Totally Exhausted? It Might Be Your Psoriasis

From glamour.com

By Alice Oglethorpe

The link between the skin condition and poor sleep isn’t fully understood, but it’s real. Here’s what researchers think is going on and a game plan for feeling more rested. 

When you first think about it, your skin and sleep seem pretty disconnected. But if you have psoriasis, they are way more closely linked than you’d think. Research has found that about 17% of people with the skin condition experience severe fatigue. And a big reason for that is sleep issues.

“We can say for certain that patients with psoriasis have a higher risk of developing sleep problems,” says Lourdes Pérez-Chada, MD, an assistant professor of dermatology at Harvard Medical School. “And it can manifest in different ways. You could have sleep apnoea or restless leg syndrome or just have disturbances in your sleep.”

You might assume that it’s just the itching that wakes people up, but that’s only, ahem, scratching the surface. Here’s a deeper look at what’s really going on.

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What we know and don’t know about the connection

People with psoriasis are four times more likely to have insomnia than those without the condition and have a 35% higher risk of developing obstructive sleep apnoea compared to the general population. So why is that?

The answer isn’t exactly straightforward.

Symptoms of psoriasis can be to blame for some poor sleep, says Tina Bhutani, MD, an associate clinical professor of dermatology at the University of California, San Francisco, and member of the National Psoriasis Foundation Medical Board. “Pain, itching, and discomfort can make you wake up in the middle of the night and have more fragmented sleep. You may not even realize it’s happening, but you could be unconsciously scratching in your sleep and not getting into the deeper sleep cycles, so you wake up feeling tired.”

But here’s the interesting thing: Take away the itching and pain, and patients with psoriasis still have worse sleep. “Even someone totally asymptomatic,” says Dr. Bhutani. And this is where the link gets a lot murkier. Researchers aren’t exactly sure what’s going on inside the body that makes getting a good night’s sleep so tough. But most experts agree that inflammation is involved.

“Psoriasis is inflammatory…and that impacts your sleep cycles,” says Dr. Bhutani. That’s because excess inflammation can impact your central nervous system, which can disturb sleep.

There’s also a mental health component. “Patients with psoriasis have a higher prevalence of mood disorders, like depression and anxiety,” says Dr. Pérez-Chada. “And those mood disorders are also associated with sleep problems.”

But the path may go the other way as well. “We don’t know which is the chicken and which is the egg. Does psoriasis lead to sleep problems, or do sleep problems lead to psoriasis?” Dr. Pérez-Chada says. “That’s what the field is trying to figure out.”

A recent study from the UK looked at almost 400,000 people without psoriasis and tracked them over 15 years. During that time span, people with sleep disorders had a much higher risk of developing psoriasis. “That’s what makes it fascinating. Previous studies looked at the association, but this looked at what preceded the other. And it showed that having a sleep disorder predated psoriasis in a large number of people,” says Ravi Ramessur, MD, PhD, a postdoctoral research fellow at the University of Pennsylvania.

But the exact reason sleep disorders can raise your risk for psoriasis isn’t known yet. “We really have very little understanding of the how, which is what we want to discover,” says Dr. Ramessur. One working theory right now involves proteins in the blood. “A study found that poorer sleep was associated with having a worse profile of proteins linked with the aging of different organs, including the skin,” says Dr. Ramessur. “And a lot of these proteins were inflammatory, so having poor sleep probably does have an effect on our systemic immunity, and one way that can manifest is with conditions like psoriasis.”

The road to being more rested

While researchers are still trying to figure out the why behind sleep issues in people with psoriasis, that doesn’t need to stop you from improving your sleep now. And this might involve seeing a few different specialists: your dermatologist, a rheumatologist, and a sleep expert.

Get your condition under control.

Though your sleep issues may not all stem from psoriasis symptoms, improving them can only help things. “Psoriasis is a chronic, ongoing condition, so if you get it under better control, at least it can be less itchy and bothersome,” says Dr. Bhutani. If your symptoms are still an issue, talk with your dermatologist about your treatment plan and whether you should try something else.

Make sure you don’t have psoriatic arthritis.

