From healthcentral.com
Despite what you may have read, experts discourage the practice of removing PsO lesions. Here’s why
Experts caution against picking at plaque psoriasis with your nails because it can damage your skin and trigger a flare. But, if your skin is itchy and uncomfortable, it can be hard to leave it alone, especially if it is on your face or in other sensitive areas. So, what to do? Start with these tips for managing plaque psoriasis symptoms and learn from top psoriasis experts why removing plaque psoriasis scales is not recommended.
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When you feel something on your skin that shouldn’t be there, it’s a natural instinct to want to remove it. But picking the scales off your skin is not the way forward. “I wouldn't recommend directly trying to peel off psoriasis lesions as they are prone to bleeding,” says George Han, M.D., a dermatologist at Northwell Lenox Hill Hospital in New York City. “We actually use this fact clinically to prove psoriasis sometimes—it’s called the Auspitz Sign.” (The Auspitz sign refers to pinpoint bleeding under the skin’s surface, named after Heinrich Auspitz, a 19th-century Austrian dermatologist.)
Removing plaques from the skin raises concerns about potential bleeding, agrees Kurt Ashack, M.D., a dermatologist and assistant professor at Michigan State University College of Human Medicine in East Lansing, MI. Those raw, open wounds can become infected, leading to even greater pain. “You can exfoliate with things like salicylic acid, but I do not recommend removing the plaques,” Dr. Ashack says.
In addition to causing even more skin inflammation by physically removing a plaque, doing so provides only momentary relief, says Dr. Han. Without treatment, the plaques will continue to show up, he explains. So instead, you’re better off playing the long game. “I would say that appropriate treatment should help reduce the thick plaques gradually by stopping the inflammation causing the thickened skin to begin with,” Dr. Han says.
If your psoriasis symptoms are flaring, there are other ways to make the scales less troubling. “If topicals are not helping and you are not on a biologic agent, we can inject the plaque with a steroid to help it go away,” says Dr. Ashack.
Outside of the derm’s office, you can also reduce some of the skin discomfort, starting with avoiding common triggers that may be making your condition worse. According to the American Academy of Dermatology Associates, (AAD) things like unmanaged stress, skin injury (bug bites or sunburn as examples), alcohol, smoking, cold weather, and even shaving can increase inflammation and make the plaques worse.
Another strategy to help the scales is to apply a fragrance-free moisturizer. According to the AAD, extra moisture applied to the skin may change the reflective property of the scales so you don’t see the scaling as predominantly.
Because all moisturizers are not created equal, it’s important to choose one that will make things better, not worse. The National Psoriasis Foundation maintains a list of products that have earned their seal of recognition that are free from irritants and can be used on psoriasis plaques.
Lactic acid is a type of alpha hydroxy acid (AHA) that has been shown to be helpful in the treatment of plaque psoriasis. Using lactic acid to elicit changes in the skin is a very old practice, with reports of Cleopatra bathing in sour milk, which contains lactic acid, in order to give her skin a youthful appearance.
Salicylic acid is also a go-to therapy for plaques associated with psoriasis, says Dr. Han, noting that topical application of products containing salicylic acid may help reduce or soften scales. “Salicylic acid products in the 2% to 6% range may be helpful,” he says.
Both lactic acid and salicylic acid have shown to be beneficial for managing psoriasis plaques. In a two-week, double-blind trial testing the efficacy of a 20% alpha-hydroxy/polyhydroxy acid emollient versus a 6% salicylic acid cream, both treatments reduced the scales of psoriatic lesions. The 20% alpha-hydroxy/polyhydroxy acid cream yielded quicker results and less toxicity than salicylic acid.
To manage skin plaques, there are a variety of products and formulations available, including oils, ointments, creams, lotions, gels, foams, sprays and shampoos. Most people with mild psoriasis will start treatment with one of these topical medications. Even if you have more advanced psoriasis that requires a systemic treatment, your doctor may still recommend you continue with a topical treatment.
According to the Mayo Clinic, the most frequently prescribed topical medications include:
Anthralin
Calcineurin inhibitors (such as tacrolimus, pimecrolimus)
Coal tar
Corticosteroids (such as hydrocortisone, triamcinolone, clobetasol)
Retinoids (tazarotene)
Salicylic acid
Vitamin D analogues (such as calcipotriene, calcitriol)
Even though the visible symptoms of psoriasis appear on the skin, it can impact the entire body. For this reason, it may be necessary for you to take a medicine that addresses the root cause of psoriasis—an overactive immune system.
There are many treatment choices available. Which one you choose will be a decision made with your provider based on factors such as which medications you have tried previously, potential side effects of medications, cost, and personal preference.
Some of the most-prescribed treatments include:
Biologics (such as etanercept, infliximab, adalimumab, ustekinumab, ixekizumab)
Cyclosporine
Light therapy
Methotrexate
Retinoids
Steroids
If you have plaques on your skin from psoriasis, it’s natural to want them removed. But direct removal is not something most dermatologist advise, due to complications and inflammation that can results.
Instead, talk with your doctor about alternate ways of managing skin plaques. Gentle exfoliation and moisturizing the plaques that may make them more comfortable and less noticeable.
Plaques can be very bothersome and a sign of undertreated disease, so proper treatment of psoriasis itself is the best way to reduce plaques and lower the odds of their return. With so many different treatment choices available, from medications that you apply directly to your skin to pills or injectables that work systematically, you will be able to find a way to control your psoriasis.
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