skin disorders

Skincare for Psoriasis

Treating psoriasis is tricky enough on its own, so how do you put together a skincare routine that won’t make it worse and that will help manage it? Are there skincare products that can help reduce psoriasis? We answer those questions and more in this must-read article for anyone struggling with this skin disorder.

In This Article:

It is certainly no surprise to anyone with psoriasis that over-the-counter or "traditional" skincare products are not capable of completely clearing an outbreak—simply put, prescription treatments are the most effective. Still, the right skincare products can make a difference, and your skincare routine can play an important role in making sure your psoriasis doesn’t get worse. A great routine also will allow the treatments that do minimize outbreaks to work their best. In this article we detail some topical products that can help, and explain how to build a gentle skincare routine to soothe psoriasis-affected skin.

Consider Topical Retinoids and Salicylic Acid (BHA)

Topical retinoids (that is, various forms of vitamin A; the over-the-counter ingredient to look for is retinol) are helpful in managing psoriasis because of their ability to improve the way new skin cells are formed. They do this by way of cell communication, meaning they essentially connect with a receptor site on a misbehaving skin cell and “tell” it to act in a more normal and healthier manner. [1]

Retinol is the most common and most thoroughly researched topical retinoid in skincare, but there are other retinoids, including retinyl palmitate, retinaldehyde, and retinoyl linoleate. These are included in select skincare products, but the gold standard—retinol—is available in a wider range of products that are available at both drugstores and department stores.

Paula’s Choice offers retinol treatments in various strengths for use on the face and body. Generally speaking, there are no agreed-on guidelines for determining what strength or type of retinol treatment is best for psoriasis; so consider beginning with a lower strength and see how your skin responds.

Salicylic acid (also known as beta hydroxy acid [BHA]), when well formulated, is an extremely gentle exfoliant that can soften and help remove the layers of scaly, thickened psoriatic lesions. Removing these layers not only improves the appearance of your skin, but also allows other topical medications to better penetrate the skin. [2]

In addition, because of salicylic acid’s chemical relationship to aspirin (aspirin is acetylsalicylic acid), it has anti-inflammatory properties, which help reduce the redness associated with psoriasis. Given how salicylic acid functions, a leave-on salicylic acid–based exfoliant (2% to 6% concentration) is considered a viable skincare treatment for psoriasis. From the Paula’s Choice line, consider SKIN PERFECTING 2% BHA Liquid Exfoliant, RESIST Weekly Retexturizing Foaming Treatment 4% BHA, and, for improving the appearance of psoriasis on the body, RESIST Weightless Body Treatment 2% BHA.

Salicylic acid exfoliants can be used once or twice daily, and present minimal to no risk of side effects. Note, however, that those who are allergic to aspirin should not apply salicylic acid unless directed to do so by a physician.

Putting Together a Skincare Routine for Psoriasis

All of the basic skincare needs that apply to every skin type remain important for those with psoriasis, but there are special considerations and warnings that must be taken even more seriously. Overall, it’s vitally important that you:

  • Do not do anything to irritate your skin, as this will only make matters worse.
  • Avoid all the things we repeatedly warn against, such as harsh cleansers, abrasive scrubs, hot water, and products with irritating ingredients.
  • Stop using fragranced products, whether the scent is synthetic or natural. This will go a long way toward improving how your skin looks and feels.

The best skincare routines for those with psoriasis start with a gentle water-soluble cleanser, followed by a skin-soothing toner. A leave-on topical salicylic acid (BHA) exfoliant comes next. [3] During the day, follow with an anti-aging serum and then sunscreen (if approved by your dermatologist). At night, apply your serum and/moisturizer (with or without retinol).

All of these types of products should be available in a texture appropriate for your skin type and preferences. In terms of moisturizers, that means gels or liquids if you have oily skin; lotions if you have normal to combination skin; and creams or balms if you have dry to very dry skin.

If you are using topical medications, such as a vitamin D, cortisone, coal-tar, or an over-the-counter or prescription retinoid product, apply them before your sunscreen during the day and before your moisturizer at night. Note that if you are using a prescription retinoid product to combat the symptoms of psoriasis, you may not need an over-the-counter retinol product as well. However, you can apply both, either at the same time or alternately (for example, apply the over-the-counter retinol during the day and the prescription retinoid at night), but always pay close attention to how your skin responds. Retinoids are potent, and you never want to tip the scales in favor of irritation.