Around 30% of people with psoriasis also have psoriatic arthritis, a related condition that impacts your joints and, as a result, your sleep (joint pain and stiffness can make you wake up throughout the night). That’s where a visit with a rheumatologist would come in, as they can screen you for psoriatic arthritis and make sure that, if you have it, you’re on the right treatment.

Study your sleep.

To find out what’s really impacting your sleep, you may need to do a sleep study. “I tell my patients: If you wake up not feeling well-rested and are groggy all day, you want to get into a sleep lab because there are treatments that can help,” says Dr. Bhutani. They will be able to see if obstructive sleep apnoea or another condition is causing your exhaustion and tailor your treatment to your actual condition. “For instance, there’s cognitive behavioural therapy for insomnia that’s been shown to be very effective,” says Dr. Pérez-Chada.

Try to improve your sleep habits.

While it’s easy to dismiss, having good sleep hygiene can have a big impact. “This won’t be the only answer if you have other disorders like chronic insomnia or obstructive sleep apnoea, but modifying your habits can help,” says Dr. Pérez-Chada. This includes having a regular sleep schedule, avoiding caffeine in the afternoon and evening, exercising regularly, and keeping your bedroom cool and dark. “Those are good tips for the general health of people with psoriasis, and they could potentially improve your psoriasis activity,” says Dr. Ramessur. “It’s a double win.”

Whatever you do, don’t think that you have to take poor sleep lying down. If you feel tired and have psoriasis, you have options—you just need to start by telling your doctor.

https://www.glamour.com/story/psoriasis-exhaustion 

6 Surprising Things That Can Trigger a Psoriasis Flare, According to a Dermatologist

From people.com

From “good” stress to your skincare routine, a dermatologist breaks down the unexpected factors that may make psoriasis worse 

NEED TO KNOW

• Psoriasis is a chronic condition linked to immune system overactivity that can worsen with lifestyle and environmental factors
• Dermatologist Dr. Adrienne Rencic emphasizes the importance of managing stress, sleep and diet to reduce the frequency of flare-ups
• Psoriasis can be triggered by skin trauma including scrubbing or irritation from skincare products, according to experts

If you have psoriasis, you may already know flares seem to come out of nowhere, no matter how well you’re managing the condition. But some of the things that can trigger or worsen psoriasis may be counterintuitive, or possibly not on your radar at all.

Psoriasis is a chronic disease in which the immune system becomes overactive, causing inflamed, scaly patches of skin. Symptoms can cycle between flares and periods of improvement, and common triggers can include stress and skin injuries, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

Get to know six surprising factors that may contribute to a psoriasis flare.

1. “Good” stress

Turns out you don’t necessarily have to feel anxious or upset for your body to experience stress. Even positive events can put physiological stress on the body. 

“People understand stress as working too long or experiencing ‘bad’ stress,” says Dr. Adrienne Rencic, a board-certified dermatologist and clinical investigator with more than 25 years of experience, who consults for RELAB, a new psoriasis-focused skincare brand. “But what people don’t understand is ‘good’ stress.”

“You could be staying up all night for two weeks preparing for your sister’s wedding, and that’s stress on your body,” she explains. “You can get flare-ups when you don’t necessarily feel stressed in a bad way.”

The takeaway: Pay attention to periods when your routine is disrupted, you’re not sleeping enough or your body is under unusual strain — even if you’re having a great time.

2. Lack of sleep

Sleep is another lifestyle factor that can contribute to psoriasis, Rencic says, along with stress, diet, smoking and alcohol. And the connection can become a frustrating cycle. Psoriasis can cause itching, burning and discomfort that interferes with sleep. 

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3. Scrubbing away your scales

When psoriasis leaves behind thick, flaky skin, aggressively scrubbing it away might seem like a logical solution. But it can backfire.

“Some people use a loofah or scrub their skin to try to remove the scale, and that’s actually trauma to the skin,” Rencic says. “That can make things worse.”

That’s because people with psoriasis can experience what’s known as the Koebner phenomenon or reaction, in which trauma to the skin can trigger psoriasis in that area. So when it comes to removing scale, more aggressive isn’t necessarily better.

4. A skincare product that irritates your skin

A reaction to a new skincare product and a psoriasis flare can sometimes look similar and, according to Rencic, one can actually trigger the other. “In a patient with psoriasis, there is a phenomenon called the Koebner reaction,” she explains. “Any trauma to the skin can trigger a psoriasis flare-up.”

