3 skin conditions compete for attention, triggered by the immune system and more

From toledoblade.com 

What would you rather have? Eczema, psoriasis, or ringworm?

Jeremy Rowe, a physician assistant at Mercy Health-St. Luke’s Dermatology in Maumee, knows his answer. He has them ranked. First, ringworm, because it is easiest to treat. Next is eczema, and psoriasis is last because it is the most complex and increases a patient’s risk for other issues, such as psoriatic arthritis and cardiovascular disease.

Ringworm has nothing to do with worms. It is a fungus. Eczema is very troubled, dry, and scaly skin. Psoriasis involves the immune system attacking healthy cells.

“They both are inflammatory skin processes,” Mr. Rowe said of psoriasis and eczema. “I would say psoriasis comes with potentially more consequences as an autoimmune disease.”

Eczema

Recent data shows air pollution, especially from wildfires, can exacerbate or trigger episodes of eczema.

Research from the 2023 Canadian wildfires and from California wildfires revealed a significant boost in visits to dermatologists. 2025 may be a booster year for such visits as Canada raised its National Preparedness Level to a 5, its highest level, on May 30, where it has remained for the past week. Air particles from the wildfires were apparent in Ohio on Monday and continued to linger for several days.

Eczema is a condition where the skin’s barrier has been weakened, making it more susceptible to irritants and allergens. The skin’s ability to retain water is lowered, resulting in dry, itchy, and flaky skin. One U.S.-based study found 91 percent of eczema patients experienced itching on a daily basis, and 36 percent of patients identified decreasing the itching as their primary treatment goal.

A 2021 study looked at data collected during the 2018 California Camp Fire, which took place from Nov. 8-25. The fire coincided with a 7.7 percent increase in weekly paediatric itch clinics, which focus on the diagnosis and treatment of chronic or severe itching.

In 2023, Massachusetts General Hospital researchers were able to correlate increased carbon monoxide levels to a striking rise in dermatology clinic visits that summer when wildfire smoke from Canada permeated the air.

“The health impact of air pollution from wildfires has not been well studied, but the evidence from our recent studies suggests that short-term exposure to wildfire air pollution can affect the skin and cause flares of certain skin disorders,” said Dr. Maria Wei, a professor of dermatology at the University of California, San Francisco.

People who have eczema were more likely to visit dermatologists during wildfires, while psoriasis patients were more likely to seek care five to nine weeks after the fires started, she said.

Once the itching begins, it begets more itching and a further breakdown of the skin barrier. About 10 percent of the U.S. population struggles with eczema that is often passed down through families. It is traced to certain genes that produce a protein that helps maintain the skin barrier. These same families often have a history of asthma or allergies, as well.

Pollution is not the only trigger, according to experts. Food allergies, dust mites, pollen, harsh soaps, detergents, and fragrances can also worsen eczema. Wool has also been known to act as a trigger. Studies have found the condition has increased two- to three-fold in industrialized countries since the 1970s.

“If you have that breakdown, the body overreacts to the threat and that causes eczema,” said Dr. Danielle Saevig, a family medicine provider at ProMedica.

Psoriasis

                                                                                                                                     PIXABAY

Eczema should not be confused with psoriasis, according to Dr. Saevig.

“I think the overlap is that each causes raised, patchy skin,” said Dr. Saevig, noting that both involve components of allergies and autoimmune conditions.

But psoriasis involves an overactive immune system attacking healthy cells. A deficiency in vitamin D can increase any breakouts, and a steroid is usually needed to curb it, according to Dr. Saevig. About 3 percent, or 7.5 million adults, in the United States has psoriasis, according to a study published in the National Library of Medicine.

Neither psoriasis nor eczema can be given to another person via contact. But another condition, ringworm, can be. This is a fungal infection and affects as much as 25 percent of the world’s population at any given time, according to Cleveland Clinic. There are about 40 types of fungus that can cause ringworm.

“Ringworm grows in warm, wet skin. You get it from exposure from other people with ringworm,” Dr. Saevig said. “Most people will get it on their foot because they will walk barefoot in a public space.”

Ringworm is common and often can be treated with over-the-counter antifungal medications. However, researchers have discovered a growing resistance to antifungal treatments among some cases of ringworm. Those with persistent cases should see their doctor. There also have been documented cases of a rare, sexually transmitted ringworm — which also is new — mostly among men having sex with men.

Ringworm, also known as athlete’s foot or jock itch, can be confused with eczema or psoriasis, but its hallmark is a scaly ring-shaped area.