Let’s recap: If you have psoriasis, it’s still important to select skincare products based on your skin type—oily, combination, normal, or dry. Topical prescription treatments to control the symptoms of psoriasis can be worked into your routine, as directed by your doctor, and you shouldn’t experience any compatibility issues by adding such products to your usual skincare routine.

Especially important: Be very careful to use only products that are free of potential irritants. Paula’s Choice Skincare is one of the few truly fragrance-free, gentle skincare lines available that also has a wide range of products formulated to address the needs of every skin type and concern—all supported by published, scientific research about what works to have healthy, beautiful skin.

References Cited:

  1. Rossetti D, Kielmanowicz M, Vigodman S, Hu Y, Chen N, Nkengne AOT, Fischer D, Seiberg M, Lin C. A novel anti-ageing mechanism for retinol: induction of dermal elastin synthesis and elastin fibre formation. Int J Cosmet Sci. 2011;33(1):62–9.
  2. Jacobi A, Mayer A, Augustin M. Keratolytics and Emollients and Their Role in the Therapy of Psoriasis: a Systematic Review. Dermatol Ther (Heidelb). 2015 Mar; 5(1): 1–18.
  3. Chan C, Van Voorhees A, Lebwohl M, Korman N, Young M, Bebo B J, Kalb R, Hsu S. Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.J Am Acad Dermatol. 2009 Jun;60(6):962-71.
hair care

Hair Rehab: 5 Ways to Repair Post-Summer Damage

From chlorine and saltwater to intense sun, summer can take its toll on your hair. Find out how to reverse the damage with these proven solutions for silky-soft hair!

In This Article:

If you’ve noticed your locks have lost some of their luster, there’s a good chance the long days of summer fun may be to blame. From sun exposure causing color to fade to chlorine and saltwater transforming healthy tresses into a dull, brittle mess, we’ve got you covered with proven solutions to get your hair back on the right track. Consider this your intervention for summer hair rehab!

Pool-Party Hair Gone Bad

Chlorine is known for leaving hair dry and dull, and for blondes, there’s also the chance that time spent in the pool may turn your hair green! A swim cap can help significantly in protecting your hair from chlorine, but let’s face it, most of us aren’t willing to go to that length … at least not in public.

The alternative solution? After being in the pool, make a beeline to the shower and wash your hair immediately, or at the very least rinse your hair thoroughly with tap water. Follow up with a good leave-in conditioner or a silicone-rich serum to restore moisture and shine.

What about that green hair issue? As it turns out, it isn’t actually caused by the chlorine in the water, rather it’s the combination of the chlorine and the minerals in the water (Ultrastructural Pathology, 1995). Chemistry expert Anne Marie Helmenstine, Ph.D., explains: "Oxidized metals in the water bind to the protein in the hair shaft and deposit their color. The metal that produces the green tint is copper. The bleach [chlorine] that is added to a pool may be responsible for oxidizing the metal, but it’s not the cause of the color."

So, what should you do if your hair turns green after a swim? Simple: Use a shampoo labeled "clarifying" to chelate (bind with) the metallic elements, allowing them to be rinsed away, and taking the green tint with it!

(Brittle) Beachy Waves

True to its name, saltwater contains salt along with other minerals (like chloride and magnesium), which can rough up the cuticle layer and cause the hair shaft to swell and feel dry.

To minimize the damage from exposure to saltwater, wash your hair with a gentle shampoo as soon as you get home. Try one with a cushiony lather, like Paula’s Choice All Over Hair & Body Shampoo.

It’s crucial to avoid letting saltwater-drenched hair dry naturally in sunlight because it puts the already-weakened hair at risk for a double dose of damage. Speaking of which …

Sun-Bleached Tresses

Too much sun exposure can be nearly as bad for hair as it is for skin! When sunlight hits hair, it immediately begins breaking down hair’s protective cuticle layer. Think of this layer like shingles on a roof; what happens when the shingles degrade? Your roof lets unwanted substances (like water) in, and damage occurs.