A product reaction will generally affect the area where the product was applied, while psoriasis may appear as a distinct patch within that area. “You may have one or both going on at the same time,” Rencic says.

If you’re unsure whether a rash is an irritation or psoriasis, it’s best to have a dermatologist evaluate it rather than repeatedly applying products that could further irritate the skin.

5. Smoking and alcohol

Smoking and alcohol may not be the first things that come to mind when you think about psoriasis, but Rencic says they’re worth paying attention to. “These things can contribute, even though people don’t necessarily think of them as triggers,” she adds.

That doesn’t mean an occasional drink will automatically cause a flare, Rencic clarifies, but rather that the use of alcohol or nicotine can contribute to the disease, particularly when it’s part of a broader pattern of lifestyle factors. NIAMS concurs, noting that smoking and excessive alcohol consumption can worsen psoriasis symptoms.

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6. Your overall diet

One candy bar isn’t going to give you psoriasis, and Rencic is careful to make that distinction.

“It’s not that eating a candy bar causes psoriasis,” she tells PEOPLE. But she does note that “consistently eating a diet that’s high in sugar and saturated fat and low in fibre is bad for psoriasis.”

Rencic points to the Mediterranean diet as an example of an eating pattern that may be beneficial. Most importantly, she says people shouldn’t feel as though they’re powerless when it comes to managing their disease. 

“This is simply something they live with,” she says, adding that people with psoriasis “aren’t doing anything wrong.” But she does note that there are factors — diet, activity, stress relief — that can help reduce flares.

“All of those things can be modified,” Rencic says, suggesting stress-reducing activities such as exercise, meditation, spending time with friends and being in nature.

(And if your psoriasis is widespread, isn’t responding to your usual treatment or is accompanied by joint pain, stiffness or swelling, talk to a doctor. Psoriasis is associated with other health conditions, including psoriatic arthritis and cardiovascular and metabolic conditions, and NIAMS recommends medical evaluation when joint symptoms occur.)

https://people.com/6-surprising-things-that-can-trigger-a-psoriasis-flare-12060302

6 Daily Habits That Can Help You Manage Psoriasis

From everydayhealth.com

By Matt McMillen

If you have psoriasis, a chronic autoimmune disease, you may feel under its control at times. It can dictate the clothes you wear, it can elevate your stress, it can influence how you see yourself and how you think others see you, and the itch that comes with it can make you really, really uncomfortable.

Psoriasis has no cure. But you can develop healthy daily habits that will help you tame your symptoms and lessen the hold psoriasis may have on you. These habits don’t replace the medications your doctor prescribes; instead, think of them as important, complementary parts of your treatment plan.

Top dermatologists recommend adopting the following habits.

1. Stress Relief

“Stress is one of the most common triggers for psoriasis flares,” says Peter Lio, MD, a dermatologist and a clinical assistant professor of dermatology at Northwestern University Feinberg School of Medicine in Chicago. “While it is impossible to eliminate stress entirely, developing a daily stress-management practice can make a meaningful difference.”

Such a practice, says Dr. Lio, requires as little as 5 to 10 minutes a day, and he offers lots of options to choose from, including:

• Meditation
• Breathing exercises
• Prayer
• Journaling
• Gentle yoga
• Spending quiet time outdoors

2. Sleep Hygiene

Stick to a regular sleep schedule that nets you seven to nine hours each night. You’ll find that to be a powerful tool for your overall health, says Lio, who adds that sleep and inflammation go hand in hand. “Poor sleep can worsen stress, affect mood, increase itch perception, and make it more difficult to manage a chronic condition,” he explains. He offers this related tip: practice your stress-management routine at bedtime to potentially help both sleep and stress simultaneously.

“Sleep is going to counter stress,” says Ross Levy, MD, the chair of dermatology for Northwell's Northern Westchester Hospital in Mt. Kisco, New York.

The discomfort of psoriasis can make it difficult to sleep, but other conditions, such as obstructive sleep apnea, also may be to blame. If you struggle with sleep, says Dr. Levy, talk with your doctor, who may recommend a sleep study to pinpoint the cause and guide treatment. But you shouldn’t expect a quick fix. “Sleep patterns take months to change,” says Levy.

