From healthcentral.com
When psoriasis flares get a little out of hand, take note of these dermatologist-approved steps to soothe pain, calm inflammation, and protect your skin
A severe psoriasis flare is more than a few thicker-than-usual plaques. Skin may become rapidly and intensely red, swollen, and cracked, with itch that feels constant and overwhelming. “I look for more widespread, thickened, scaly plaques extending beyond prior areas of involvement, along with fissuring, pain, and intensifying itch,” says Meena Singh, M.D., a board-certified dermatologist and medical director of the Skin and Hair Center in Overland Park, KS. Skin warmth or new pustules can also signal trouble. Beyond physical symptoms, severe flares often take an emotional toll, disrupting sleep, work, and daily life.
First Priority: Calm the Inflammation ASAP
During a severe flare, the main goal is to calm inflammation as quickly and safely as possible, says Dr. Singh. For flares limited to certain areas, dermatologists may temporarily use stronger topical steroids like clobetasol, often followed by steroid-sparing treatments such as roflumilast. Thick scale may be gently reduced first so medications can work better. For stubborn plaques, steroid injections may help. If symptoms spread quickly or interfere with daily life, doctors may adjust prescribed systemic or biologic treatments (if you take them) to bring inflammation under control.
Soothing Baths Can Help
Short, lukewarm baths can help calm inflamed skin and soften plaques. “I usually recommend lukewarm baths with colloidal oatmeal and occasionally Dead Sea–style salts,” says Dr. Singh. Adding a bath oil can help seal in moisture, per the Mayo Clinic. What doesn’t help: long, hot baths or showers. “Hot water and harsh soaps disrupt the skin barrier and increase inflammation, even if they feel soothing at first,” she explains. Fragrances and essential oils can also worsen flares. Bonus tip: Moisturize within two minutes of bathing to lock in hydration.
Moisturize Like a Derm
During a severe flare, the simple act of moisturizing becomes a form of treatment. “Proper moisturization alone can be therapeutic,” says Dr. Singh. She recommends thick creams or ointments—especially ceramide-containing formulas—applied at least twice daily. Prescription treatments should go on first, followed by moisturizer layered over the entire area. Timing matters, too: Apply within minutes of bathing while skin is damp. “Heavier creams work better than lotions,” adds Harvard-trained dermatologist Calvin Williams, M.D., who is the director at the Essential Dermatology Group in Bedford, TX, noting that dry skin worsens psoriasis and prolongs inflammation.
Using Bandaging and Occlusion Safely
Occlusion—a.k.a. covering treated skin—can reduce scaling and protect cracked areas when done carefully. Cotton gloves, socks, or soft dressings over petroleum-based ointments can help during severe flares. “Occlusion can be effective [for severe psoriasis], but it should be done under dermatologic guidance,” says Dr. Singh, since it increases absorption of topical steroids. Overuse may raise the risk of side effects like thinning skin. Contact your physician for guidance on bandaging and occlusion; they may even be able to walk you through it virtually if needed.
Scalp Psoriasis Crisis Care
Scalp flares can be especially painful and frustrating, particularly when plaques spread to the hairline or behind the ears. Medicated shampoos help reduce inflammation and scaling, but they should be used gently to avoid irritation. Overnight treatments can soften thick plaques, making them easier to remove in the morning. The biggest thing: “Avoid aggressive picking,” Dr. Singh warns, since it can worsen inflammation and raise the risk of infection. Consistent, careful care can ease pain while protecting both the scalp and hair during severe flares.
Managing Pain, Itch, and Cracking
During severe flares, pain and intense itch often go hand in hand. Cooling gels, cold compresses, or ice packs wrapped in cloth can calm burning skin, notes the American Academy of Dermatology. Antihistamines may help control night-time itch and improve sleep, even though they don’t treat inflammation. The catch-22 is that “dry skin worsens psoriasis,” says Dr. Williams, making frequent moisturizing and humidifier use especially important. When skin cracks, apply thick ointments and protective dressings to reduce pain with movement. To limit damage, keep nails trimmed, wear cotton gloves at night, and avoid scratching whenever possible.
Clothing and Daily-Life Hacks
Your daily habits can either soothe or aggravate inflamed skin. Soft, breathable fabrics like cotton reduce friction, while tight seams and rough materials can worsen plaques. Loose-fitting clothes can also help prevent overheating, which can intensify itch. Fragrance-free detergents and skipping fabric softeners are also key to avoid unnecessary skin irritation. Protective dressings under clothing can shield painful plaques during the day. These small adjustments won’t stop a flare—but they can make work, errands, and social situations far more manageable.
When It’s Time for Medical Help
“Rapidly spreading disease, pain that outweighs itch, pustules, or widespread redness are red flags,” says Dr. Singh. Fever, chills, or bleeding that won’t stop could signal an infection and need immediate attention. Other infection signs include increased warmth, oozing, yellow crusting, or worsening pain despite treatment. Dr. Williams adds that flares not responding to usual treatments should also prompt a medical visit. In rare cases, severe flares can lead to erythroderma, a medical emergency marked by near-total redness of the skin. Bottom line: When symptoms escalate, don’t wait.
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