“This is a fungal infection that feeds on skin cells,” said Mr. Rowe, adding that it has a softer scale and likes heat and moisture that may accumulate in the body’s crevasses.

Ringworm is easily passed from pets or farm animals, through contact sports, such as wrestling, and even while gardening, according to Mr. Rowe.

“If you think you have one of these conditions, you want to talk with your doctor,” Dr. Saevig said.

https://www.toledoblade.com/health-well-being/2025/06/08/skin-conditions-eczema-psoriasis-ringworm-immune-system/stories/20250604093

Increased belly fat associated with higher psoriasis risk

From diabetes.co.uk/news

Central body fat “contributes to psoriasis” more than total body fat, latest evidence has claimed. 

A new study has found that women with increased belly fat are at greater risk of developing psoriasis compared to men with increased abdominal fat.

Psoriasis is a skin condition that causes flaky patches of skin, which form silvery-white or grey scales.

In the trial, the team of researchers examined the health data of 330,000 people, 9,000 of whom are living with psoriasis.

Using both traditional methods and advanced imaging techniques, the scientists analysed 25 different measures of body fat to see how they are linked with psoriasis.

First author Dr Ravi Ramessur said: “Our research shows that where fat is stored in the body matters when it comes to psoriasis risk.

“Central fat – especially around the waist – seems to play a key role. This has important implications for how we identify individuals who may be more likely to develop psoriasis or experience more severe disease, and how we approach prevention and treatment strategies.”

Corresponding author Dr Catherine H Smith said: “As rates of obesity continue to rise globally, understanding how different patterns of body fat influence chronic inflammatory conditions such as psoriasis is important.

“Our findings suggest that central body contributes to psoriasis risk irrespective of genetic predisposition and reinforces the importance of measuring waist circumference and pro-active healthy weight strategies in psoriasis care.”

Dr Ramessur explained: “We were surprised by how consistently strong the association was across different central fat measures and how much stronger the effect was in women.

“The observed links between central body fat and psoriasis suggest that there may be underlying biological mechanisms contributing to the disease that are not yet fully understood and which warrant further investigation.”

Dr Joel M Gelfand commented: “The strong relationship between psoriasis and obesity and the emerging promise of glucagon-like peptide-1 receptor agonists (GLP1RA) for reducing psoriasis morbidity is a call to action for large scale clinical trials of GLP1RA monotherapy for treatment of psoriasis.

“Our current paradigm of just focusing on the skin and joint manifestations when treating psoriasis is outdated in the context of our evolving understanding of the right relationship of psoriasis is outdated in the context of our evolving understanding of the tight relationship of psoriasis, obesity and cardiometabolic disease.”

Read the study in the Journal of Investigative Dermatology.

https://www.diabetes.co.uk/news/2025/jun/increased-belly-fat-associated-with-higher-psoriasis-risk.html 

Living Better with Psoriatic Arthritis: How Lifestyle Changes Can Make a Difference

From medscape.com

Psoriatic arthritis (PsA), a chronic inflammatory condition characterised by dactylitis, enthesitis, peripheral arthritis, skin and nail psoriasis, and spondylitis, occurs in around 10%-30% of people with psoriasis. While several pharmacological treatment strategies exist, PsA continues to significantly impact patients' pain levels, functional capacity, and mental well-being. 

Along with joint and skin manifestations, PsA is associated with several comorbidities, including cardiovascular disease (CVD), central sensitization syndrome, diabetes mellitus, dyslipidemia, fatty liver disease, gout, infections, inflammatory bowel disease, kidney disease, metabolic syndrome, obesity, osteoporosis, and uveitis, all of which negatively impact quality of life (QOL). Patients with PsA are also more likely to experience psychological issues, such as anxiety and depression. Given these challenges, nonpharmacological interventions play a key role in disease management. Healthy lifestyle changes, including dietary modifications, regular exercise, and quitting smoking — along with psychological interventions — are essential to improve PsA and QOL. Here are common nonpharmacological interventions that can improve symptoms and QOL of patients with PsA.

In their treatment guideline, the American College of Rheumatology and National Psoriasis Foundation (ACR/NPF) recommend nonpharmacological interventions for PsA, including acupuncture, low-impact exercise, massage, occupational therapy, physical therapy, smoking cessation, and weight loss despite weak evidence for all except smoking cessation.