3. A Healthy Diet

Lio encourages his patients to adopt healthy eating habits that emphasize whole foods, vegetables, fruits, lean proteins, and healthy fats like olive oil, while minimizing highly processed foods.

One eating plan that promotes this approach: the Mediterranean diet, which may help reduce inflammation while supporting your overall health. “While research on its specific benefits for psoriasis is still evolving, it represents a practical and sustainable approach for many people,” says Lio.

Bonus: A nutritious diet can help you achieve and maintain a healthy weight. “Excess weight is associated with increased inflammation, and weight reduction has been shown to improve psoriasis severity in many patients,” says Lio.

Levy cautions against following very restrictive eating plans. For example, the ketogenic diet has shown benefits for psoriasis in some studies. But the diet drastically limits carbohydrates, and that can be difficult to sustain. Your best bet, he says, is to find what works for you.

“Never think ‘If I don’t do this or that type of diet, I’m in trouble,” says Levy. “That just adds to your stress. Look into an eating plan that’s not complicated, like the Mediterranean diet, and consider eating less red meat or eating a vegetarian diet.”

4. Daily Movement

“Exercise is the quickest and easiest way to reduce stress and get healthier,” says Levy.

You don’t need to join a gym or push yourself to sweaty extremes. A short daily walk, especially when paired with a healthy diet, may ease your psoriasis, says Lio. How? In large part, by helping you toward a healthy weight, says Lio. In addition to walking, experts also recommend other gentle exercises, like yoga and cycling. Aim for 30 minutes of activity a day, four to five days per week.

Daily exercise also can improve your mood. That’s important because psoriasis raises your risk of both depression and anxiety by more than 30 percent.

Finally, exercise — along with a healthy diet — offers protection against the risks psoriasis poses to your overall health, such as heart disease and diabetes, says Lio.

5. Consistent Skin Care

"Regular skin care helps support the skin barrier and can reduce dryness, scaling, itching, and irritation,” says Lio, adding that consistency is critical. He recommends moisturizing daily, particularly right after bathing. It’s also important to find the bathing temperature that’s right for you. For some people, warm water causes itching, while others’ itching gets triggered by cold water. Experiment to determine your best temp and stick to it.

Gently pat yourself dry before applying your moisturizer. You may find it helps to moisturize more than once a day.

Lio says that many of his patients prefer thicker creams or ointments. Oils and heavy ointments may be your go-to if you have super dry skin. If you have thick scaling, moisturizers with salicylic acid offer additional benefits. They aid in lifting and removing those scales, allowing your topical medications to really get into your skin and do their work.

Which moisturizers will work best for you? Ask your dermatologist for recommendations and expect some trial and error.

“You need to experiment to find the ones you like,” says Levy.

6. A Little Time in the Sun

The right amount of sunlight every day may improve your psoriasis, though too much sun exposure can lead to psoriasis flares or worsen your ongoing symptoms. Ask your dermatologist for guidance.

Be sure to use sunscreen if you’re going to be outdoors for longer periods. This will help prevent flares. Do this year round, even on cloudy, cold days.

How to Build a Routine That Sticks

Establishing new healthy habits can feel daunting in the beginning, and such habits can be a challenge to maintain. Work on one habit at a time, says Levy. You and your doctor can determine the best place to start. If sleep’s your biggest issue, for example, focus on that first.

And remember that small changes will add up. Need to improve your diet? Don’t overwhelm yourself by going all in right away. For example, says Levy, if you eat red meat every day, consider slowly cutting back to once every week or two while gradually incorporating more vegetables.

Patience is key. You won’t see results from your new habits right away. In fact, says Levy, it likely will be months before you notice improvements. Keep going!

You can log your progress to help yourself stay on track. Use a journal or smartphone app daily to note your stress level, sleep quality, and other lifestyle factors that you’re working on. Also, jot down your psoriasis symptoms. Over time, says Lio, this may reveal patterns and reinforce positive changes. For example, if your symptoms bother you less when you sleep well, use that as encouragement to keep practicing your new and improved sleep habits.

