Interview with Dr AMODE: "Psoriasis in everyday life."

"Psoriasis is not a skin barrier abnormality like eczema. Nonetheless, the presence of scales may impair quality of life and skin comfort. For daily cleansing, it is advisable to choose a gentle, superfatted cleansing bar , preferably soap-free (detergent-free) and fragrance-free to avoid irritating the skin.

The frequency of washing varies according to daily demands and individual needs. Moreover, it may be tempting to resort to “aggressive” cleansing to remove the scaly lesions of psoriasis. However, skin trauma can trigger psoriatic lesions (Koebner phenomenon). Therefore, gentle hygiene practices should be adopted.

For example, wash yourself inlukewarmwater. Indeed, hot and frequent baths or showers can dehydrate the skin and exacerbate psoriasis. Similarly, it may be tempting to use a flannel or another bathing accessory to remove psoriatic scales. However, excessive or vigorous exfoliation or rubbing can inflame the skin, potentially causing minor injuries or skin infections that lead to psoriasis flare-ups. Instead, use your hands to cleanse yourself.

"For a gentler bath, it is often recommended to add oat flour or starch. Starch has long been used in dermatology across all inflammatory dermatoses. Indeed, it can be used in one’s bath. They have anti-inflammatory, soothing, softening and emollient properties, thereby providing comfort to the patient."

For your baths, preferably use a colloidal oatmeal powder. This is very finely milled oatmeal that forms a homogeneous suspension in water, thus preventing blockages in your pipework.

"Also, both during and between flare-ups, thedaily use of an emollient after washing is recommended over your entire body at least twice a day using a hydrating formulation such as a balm or rich cream to strengthen the skin barrier, maintain skin hydration, reduce uncomfortable scaling and extend the periods between flare-ups. This moisturiser can be enriched with keratolytic agents such as urea, which help to gently remove scales."

Over-the-counter bathing and skincare regimens cannot heal skin lesions, as the psoriasis is an autoimmune inflammatory disease.

"Make-up is not contraindicated. In the event of facial involvement, prioritise the application of treatments. Camouflage is permitted, provided certain principles are followed. Before applying make-up, ensure your skin is fully prepared. Consider applying a moisturising treatment."

Applying a moisturiser first helps to soften the skin. This prevents makeup from clumping on dry, flaky patches and causing further irritation.

"Next, use fluid cosmetic formulations that are non-irritating, non-occlusive and hypoallergenic. Opt for moisturising products and avoid those that could dry out your skin and exacerbate psoriasis symptoms, such as formulations containing essential oils, fragrances or alcohols."

Some garments and fabrics can exacerbate the symptoms of psoriasis. Wool, mohair and synthetic textiles tend to retain heat, triggering a psoriasis flare-up or worsening existing scaly plaques.

"It appears that the natural fibres provide greater skin comfort: cotton, linen, silk and other plant-based fibres," says Dr. Amode.

Moreover, it is recommended toavoid clingy clothing and to favour loose-fitting garments. Beyond clothing, the bed linen you use should also be carefully selected. Use sheets, pillowcases and duvets made from cotton, bamboo fibres, silk or linen.

"Yes, poor lifestyle habits or overexertion can indeed trigger a psoriasis flare-up or worsen the condition. Moreover, the itching (pruritus) associated with psoriasis, as well as potential comorbidities (depression, anxiety, etc.), can make it difficult to fall asleep, affect sleep quality and lead to sleep disorders (insomnia, sleep apnoea, restless legs syndrome)."

"Thermal spa treatments can improve symptoms, well‐being, self‐esteem and quality of life. The observed benefit is multifactorial: stress reduction, control of diet and lifestyle, and the soothing effects of both the treatments and thermal waters. This is a prescription-based medical therapy, used alongside pharmacological treatments." according to Dr AMODE.

It is possible to observe an indirect benefit of spa therapy on psoriasis by taking a break, experiencing less stress since we know that environmental factors can trigger flare-ups (chronic stress, psychological shock, etc.). Although it is not a psychosomatic disease, psoriasis involves psychological risk factors and life events that can trigger flare-ups.

"It is not contraindicated to undergo laser hair removal. However, it is logical to avoid any affected areas and periods of flare-up. As a reminder, any trauma can precipitate a psoriasis flare (the Koebner phenomenon)."