelling, and pain in the joints and surrounding areas. The chronic inflammation in psoriasis is also associated with other serious conditions such as cardiovascular disease and diabetes.
There are many treatment options for psoriasis sufferers. Mild to moderate cases can be treated topically with a combination of steroids and emollients such as petroleum jelly mixed with salicylic acid, retinoids, and vitamin D. Phototherapy treatment can help by exposing the skin to an artificial source of UVB, a type of ultraviolet light. Moderate to severe psoriasis usually requires systemic treatment with oral medication (such as methotrexate and systemic retinoids) or biologics.
It was treatment with biologics that finally helped Jennifer Kerner, 37, a scientist and consultant with Booz Allen Hamilton in Washington, DC, control her psoriasis. Diagnosed in high school after many years of developing red, itchy skin patches, she tried every topical medication available, without success. Kerner had heard about biologic medications, but they were described as a last resort by her doctor.
She became more desperate as her condition worsened. “The patches became more visible; they were on my arms and legs,” she says. “To cover them up I would wear long sleeves, turtlenecks, and pants—all the things you shouldn’t do with psoriasis because it overheats the skin and makes it worse.”
Finally Kerner consulted another doctor, who listened to her story and immediately said, “We’re going to put you on a biologic.”
Kerner was so relieved she burst into tears. “I began giving myself biologic injections every two weeks, and I felt like a new person,” she says.
As with eczema, psoriasis can make people feel shunned because of their skin’s appearance, even though the condition is not contagious. “There’s a huge social impact for psoriasis patients,” says Mark Lebwohl, MD, a dermatologist with Mount Sinai in New York. “I’ve heard of hairdressers turning patients away, as well as blood banks not allowing people to donate. Sometimes it even results in job losses and absenteeism. Someone once said, ‘Psoriasis is not fatal, but dealing with it is murder,’ and that’s a great description of it. It’s a truly devastating disease.”
“PSORIASIS IS NOT FATAL, BUT DEALING WITH IT IS MURDER.”