The Takeaway

• Healthy daily habits, like a nutritious diet, exercise, and good sleep, can improve your psoriasis and complement your medical treatment.
• Psoriasis is a very individual condition, so expect some trial and error before you find the most effective daily habits for you.
• Your new habits will help you improve your overall well-being and offer protection against the health risks that come with psoriasis, such as heart disease and diabetes.

https://www.everydayhealth.com/psoriasis/daily-habits-that-can-help-manage-psoriasis/

 

How to Get Better Sleep When You Have Psoriasis

From everydayhealth.com

From itchy skin to ongoing stress and anxiety, psoriasis symptoms can make getting a good night’s sleep difficult.

As many as 50 percent of people with psoriasis have sleep problems at least once a month — and another 11 percent say their sleep is disturbed on more than half of each month’s nights. And when sleep is disrupted night after night, it can take a real toll on both mental and physical health. It can play a role in fatigue, stress, and even increased inflammation and disease severity.

Taking steps to better control your symptoms and make your sleep space as comfortable as possible may help reduce night-time flare-ups and help you get better shut-eye. Here’s a look at dermatologist-backed tips for managing psoriasis and improving sleep quality.

Optimize Your Skin Care Routine Before Bed

Itching and pain are common reasons people with psoriasis struggle to sleep. That's why dermatologists focus first on treating its root cause: your psoriasis. When it comes to night-time psoriasis management, the goal is simple: Calm irritation and lock in moisture so you can rest more comfortably.

Adjust Your Treatment Plan

If plaques or rashes are keeping you awake, it may be time to review your medications. Your doctor may adjust your medications or introduce a new one, whether they’re topical creams, medicines taken by mouth, or biologics, says Chris Adigun, MD, a board-certified dermatologist in private practice in Chapel Hill, North Carolina. “As a dermatologist, I’m going to focus on the skin disease component of your care first. The best thing I can do in my role is optimize disease control,” she says.

When psoriasis is under control, it should affect 1 percent or less of your skin, says Steven Daveluy, MD, a professor and director of Wayne State University School of Medicine's dermatology residency program in Detroit. He specializes in treating patients with skin diseases such as psoriasis and eczema. “We have such great options for psoriasis, that everyone's skin should be clear or almost clear. The right treatment plan can significantly reduce night-time itch and help you sleep better,” Dr. Daveluy says.

Take a Warm Bath or Shower Before Bed

A warm — never hot — shower or bath can help loosen and remove scales, which may otherwise make itchiness worse. This can be especially helpful if you have visible plaques or build-up on your skin, says Lawrence Green, MD, a clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C.

Moisturize Immediately After Bathing

Timing matters, and you should apply moisturizer right after bathing, says Dr. Green. He recommends using thick, heavy creams or ointments — think jar-based products rather than pump lotions — to help seal in moisture and reduce itching overnight.

Petroleum-based moisturizers, like Vaseline, tend to work best for psoriasis, particularly on stubborn or itchy areas. “These heavier-cream moisturizers help prevent the scales from building up because that, again, can be causing a lot of itch,” he says.

Some people do well with using salicylic acid, lactic acid, or urea creams or lotions to help soften thick scales, says Mary Wu Chang, MD, an associate professor of dermatology and paediatrics at the University of Connecticut.

Look for “sensitive-skin,” or “fragrance-free” labelling, since these products have the least risk of irritation, too, Daveluy says.

Use Topicals That Target Itch Relief

Using prescription topical treatments, including topical steroids, should also help to soothe your psoriasis itch, Daveluy says. But for lingering itch, use of some over-the-counter anti-itch products may offer short-term relief, like pramoxine and menthol, he says.

Take an Oral Antihistamine or Sleep Aid if Needed

Antihistamines don’t treat psoriasis-related itch, because this itch isn’t driven by histamine, a chemical your immune system releases. But taking antihistamines can help some people fall asleep. Look for over-the-counter sedating antihistamines or natural sleep aids like melatonin, Dr. Chang says. “This would be more of an add-on medication to use from time to time, rather than a cure for problematic sleep from psoriasis,” she says.

Dr. Adigun says you can take an antihistamine for just a few nights as you bridge the gap with your new treatment plan, which could take up to two weeks.

Keep Fingernails Trimmed

Short, smooth nails reduce the risk of skin injury, especially if you scratch in your sleep. Scratching can worsen inflammation and may even trigger new psoriasis patches through the Koebner phenomenon, a response in which skin trauma (like scratches) can cause psoriasis to spread to areas of your skin that hadn't been affected in the past, Green says.

