The sun has a beneficial effect on psoriasis, but lesions often spoil the summer for patients. Follow our practical advice to make the most of the summer. The right sun cream, comfortable clothing, a healthy lifestyle and a few precautions will let you enjoy the great outdoors.
Summer is coming. All the magazines have special summer features, and everyone is looking forward to better weather. Or are they? Perhaps not everyone. Summer poses a cruel dilemma for people with psoriasis. It has been proven that the sun has a beneficial effect on lesions, but that means exposing your skin. It means that you can no longer hide beneath long sleeves and trousers as you can in the winter. However, some tricks and precautions will help you enjoy the summer - without a cloud.
Psoriasis and the climate
The sun is good for psoriasis as ultraviolet (UV) rays, and particularly UVB rays, help the skin to heal and reduce inflammation. They also slow down the over-production of skin cells, which is the cause of scaling. Areas affected by psoriasis heal by themselves after exposure to natural sunlight. A short daily period of exposure to the sun, avoiding burning, is enough to make plaques disappear. However, prolonged, unaccustomed exposure to the sun can be harmful, especially for people with fair complexions. Apart from the risk of cancer and damage to the skin, over-exposure can make the symptoms of psoriasis worse. For example, burning can trigger the Koebner phenomenon. It is also inadvisable to expose skin to the sun during a flare. So be careful when you go out in the sun: protect your skin, avoid exposure between and and expose your skin to the sun for gradually increasing periods. Do not forget that the rays of the sun can pass through glass, clouds, water and light clothing and reflect off water and sand.
It is generally better to opt for a holiday in a dry and sunny climate, such as the Mediterranean coast, in order to control flares, especially if your condition is mild. Hot, wet climates tend to exacerbate severe cases.
However, everyone is different and your doctor will assess the risks and benefits of sun exposure for you as an individual, taking into consideration factors such as your symptoms and the treatment you are following as well as your complexion, hair colour and age. You should also be aware that if your psoriasis is not completely improved by the sun, local treatments are still an option but should be administered away from exposure to the sun. Many topical treatments screen out UV rays, or they can be degraded by UV rays, leading to a risk of phototoxicity (especially for corticosteroids).
Choosing the right sunscreen
Although sun can be good for psoriatic skin, people with psoriasis should protect themselves against the harmful effects of UVA and UVB rays. Sunscreen products formulated for atopic skin are available (see the section on skin care products). These products moisturise the skin as well as protect it from the sun, which is essential in psoriasis. Dermatologists generally recommend sunscreen with a protection factor of at least SPF 25 for the body and total sunblock for the face, especially during a flare. Inflammation can be made worse by the heat and sun. It is a good idea to look for a water resistant sunscreen.
Apply sunscreen every few hours, more often if you are swimming or taking exercise, and dry the skin with a towel. Cover yourself generously with lotion – better to apply too much than too little, and in fact people tend to use too little sunscreen.
Whether you are exposed to the sun or not, keep your skin moisturised with a good quality cream. Hot, sunny days can dry the skin out, as can air conditioning. Using a moisturiser reduces itching and chapping, and soothes scaly patches.
It also helps to know that some types of corrective makeup contain sunscreen.
If you are shy about exposing your skin, self-tanning lotion is still an option if you have psoriasis.
Photoinduced and photosensitive psoriasis
Most patients with psoriasis benefit from either natural or artificial ultraviolet light. Unfortunately, some people find that sunlight exacerbates or triggers their lesions. This is known as photoinduced or photosensitive psoriasis. It is a rare condition which affects only 5.5% of people with psoriasis. It has been little studied, but it may simply result from intense and unaccustomed exposure to the sun, or from the Koebner phenomenon. Photoinduced psoriasis is more common in older people, in people with fair complexions and in people whose hands are involved in the psoriasis.
Clothing which is too tight can irritate the skin and tends to make symptoms worse. Take advantage of warm weather to leave your jeans, figure-hugging trousers and shoes with pointed toes in the wardrobe. Avoid wearing synthetic fibres and lycra next to the skin as these make the skin sweat. Instead, wearing light, loose, comfortable clothing will make you feel more relaxed and confident. Choose soft, natural fibres such as cotton for all your clothes, including underwear. Men with genital psoriasis or psoriasis in the groin area can opt for boxer shorts instead of briefs.
Shoes and sandals should be open and roomy, especially as the feet swell slightly in the heat. Go for leather shoes rather than synthetic materials as leather absorbs moisture better. You can also use foam, cork or water-filled inner soles to relieve pressure on skin affected by psoriasis. Inner soles made from visco-elastic polymers will also act as shock-absorbers and protect healing skin. You can wear these with good quality trainers, which should be soft and made from breathable material.
Summer is also a good time to put socks, tights and stockings made from synthetic materials at the bottom of your drawer. Why not have a few sessions of phototherapy in the months leading up to summer so that you can take full advantage of wearing shorts and skirts?
And lastly, don't forget those must-have accessories: a properly adjusted hat and sunglasses.
Swimming: in moderation
People with psoriasis can enjoy summer pleasures such as swimming. You should just remember the risks associated with the condition and take some precautions. Apply a moisturiser beforehand, limit the time you spend in the water and take a shower afterwards to get rid of any chlorine, chemicals or salt which may irritate sensitive skin. Over-exposure to sea water, or chlorine and chemicals in swimming pools, can make skin itchy and chapped. After showering, dry yourself thoroughly with a soft towel, patting instead of rubbing. Then generously apply a moisturiser and sunscreen to keep the skin well moisturised and protected against UVA and UVB rays.
Although you should avoid swimming if you have weeping lesions, sea water often has a beneficial effect on psoriasis, especially when combined with exposure to the sun. Many people say that bathing helps get rid of scale and is also relaxing. The trace elements in sea water may also be good for psoriasis.
Les Nouvelles Dermatologiques, June 2000
Le psoriasis en médecine générale, published by Arnette, 2005
With thanks to Dr Patrick Brun, dermatologist attached to CannesUniversityHospital.
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