The Importance of Physical Activity in Reducing Inflammation

Physical activity and targeted exercises play an important role in reducing inflammation, disease severity, and outcomes in patients with PsA. Studies have found that exercise, particularly when combined with dietary modifications, can improve PsA symptoms. The ACR/NPF recommend low-impact exercise over high-impact exercise for managing PsA. In their guideline, the European Alliance of Associations for Rheumatology notes regular physical activity as an integral part of care for patients with PsA.

Regular exercise, including resistance training, aerobic, and flexibility exercises may improve and preserve joint function, reduce inflammation, and enhance QOL in patients with PsA. A 12-week single-blind parallel randomized controlled trial by Silva et al found functional training and resistance training similarly improved disease activity, functional capacity, functional status, general QOL, and muscle strength in patients with PsA. 

The Link Between Diet and Inflammation in PsA

Dietary interventions focused on weight loss alleviate mechanical strain on the joints and reduce the risk of CVD in patients with PsA. Weight loss has also been shown to improve disease activity. Moreover, research suggests some dietary modifications, along with exercise, can improve PsA disease outcomes independent of weight loss. Diets rich in saturated fats or certain omega-6 fatty acids while anti-inflammatory diets can improve PsA symptoms and disease activity. Among various anti-inflammatory diets, the Mediterranean diet has gained the most popularity as studies have found it to be associated with lower disease activity in patients with PsA. 

According to the Medical Board of the National Psoriasis Foundation, patients with PsA may consider the Mediterranean diet on a trial basis in conjunction with pharmacotherapy. The NPF medical board also emphasizes increased intake of fibre, complex carbohydrates, monosaturated fatty acids, and omega-3 fatty acids. Although other dietary interventions for improving PsA are less studied, a case report by Lewandowska et al found a whole-food vegan diet improved PsA symptoms a 40-year-old woman. Further research, however, is needed to confirm the role of vegetarian or vegan diets in modulating PsA disease activity.

Smoking: What Role Does It Play?

The association between smoking and the development of PsA remains inconclusive, with studies yielding mixed results. At the population level, smoking is positively associated with PsA. However, some studies suggest smoking increases the risk of developing PsA, while others indicate no significant association between cigarette smoking and the progression of joint damage. Beyond disease onset, smoking has been linked to poorer treatment outcomes in PsA. An observational cohort study by Højgaard et al found that patients with PsA who smoke had poor responses to treatment with tumour necrosis factor-α inhibitors and were also less likely to adhere to their treatment plan. Additionally, smoking is a risk factor for CVD and other comorbidities common in PsA. Therefore, smoking cessation is an important lifestyle intervention for patients with PsA — not only to improve treatment efficacy but also to reduce the risk of other comorbidities, thereby improving the QOL.

Integrating Weight Management in PsA Care

The relationship between PsA and obesity appears to be bidirectional: Research has shown obesity is a common risk factor for developing PsA and that joint dysfunction and reduced physical activity due to PsA itself may result in weight gain. Patients with PsA and obesity often exhibit higher disease activity and poor response to treatment. An interventional study by Klingberg et al showed weight loss treatment with a very low energy diet improved disease activity, pain, fatigue, and C-reactive protein in patients with PsA and obesity. Similarly, another study by Klingberg et al also reported improvement in PsA disease activity after 12 months of weight loss treatment.

In addition to diet and exercise, GLP-1 and glucose-dependent insulinotropic polypeptide receptor agonists and incretins associated with weight loss may benefit patients with PsA and obesity. However, research on the effect of such drugs on PsA is quite limited still and requires further investigation. 

The Bidirectional Link Between Sleep and Inflammation

In addition to obesity, there also appears to be a bidirectional relationship between PsA and sleep disorders. Persistent sleep disorders in PsA may be interconnected with inflammatory disease activity, chronic pain, fatigue, and psychological distress, creating a vicious cycle where each factor intensifies the others. Prolonged and significant decline in sleep quality reduces overall QOL and increases a patient’s risk of developing CVD, hypertension, and metabolic disorders, comorbid conditions associated with PsA. Prolonged deterioration of sleep quality can negatively impact the QOL of PsA patients and increase the risk of developing hypertension, CVD, and metabolic disorders. 

Several lifestyle changes can help to improve sleep quality in patients with PsA. These include maintaining regular sleep-wake cycles, limiting alcohol and caffeine intake, and improving the patient's sleeping environment. Additionally, medications used to treat PsA — such as guselkumab, tumor necrosis factor inhibitors (adalimumab, certolizumab pegol, etanercept, golimumab, infliximab), and the Janus kinase inhibitor filgotinib — have shown potential in improving sleep outcomes in patients with PsA.