As an extra layer of protection, wear cotton gloves if you find you’re scratching yourself at night, Daveluy says. “[Gloves] can also help keep creams or ointments on the hands, if you have psoriasis there,” he says.

Create a Psoriasis-Friendly Sleep Environment

Even with well-controlled psoriasis, your sleep environment can soothe your skin — or make night-time itchiness worse. Dermatologists recommend creating a sleep space that stays cool, breathable, and gentle on skin through small adjustments:

Keep the Room Cool

Sleeping in a cooler room — aim for around 68 degrees F — can help prevent overheating and sweating, which can make itching worse and disrupt sleep, says Chang. A fan gently blowing across the bed may also feel soothing. This is especially important for children with psoriasis, who can become hot and uncomfortable if they’re over-bundled at night, she says.

Choose Breathable Fabrics

Wear lightweight, breathable fabrics such as cotton or bamboo, because they're less likely to irritate psoriasis-prone skin, Daveluy says. He notes that natural fabrics are generally better than synthetic ones, which can trap heat and moisture.

Unlike atopic dermatitis, psoriasis is generally less sensitive to fabric types or thread count, Green says. Your goal is to pay attention to which fabrics may be rubbing against plaques or triggering itchiness, he suggests.

Do Laundry With Gentle Detergent

Scented detergents and fabric softeners contain chemicals that can irritate sensitive skin, Daveluy says. Dermatologists recommend using fragrance-free, dye-free products like Tide Free and Gentle or All Free Clear, Chang says. “Also skip the fabric softener and use dryer balls to bounce around in the dryer and soften fabrics,” she says.

Practice Good Sleep Hygiene and Relaxation Techniques

When you’re facing symptoms like itchiness, anxiety, or stress at night, your bedtime routine is going to make a difference. That’s why dermatologists talk to their psoriasis patients about sleep hygiene, Green says. “It’s about creating an environment that is in your favour when you're already working against something,” he says.

Some good sleep habits are:

• Set up — and stick to — a consistent bedtime and waking schedule.
• Make sure your room is dark and quiet.
• Limit your exposure to bright lights in the evening.
• Turn off your electronics about an hour before bedtime.
• Keep the room at a comfortable, cool temperature.
• Unwind with quiet reading, low-impact stretching, or listening to soothing music.
• Limit caffeine and avoid having it later in the day.
• Don't eat large meals for dinner.
It’s worth doing an audit of sorts of your overall health, too, Adigun says. For instance, if you smoke, try to quit. If you drink alcohol, cut back on how much you have. And aim to get regular exercise. “All of these factors can improve psoriasis severity – but they can also improve sleep quality,” she says.
See Your Doctor if Sleep Problems Persist
If itching or pain are keeping you awake, talk with your dermatologist, Green says. “Everything that psoriasis is doing to your body besides being visible on the skin, you should mention to your dermatologist. They can help you through it,” he says.
They may:
• Adjust your current topical or systemic treatment plan.
• Recommend a different type of medication.
• Talk with you about healthy sleep habits in more detail.
• Refer you to specialists who can check for underlying sleep disorders.
While itching and pain are common reasons for worse sleep in people with psoriasis, they're not the only causes. People with psoriasis can develop other health conditions — such as anxiety and depression, sleep apnoea, and restless legs syndrome — all of which affect sleep, Daveluy says.
The Takeaway
• Fine-tuning your skin care routine with dermatologist-recommended psoriasis treatments and consistent moisturizing can help reduce night-time itching and improve your sleep quality.
• Creating a comfortable sleep space may also help you sleep better. For instance, lower the bedroom temperature and choose breathable fabrics.
• Practice habits that can help sleep. For example, wake up and go to sleep at the same times each day, and try relaxation techniques. Good sleep hygiene can positively impact your overall psoriasis management and sleep.
• Don't hesitate to talk with your dermatologist or healthcare providers if your psoriasis symptoms continue to disturb your sleep. Your doctor can provide tailored treatment options and remedies to address any underlying sleep disorders you might have.
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• https://www.everydayhealth.com/psoriasis/how-to-get-better-sleep-when-you-have-psoriasis/