It’s important to note that your bathing and over-the-counter skin-care regimen won’t actually heal individual lesions, because psoriasis is an inflammatory disease that originates from the immune system. “It’s not something that we think about as a direct result of dry skin and bathing,” says Rashmi Unwala, MD, a dermatologist specializing in psoriasis at Cleveland Clinic in Ohio. “Focusing on skin care can be detrimental to patients. Just switching their products won’t make a difference for the internal disease and delays care.” It’s essential to see a doctor to diagnose and treat the underlying condition with a variety of safe and effective topical and systemic medicines. With that said, your bathing routine during a psoriasis flare can impact how your skin feels. Here’s how to get the most out of your shower or bath.
1. Limit showers to 5 minutes and baths to 15 minutes once per day
Showering or bathing too often can increase the amount of moisture you lose through your skin, making it dry and irritated. “It can make already inflamed skin feel even worse,” says Dr. Unwala. She suggests bathing once a day and limiting baths to no more than 15 minutes and showers to 5 minutes.
2. Make sure the water is lukewarm, not hot
When your skin is irritated, keep the water temperature of your baths and showers warm, not hot. “Hot water will make skin drier and more irritated,” says Unwala.
3. Add coal tar, ground oatmeal, or bath oils to bathwater
Baths can help gently remove some psoriasis scales without damaging underlying skin or worsening individual lesions. “Especially if a person is extremely irritated and struggling with itch, baths can soothe and relieve discomfort,” says Unwala. She suggests adding a coal tar solution to your bath, which can help ease itching and scaling and reduce some of the inflammation of the psoriasis, according to the National Psoriasis Foundation. You can also add bath oils to moisturize the skin as well as oatmeal, which helps moisturize by sealing the cracks in dry skin. If you have questions about which bath products to use, talk to your doctor or dermatologist.
4. Use gentle, moisture-rich body wash made for sensitive skin
Instead of bar soap, use a gentle, fragrance-free cleanser or bodywash to avoid irritating your skin. “There’s a theoretical risk that because you have broken [and inflamed] skin, you could develop an allergy to some products,” says Unwala. Many cleansers, shampoos, and lotions labeled for psoriasis contain coal tar. “It’s one of the most effective over-the-counter ingredients for psoriasis,” says Unwala. She adds that cleansers with salicylic acid can help gently work away psoriasis lesions on the skin without trauma. Lactic acid, urea, and phenols are also used as scale lifters, or keratinolytics. Talk to your doctor or dermatologist about which ingredients to look for in your skin-care products.
5. Skip the washcloths and scrubbing beads
It might be tempting to use a loofah, a washcloth, or scrubbing beads to slough off psoriasis lesions. But excessive exfoliation with abrasive materials can inflame skin, potentially causing the Koebner phenomenon, in which minor skin injuries or infections lead to psoriasis flares. “Trauma to the skin will lead to more psoriasis. Vigorous rubbing and scrubbing can lead to enlargements of areas of psoriasis,” explains Unwala. Instead, use your hands to gently apply your cleanser and rinse thoroughly.
6. If you have scalp psoriasis, gently massage shampoo and conditioner into your hair
The same principles apply if you have scalp psoriasis. Rather than rubbing shampoo into your hair, gently massage and rinse. Ask your doctor whether a medicated shampoo that contains coal tar to help ease inflammation could work for you.
7. Dry your skin by blotting your body with a towel
When you’re done bathing, avoid rubbing your towel on your skin or hair. Instead, gently pat yourself dry, leaving your skin slightly damp. Use towels washed in a fragrance-free detergent to avoid potentially irritating your skin.
8. Apply a fragrance-free moisturizer after getting out of the bath or shower
As soon as you’re done bathing, apply prescription topicals to any affected areas and then apply moisturizer to damp skin. Some experts recommend choosing a thick cream or ointment over a lotion to lock in moisture. If your skin is extra dry, you may want to consider using an oil. Some ointments and moisturizers created for psoriasis also contain coal tar or salicylic acid, which can help calm inflammation and gently remove plaques. “Choose something that doesn’t have an exfoliant and isn’t irritating to the skin,” says Unwala. “Anything that burns or stings is going to make things worse.” And remember, bathing can only do so much to help your skin during a psoriasis flare. It’s important to take your medications as prescribed and reach out to your doctor if your psoriasis isn’t improving or is getting worse. Adjusting your treatment to address the underlying cause is the only way to effectively treat psoriasis.