The Psychological Burden of PsA

Pain, fatigue, anxiety, and depression are common psychological comorbidities of PsA that have a negative impact on QOL. The odds of being diagnosed with behavioural and mental health disorders are higher in patients with PsA compared to the general population. Even with treatment, studies have shown that PsA affects patients emotionally, socially, and occupationally, underscoring the importance of comprehensive management since targeting the inflammatory activity of PsA alone may not improve the QOL. 

Cognitive behavioural therapy is a well-established psychological intervention that can improve symptoms of depression, anxiety, and sleep disturbances in patients with PsA. It can also improve sleep quality in PsA patients. Although research is limited, the effectiveness of cognitive behavioural therapy (CBT) to improve psychological distress may in turn improve overall QOL in patients with PsA. Although research on this is limited, CBT can prove to be beneficial in improving mood disorders and the overall QOL of PsA patients.

https://www.medscape.com/viewarticle/living-better-psoriatic-arthritis-how-lifestyle-changes-can-2025a1000cvn?src= 

Psoriasis, Sleep, and Mental Health: What’s the Connection?

From healthcentral.com

A new study has uncovered a strong link between psoriasis, REM disturbances, and depression—suggesting the condition is anything but skin deep 

If you have psoriasis and struggle to sleep at night, your issue might be more than skin deep. New research reveals a strong connection between psoriasis, sleep problems, and mental health—with each condition potentially worsening the others. Psoriasis itself causes an overactive immune system to produce inflammation and rapid skin cell build-up, leading to itchy, uncomfortable patches that can disrupt sleep. “Stress, injury to the skin, allergens, certain medications, even infections, can all trigger a psoriasis flare,” explains Veena Vanchinathan, M.D., a board-certified dermatologist at Kaiser Permanente in San Jose, CA who is not associated with the study. These same triggers often disturb sleep patterns as well, making sleep management just as important as traditional treatments for managing psoriasis effectively.

People With Psoriasis Sleep Poorly—and Feel Worse

In the recent study, presented at the American Academy of Dermatology Spring 2025 conference, Tina Bhutani, M.D., a board-certified dermatologist in private practice and volunteer faculty member at University of California, San Francisco, found that poor sleep doesn’t just cause daytime fatigue—it can amplify mental health issues and create a cycle of worsening psoriasis flares and increasing sleep disruption.

Dr. Bhutani and fellow UCSF researchers surveyed 487 people with psoriasis and 69 individuals without the condition, using validated questionnaires to assess sleep quality, depression, and anxiety. Psoriasis patients scored significantly worse across all measures—they had more trouble falling asleep, woke more frequently, experienced more insomnia symptoms, and showed higher depression and anxiety levels.

When examining the relationship between sleep and mental health specifically within the psoriasis group, the researchers found that even after adjusting for factors like disease severity or treatment, greater sleep impairment was significantly associated with anxiety and depression.

“Our results confirm the association between sleep quality and mental health in these patients,” says Dr. Bhutani. “But it’s not just that psoriasis patients tend to have sleep issues and mental health issues separately. The data shows the worse your sleep is, the more likely you are to also be experiencing anxiety and depression.”

Why Psoriasis Might Ruin Your Sleep

It makes sense that the itching and pain from psoriasis patches significantly impact sleep quality. Past research has shown that people with psoriasis are twice as likely to have sleep issues than the general population, with more than 85% of psoriasis patients reporting sleep difficulties. But physical discomfort isn’t the only culprit.

“There’s also research that suggests the heightened inflammatory process—the very thing driving the psoriasis—might interfere with the body’s sleep regulation system,” explains Dr. Bhutani.

Dr. Bhutani first became interested in this connection when one of her patient’s psoriasis dramatically improved after his sleep quality increased. “He had really tough to treat psoriasis and we had basically tried everything,” says Dr. Bhutani. “He came in one day and his skin was practically clear.” The patient’s wife had been treated for sleep apnoea, which had been disturbing both their sleep. Once she received treatment, both got better rest—and his psoriasis nearly disappeared. This case inspired Dr. Bhutani to investigate the sleep-psoriasis relationship further.

A Holistic Approach to Managing Skin Flares

The strong interconnection between psoriasis, sleep problems, and mental health suggests these aren’t simply co-occurring conditions—they’re actively influencing each other. Psoriasis symptoms directly interfere with sleep, and that lack of restorative rest takes a toll on mental health, creating what Dr. Bhutani calls “a potentially vicious cycle” of worsening skin, poorer sleep, and increasing depression and anxiety.