As the sun exposure breaks down hair’s cuticle layer, it exposes the delicate inner portion of the hair, which is even more vulnerable to damage, including color loss (Collegium Antropologicum, October 2008). Such damage is especially noticeable in the case of dyed hair—in particular, reds tend to lose their vibrancy and rich brunette tresses can turn utterly drab.

A hat is probably sounding pretty good right about now, and that’s certainly a smart option for days when you’ll be outdoors for an extended period of time; on the other hand, we realize that not everyone is a hat person, nor is it convenient for all situations. Thankfully, research has shown that using leave-on products with silicones (such as dimethicone or trimethylsiloxysilicate) can help limit the fading of hair dye due to sun exposure (Journal of Cosmetic Science, 2004). So, by all means, slick a silicone serum or spray through your hair before hitting the beach.

What about SPF-Enhanced Hair Care?

Repeated, ongoing sun exposure will gradually weaken your hair (Journal of Cosmetic Science, April 2008), allowing it to break more easily and leading to a change in texture from silky-smooth to dry and rough. Overall, hair becomes dry, frizzy, and generally a lot less manageable from the cascade of damage.

To combat this damage, some haircare products claim to contain UV filters, but there is no reliable way to measure how much sun protection they provide because the United States Food and Drug Administration (FDA) does not permit SPF rating for hair products. While it’s likely they provide some protection, the bigger question remains: How long will they really hold up with all that hair goes through?

What can you do instead? Try misting your hair with an alcohol-based spray-on sunscreen rated SPF 25 or greater. Although it’s true that alcohol isn’t the best for hair, it evaporates quickly and keeps the active sunscreen ingredients from weighing hair down. Do this as the last step once your hair is styled, just like applying hairspray, and reapply throughout the day when you know you’ll be in the sun for long periods.

DIY Hair Rehab Treatments: DO or DON’T?

If you’ve dropped by Pinterest lately or skimmed through a beauty magazine, you’ve likely seen your fair share of DIY hair tips telling you to drench your locks in all kinds of food ingredients, including mayo, avocado, eggs, yogurt, and honey. While some of these can help moisturize hair to a minor degree, they don’t hold a candle to the types of ingredients that are used in even the most basic haircare formulas today in terms of softening and smoothing dry/damaged hair. Factor in the unpleasant aroma (do you really want your hair to smell like mayo?) + messy application and it’s easy to see why you’re better off sticking to conditioning treatments from the drugstore.

That said, we understand that sometimes it’s fun to try something "outside the box," so if you’re keen to try a DIY hair treatment, opt for coconut oil. Not only is it rich in fatty acids to moisturize and help smooth damaged hair, it’s also less difficult to work with than other food-related hair treatments—plus it smells a whole lot better!

Apply the coconut oil to dry hair, but only to the ends (avoid getting it any closer to your scalp or on the roots, as it will look really greasy). Leave it on overnight (the longer it is in contact with hair, the better to soften and add shine) and put a towel over your pillow to avoid staining. In the morning, wash with your normal shampoo and conditioner, and voilà, you’re on your way to softer, smoother, shinier hair!

skin disorders

Psoriasis Treatments

While there is no cure for psoriasis, that doesn’t mean you can’t do anything about it! Psoriasis can be managed—and even go into periods of remission—with treatment. The key is finding the treatment that works best for you.

In This Article:

Psoriasis is a chronic, inflammatory immune system disorder that affects the skin of millions of Americans. So far, there is no cure for the red, inflamed lesions that come with psoriasis, but that doesn’t mean there isn’t anything you can do about them! Psoriasis can be managed—and even go into periods of remission—with treatment. The key is finding the treatment that works best for you, which for some may take months, if not years.

Topical Treatments

The number of options for managing psoriasis continues to grow as new research emerges. In this article we detail some of the most common treatments, from topical options all the way up to injectable medications. Keep in mind that not every treatment works for everyone, and that it’s important to find a dermatologist who specializes to determine the severity of the disorder and prescribe what might work best. The list of topical treatments includes, but is not limited to, those listed below.