While more research is forthcoming, this study demonstrates why a holistic approach to psoriasis treatment is essential. “As dermatologists, we’re trained to treat skin diseases, but we also need to encourage our patients to seek help for sleep disorders, anxiety and depression, and other associated conditions, like cardiovascular disease and diabetes,” emphasises Dr. Bhutani.

Beyond medication, making lifestyle changes that improve overall health can have a big impact on your psoriasis. Eating better, exercising more, managing stress, and, yes, improving sleep quality can all lead to fewer flare ups, clearer skin, and a happier outlook on life.

If your psoriasis symptoms are keeping you awake, talk to your doctor about topical treatments that can help soothe the itch and inflammation. After that, make sleep a priority by keeping your bedroom cool and dark to encourage your body to fall asleep and sticking to a regular schedule. “A consistent sleep schedule, same bedtime, same wake up time—even on weekends, can help you get higher quality sleep,” says Dr. Bhutani.

https://www.healthcentral.com/news/psoriasis/psoriasis-sleep-and-mental-health-connection

Belly fat compared to overall body fat is more strongly linked to psoriasis risk

From medicalxpress.com/news

Researchers have found that central body fat, especially around the abdomen, is more strongly linked to psoriasis risk than total body fat, particularly in women. This link between central fat and psoriasis remained consistent regardless of genetic predisposition, indicating that abdominal fat is an independent risk factor.

The study in the Journal of Investigative Dermatology, provides insights that could help improve early risk prediction and guide personalized prevention strategies.

Psoriasis is a chronic inflammatory skin condition that can have a significant impact on quality of life. Many individuals with psoriasis also have elevated levels of body fat. While it is well established that increasing levels of body fat raise the risk of developing psoriasis, the impact of specific fat distribution and genetics remains unclear.

Researchers of the current study analysed data from over 330,000 participants with white British ancestry in the UK Biobank, including more than 9,000 people with psoriasis. They examined 25 different measures of body fat using both traditional methods and advanced imaging techniques, assessing how each was associated with psoriasis.

Lead investigator Ravi Ramessur, MD, St John's Institute of Dermatology, King's College London, explains, "Our research shows that where fat is stored in the body matters when it comes to psoriasis risk. Central fat—especially around the waist—seems to play a key role. This has important implications for how we identify individuals who may be more likely to develop psoriasis or experience more severe disease, and how we approach prevention and treatment strategies."

Catherine H. Smith, MD, also at St John's Institute of Dermatology, King's College London, and senior author, adds, "As rates of obesity continue to rise globally, understanding how different patterns of body fat influence chronic inflammatory conditions such as psoriasis is important.

"Our findings suggest that central body fat contributes to psoriasis risk irrespective of genetic predisposition and reinforces the importance of measuring waist circumference and pro-active healthy weight strategies in psoriasis care."

Because this study only included individuals of white British ancestry from the UK Biobank, the generalizability of these findings to more diverse populations may be limited. Future studies incorporating datasets with dermatologist-confirmed diagnoses and broader ethnic representation will be important to further validate these associations and refine risk stratification approaches.

Dr. Ramessur notes, "We were surprised by how consistently strong the association was across different central fat measures and how much stronger the effect was in women. The observed links between central body fat and psoriasis suggest that there may be underlying biological mechanisms contributing to the disease that are not yet fully understood and which warrant further investigation."

In an accompanying editorial, Joel M. Gelfand, MD, MSCE, FAAD, Department of Dermatology and Center for Clinical Sciences in Dermatology, University of Pennsylvania Perelman School of Medicine, points to the potential of incretin therapy for psoriatic disease. Incretins are gut-derived hormones, principally glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), that regulate glucose, digestion, and appetite, and are approved for the treatment of diabetes, obesity, and obesity-associated obstructive sleep apnoea.

Dr. Gelfand comments, "The strong relationship between psoriasis and obesity and the emerging promise of glucagon-like peptide-1 receptor agonists (GLP1RA) for reducing psoriasis morbidity is a call to action for large-scale clinical trials of GLP1RA monotherapy for treatment of psoriasis.

"Our current paradigm of just focusing on the skin and joint manifestations when treating psoriasis is outdated in the context of our evolving understanding of the tight relationship of psoriasis, obesity, and cardiometabolic disease."

https://medicalxpress.com/news/2025-05-belly-fat-body-strongly-linked.html 

Your Essential Care Guide for Scalp Psoriasis

From healthcentral.com

Check out these dermatologist-approved techniques to manage scalp psoriasis flakes and find lasting relief for your hair type 

Have you ever run your fingers through your hair and wondered, How can I get rid of these flakes? If you’re one of the estimated 3.5 million people in the US who have scalp psoriasis (per the Cleveland Clinic), it’s a common question.

Scalp psoriasis is a type of psoriasis, a chronic autoimmune disorder that causes the body to attack its own skin. It can look like fine scaly areas along the hairline or thick, crusted patches all over the scalp, and it’s caused by a mix of factors.

“Most cases develop due to a combination of genetic susceptibility along with an environmental trigger,” says Veena Vanchinathan, M.D., a board-certified dermatologist who practices at Kaiser Permanente in California’s San Francisco Bay area. That means if you have a family history of psoriasis, you might be prone to it, and it can then be kick-started by something like stress, an injury to the skin, a chemical irritant, or an allergen. Once triggered, your immune system mistakenly identifies your skin as a threat, leading to inflammation and increased skin cell production. All those extra skin cells pile up into thick, sometimes itchy patches on your scalp that become dry, scaly, and flaky.

Those persistent flakes aren’t just annoying—they can be uncomfortable and embarrassing. But should you try to remove psoriasis scales yourself, or could that make things worse? We asked top dermatologists for their very best DIY strategies to safely manage your scalp psoriasis at home—plus, when it’s time to put down the coal tar and seek professional help.

Treating Psoriasis Scales on Your Scalp

Psoriasis scales are very different from other scalp flakes, like dandruff. “Psoriasis typically involves much thicker, white or yellow, and more adherent scaling than dandruff, which tends to have fine, white flaking,” says Dr. Vanchinathan. Unlike dandruff, which is typically caused by seborrheic dermatitis or scalp eczema, psoriasis scales are not easily removed by brushing or combing.

“If you have scalp psoriasis, it’s never a good idea to physically scrape or comb out the flakes,” says Alison Ehrlich, M.D., a board-certified dermatologist in Chevy Chase, MD, and the former founding chair and director of clinical research in the department of dermatology at The George Washington University in Washington, D.C. “Picking at scales on the scalp can lead to irritation and bleeding,” she says.

Dr. Vanchinathan doesn’t recommend manual removal or exfoliation either. “Removing those scales can be very uncomfortable, even painful, and it’s not a long-term fix,” she says. “It increases the risk of skin infection and can lead to permanent hair loss.” If you do try to peel off a patch of psoriasis scales, you might see dots of blood underneath. “That’s called the Auspitz sign,” says Dr. Vanchinathan. It’s confirmation that the inflammation and the blood vessels are much closer to the surface in those psoriasis patches and underscores why being super gentle is important, she says.

Still, there are safe, effective ways to manage scalp psoriasis and reduce flaking and scaling with targeted, dermatologist-approved treatments.

Exploring the Effectiveness of Scalp Psoriasis Treatments

There are a number of over-the-counter and prescription psoriasis scalp treatments that can moisturize and soften scales and gently exfoliate dead skin cells, without the risk of irritation.

Medicated Shampoo

“I am a huge fan of over-the-counter shampoos,” says Dr. Vanchinathan. “Shampoos with ingredients such as ketoconazole and zinc pyrithione, which reduce inflammation and fight fungal overgrowth on the scalp, can be incredibly helpful for long-term scale reduction,” she says. These types of shampoos can also ease itching. If over-the-counter products aren’t giving you the results you want, your doctor can prescribe a stronger formula.

Salicylic Acid

Commonly found in topical solutions and shampoos, salicylic acid is an excellent ingredient for treating the scaly patches of psoriasis. Studies show salicylic acid can soften and loosen the outer layer of skin, helping to remove dead skin cells that build up at the surface. That said, “salicylic acid can be too drying for people with curly or textured hair,” says Dr. Ehrlich, who recommends using a moisturizing conditioner after shampooing.

Coal Tar

Coal tar has been used for over a century to treat psoriasis by slowing down cell turnover, according to the American Academy of Dermatology (AAD). “It soothes scaling and itching,” says Dr. Ehrlich. Coal tar shampoos are thick, so be gentle when working it into your scalp. And wear a hat when you head outdoors—the AAD notes coal tar can make your skin more sensitive to the sun.