Phototherapy/Sunlight: This may seem contradictory to the usual warnings about avoiding prolonged, unprotected sun exposure, but extended periods of time in the sun (also referred to as "climatotherapy") can significantly improve, or even clear, psoriasis. In fact, some research indicates that 60% of those who use this kind of treatment obtain relief at least for some period of time. Ultraviolet (UV) light from the sun suppresses the skin’s immune response and, therefore, reduces that type of inflammation, slowing the overproduction of skin cells that causes the scaling. Daily, short, non-burning exposure to sunlight clears or improves psoriasis in many people. Therefore, sunlight may be included among the initial treatments for the disorder. Of course, this convenient, inexpensive treatment has serious drawbacks, including advanced skin aging, far greater risk of skin cancer, and an impaired immune response that can cause other health problems. [1,2]

UVB lamps: An alternative to natural sunlight is medically supervised exposure to narrow-band ultraviolet B (UVB) lamps. UVB light is used when topical treatments have failed, or in combination with topical treatments. The short-term risks of using controlled narrow-band UVB exposure to treat psoriasis is minimal, and long-term studies of large numbers of patients treated with narrow-band UVB have not demonstrated an increased risk of skin cancer, suggesting that this treatment may be far safer than sunlight. Narrow-band UVB lamps are safer than natural sunlight because they do not emit ultraviolet A (UVA) light and because users can better control the range of UVB impact. Sunlight emits both UVA and UVB radiation; the UVA light is considered more dangerous and there is a great deal of research indicating that UVA is the main cause of skin cancer and skin aging. Narrow-band UVB treatments are considered one of the most efficacious and cost-effective therapies for moderate to severe psoriasis. This type of therapy is generally effective for 2/3 of psoriasis patients. [3,4]

It is important to point out that most of the tanning beds or sun beds found in salons or spas are fitted with UVA bulbs that emit only minimal UVB radiation. Unfortunately, these are widely used by those with psoriasis, but they are only minimally effective in treating it, while presenting the dangers of UVA exposure.

UVB-emitting lasers: A relatively new treatment for psoriasis is lasers that emit narrow-band UVB light. It can clear skin lesions faster than direct sunlight or UVB lamps. Approximately 70% of psoriasis patients who receive this treatment are almost completely free of lesions after 10 sessions. UVB lasers work by initiating the death of T-cells, rendering them unable to trigger the immune system to signal rapid cell proliferation, which is the cause of psoriasis. The most well-known laser for psoriasis is the 308-nanometer (nm) excimer laser. It emits a single wavelength, and, unlike the light from UVB lamps, the excimer laser light can be focused solely on psoriatic lesions, thus sparing the surrounding healthy skin from radiation. Because it can be precisely focused, the UVB light from the laser can be used at a strength six times that of the UVB lamp radiation. The result? Better clearance of psoriasis lesions with fewer treatments; typically 4–10 sessions for the UVB laser, compared with 25–30 sessions for UVB lamp treatments. [5]

Pulsed dye lasers: Pulsed dye lasers (PDL) have a successful treatment history for psoriasis, with 585nm being the most common wavelength used. The light emitted by these devices targets the blood vessels contributing to the formation of lesions. Extended clearance of lesions is a common outcome for many psoriasis patients undergoing PDL treatments, but not all lesions respond in the same way. For example, you may get great results on your arm or elbow, but see only minimal improvement in facial lesions. This inconsistency is attributed to differences in the underlying (dermal) pattern of blood flow that affects each lesion. In general, larger and redder lesions respond less favorably than lighter ones. Despite this news, the excimer laser is still the best choice for successful treatment of psoriasis lesions. [6]

Coal tar: Treating psoriasis with coal tar is a very old option that is not used as frequently as it once was. This topical medication is available both over-the-counter and by prescription; the determining factor being the potency and amount of coal tar the medication contains. Coal tar inhibits the substances in skin that trigger rapid cell proliferation, thus reducing the appearance and severity of psoriasis. [7] Coal tar can be combined with other psoriasis medications (like topical steroids) or with sunshine (UV light). However, coal tar can make the skin more sensitive to UV light, and extreme caution is advised when you combine coal tar use with UV therapy (or exposure to the sun) to avoid a severe burn or skin damage. Other negative aspects of using coal tar are the irritation, the smell, and its tendency to stain clothes.