Lactic Acid and Urea

Lactic acid promotes exfoliation and urea helps to break down the thick scales of psoriasis. “Together these ingredients can be helpful for softening scales and reducing flakes,” says Dr. Ehrlich. Research shows creams containing the combo can reduce skin thickening and improve the appearance of psoriasis patches. But be careful if you have broken or irritated skin. “These ingredients can cause burning or stinging,” says Dr. Vanchinathan.

Moisturising the Scalp

“Keeping the scalp moisturized can help prevent scales from becoming dry, flaky, and itchy,” says Dr. Vanchinathan. Look for scalp oils or moisturizers with the National Psoriasis Foundation (NPF) Seal of Recognition—they’re vetted to be free of common irritants. Try applying one and letting it sit on your scalp for 10 to 15 minutes before rinsing with warm (not hot) water. Just note: “Moisturizing feels good, but it doesn’t treat the underlying psoriasis,” says Dr. Ehrlich.

Should You Use a Soft Brush?

Experts advise against brushing your hair—even softly—due to the risk of scalp wounds, infection, and permanent hair loss. If you do try to manually loosen scales with a brush, be as gentle as possible. Use a soft-bristle brush, go slowly to minimize irritation and injury to the skin, and stop immediately if you feel pain or see blood (the Auspitz sign).

Light Therapy

Professional light therapy, or phototherapy, relies on shining a narrow band of UV-B light directly on affected areas of the scalp to ease inflammation and reduce the scaling, redness, and itch of psoriasis. “It’s one of the most helpful treatments I have for patients who don’t respond to topicals,” says Dr. Vanchinathan. Phototherapy is usually done in a clinic or doctor’s office and involves a series of treatments, two or three times a week for a few months. Hair on the scalp can make it tricky to get good results, says Dr. Ehrlich, so your dermatologist may combine it with other treatments.

A Healthy Scalp-Care Routine for Psoriasis

Want to keep your scalp flake-free? “The best way to minimize scaling is to treat the underlying psoriasis that’s causing it,” says Dr. Ehrlich. Talk to your doctor to create a treatment plan that makes sense for the severity of your scalp psoriasis, which might involve over-the-counter psoriasis scalp treatments, prescription topicals, or systemic medications. After that, how you wash your hair matters, too.

The AAD recommends using a medicated shampoo every two to three days, and washing gently—no aggressive rubbing or scrubbing, which can make psoriasis flare. “Shampooing with powerhouse skincare ingredients can reduce scaling and is a successful long-term strategy,” says Dr. Vanchinathan.

Medicated shampoos can dry out your hair, so be sure to follow up a suds session with a conditioner. If you have curly or textured hair, you might prefer to wash once a week and use a prescription treatment in between, says Dr. Ehrlich. And if you have especially thick patches of scalp psoriasis, consider adding a salicylic acid-based scale softener to your routine.

Be cautious about social media advice. “It’s never a good idea to put undiluted essential oils on your scalp, or to ‘correct the pH’ of your skin with lemon juice or vinegar,” warns Dr. Vanchinathan. “And never use unsafe tools like knives to remove psoriasis scales.”

Always consult your dermatologist before trying trending online remedies.

If you don’t see improvement after three to four weeks of using an over-the-counter shampoo or psoriasis scalp treatment, check in with your dermatologist. “There are effective prescription treatment options, including newer oral and injectable medications,” says Dr. Ehrlich. “If one doesn’t work, another might.”

Diet and Lifestyle Adjustment to Ease Scalp Psoriasis

In a survey published in Dermatology and Therapy, psoriasis patients reported skin improvements when they cut back on alcohol, gluten, and night shades, and also when they ate more fish and vegetables and took a vitamin D supplement.

Certain diets, like the Mediterranean, Pagano, vegan, and Paleo, have also been linked to clearer skin. The Mediterranean diet in particular, which is based on eating fresh fruits and vegetables that have anti-inflammatory properties, has positive effects on both skin and heart health, which is important since psoriasis is linked to an increased risk of cardiovascular disease.

Moving more can help your scalp psoriasis, too. In a study published in Skin Health and Disease, psoriasis patients who walked regularly for 20 weeks saw major improvements (half experienced 50% clearer skin), likely because increased blood circulation helps deliver anti-inflammatory compounds to affected skin while supporting the removal of dead skin cells and toxins. Exercise also improved their blood pressure and mental health.

Bottom Line

“Picking at scalp scales can result in hair loss,” says Dr. Ehrlich, so it’s not a good idea to remove psoriasis scales on your own. Instead, focus on managing and reducing scales with scalp psoriasis treatments made with ingredients that soften skin and encourage cell turnover, likeketoconazole, zinc pyrithione, salicylic acid, coal tar, lactic acid, and urea, and be gentle when applying them.

Your scalp psoriasis may also improve if you make healthy food choices, avoid smoking and drinking alcohol, and get more exercise. And if over-the-counter shampoos and treatments aren’t keeping your scalp psoriasis scales in check, it’s time to explore prescriptions and other treatments with your dermatologist.

https://www.healthcentral.com/condition/psoriasis/your-essential-care-guide-for-scalp-psoriasis

New Study Links High Blood Sugar to Psoriasis Flares

From healthcentral.com 

Scientists took a close look at the connection between psoriasis and diabetes. The findings could change the way some healthcare is practised

High blood sugar may do more than coexist with psoriasis (PsO)—it might actually trigger flare-ups. That’s the key takeaway from a new study published in Clinical, Cosmetic and Investigational Dermatology, which found that hyperglycaemia (elevated blood sugar levels) is associated with worsening psoriasis symptoms, especially in people with severe disease.

“This is significant because it reinforces the idea that psoriasis is not just a skin-deep issue,” says Hannah Kopelman, D.O., a board-certified dermatologist and skincare podcast host in Boston who was not involved in the research. “It’s a systemic inflammatory disease that interacts with other metabolic conditions in complex ways.”

For years, researchers have known that people with psoriasis (PsO) tend to have elevated levels of inflammatory substances in their blood—raising their risk for metabolic syndrome, cardiac events, and diabetes. But this new research suggests a more active role for blood sugar: it may not only reflect disease severity but actually drive it. The bidirectional relationship could have profound implications for how we approach treatment strategies for the estimated 7.5 million Americans living with this chronic skin condition.

Blood Sugar’s Role in Predicting Psoriasis Flares

                                                                              GettyImages/Halfpoint Images

So, what did the research show? In a retrospective cohort study, scientists reviewed 15 years of medical data from 201 patients with plaque psoriasis treated at Ramathibodi Hospital in Bangkok, Thailand. Of those, 95 had severe psoriasis and 106 had mild disease. All participants also had either type 2 diabetes or prediabetes.

To examine the possible connection between long-term blood sugar levels and psoriasis flare-ups, the researchers analysed data from more than 1,700 follow-up visits between 2008 and 2022. Specifically, they looked at HbA1c levels—a measure of blood sugar control over time.

The findings revealed that patients with severe psoriasis who had an HbA1c of 7% or higher (indicating poorly controlled diabetes or prediabetes) were significantly more likely to experience flares. The study also identified alcohol consumption as a separate risk factor for flare-ups.

“In our study, we found that hyperglycemia (HbA1c ≥ 7%) and alcohol drinking status were independent prognostic factors for exacerbation in severe psoriasis patients with diabetes or prediabetes,” the researchers wrote. “We believe that diabetes surveillance may be necessary for all psoriasis patients, and strict glycaemic control may aid in managing severe psoriasis.”

A Call for Cross-Specialty Collaboration

The findings also underscore that rarely does a chronic disease—or its treatment—exist in isolation—the study links dermatology, endocrinology, and primary care as essential components in managing psoriasis.

“This research reminds us that everything is interconnected,” says Dr. Kopelman. “In the clinic, we may start emphasizing not just topical or biologic treatments but also the importance of metabolic health as part of the treatment plan for psoriasis.”

For patients struggling with both conditions, this study offers hope that better control of one condition may positively impact the other. This research gives us another tool in our toolkit, explains Dr. Kopelman. We now have stronger evidence to motivate patients to work on their blood sugar control as part of their comprehensive psoriasis management strategy.

While more research is needed to fully understand how high blood sugar influences psoriasis flares and treatment outcomes, the takeaway is clear: for people with severe psoriasis, managing blood sugar may be a meaningful part of reducing flare risk—and a reminder that whole-body health matters in skin disease management.

https://www.healthcentral.com/news/psoriasis/new-study-links-high-blood-sugar-to-psoriasis-flares?ap=nl2060&rhid=67ec2b8321f52bf01b0cca01&mui=&lid=141093361&mkt_tok=NTQxLUdLWi0yNDMAAAGajPuEoJA8iWy1Iex1N-bygus2vIIdzmPYIfzvqoaZBIMzQ5QiwZYXDGepKzzFs9F1Ku6WdnO3HZVG1CGYyyFtr_OqJe65UNQBcnkj5uDZbxZwhjM