Anthralin or dithranol: Similar to coal tar, anthralin (also called dithranol) is a topical, paste-like prescription medication that has been used to treat psoriasis for decades. It works best in cases of mild to moderate psoriasis. Although the specific activity of anthralin on skin is not completely understood, it appears to inhibit cell proliferation and can be very effective in treating psoriasis. It is often used in combination with other treatments. [8] Anthralin has few serious side effects, but can cause extreme irritation or burn the normal-appearing skin surrounding the psoriatic lesions. Similar to coal tar, anthralin stains on contact. There are a variety of regimens for its use, but the negative side effects limit its appeal.

Vitamin D analogues: Multiple studies have demonstrated impressive improvement in psoriatic lesions with topical application of calcipotriene (trade name Dovonex), a derivative of vitamin D3, when used alone or in combination with other therapies. Note: calcipotriene is not the same compound as the vitamin D found in commercial vitamin supplements or added to food products such as milk or cereal.

Calcipotriene not only inhibits cell proliferation and enhances cell differentiation in the skin of patients with psoriasis, but also appears to affect the substances in skin that generate the increased production of cells. In several well-designed, short-term studies in adults, the efficacy of calcipotriene ointment (50 micrograms, twice daily) was similar or superior to the efficacy of several other anti-psoriatic agents in adult patients with mild to moderate psoriasis. Calcipotriene generally was well tolerated in short- and long-term studies in adult patients, with the major side effect being irritation. Given calcipotriene’s compatibility with other psoriasis treatments, it is valuable as a first- or second-line therapy option for severe psoriasis. [9,10,11] Other forms of vitamin D3 creams include calcitriol and tacalitol.

Topical corticosteroids: Cortisone creams have been used for years as the first step in treating psoriasis and are available in a wide variety of textures (from ointments to gels) and concentrations. Cortisones reduce inflammation, itching, and, potentially, slow skin cell proliferation, and often are used in combination with other psoriasis treatments. [12] However, the more powerful the corticosteroid, the higher the risk of more severe side effects, which include burning, irritation, dryness, acne, thinning of the skin (with long-term use), dilated blood vessels, and loss of skin color. Less potent topical steroids are often used for mild to moderate psoriasis; the high-potency versions are reserved for more severe conditions.

An effective regimen of high-potency cortisones, such as halobetasol (Ultravate), is to use it daily until the psoriasis plaque flattens out, after which the medication is applied only on weekends. Another high-potency corticosteroid, mometasone (Elocon), is administered only once per day, and is as effective (or possibly more effective) as other corticosteroids while presenting a lower risk of severe side effects. These very potent drugs present a small risk of hormonal problems for a period of time after the drug has been withdrawn. The larger the area treated with corticosteroids, the higher the risk, especially if the area is covered by heavy material or is bandaged. Also, in most cases, resistance to these drugs eventually develops.

Topical retinoids: Prescription retinoids such as Tazorac (active ingredient tazarotene) have been shown to have a positive effect on plaque psoriasis, particularly in combination with other treatments. The manner in which retinoids work is similar to that of potent topical steroids, but with the advantage of a longer period of relief during treatment and no detrimental side effects or damage to skin.

Salicylic acid: Often called beta hydroxy acid (BHA), salicylic acid is sold over-the-counter in strengths of 1.8% to 3%; however, treatment for psoriasis often requires a strength of 6%, which is available only by prescription. Because BHA is an exfoliant, it can soften and help remove the scaly skin layers of psoriatic lesions.

Systemic Treatments

Researchers do not know with certainty exactly what causes psoriasis, but they agree that it’s an overactive immune system disorder. Systemic treatments work by targeting the immune system (often in an immuno-suppressant capacity). These treatments are prescription medications that usually are prescribed for people who have moderate to severe psoriasis. Some of the best-known systemic medications include:

  • Methotrexate: Methotrexate is an immune-modulating drug known for its ability to reduce the uncontrolled overproduction of cells. It works by binding to an enzyme involved in the rapid growth of cells, and slowing the overproduction of skin cells that leads to psoriasis. The most frequent adverse effects of methotrexate therapy are abnormal liver function test results, nausea, and gastric complaints. The most feared adverse effects are liver damage and the suppression of bone marrow activity. The liver problems associated with methotrexate are related to a high cumulative dose; therefore, alternating the types of therapy or using methotrexate only intermittently instead of continuously reduces that risk. Methotrexate is not recommended for women who are or plan to become pregnant.
  • Cyclosporin (trade name Neoral): A strong immuno-suppressant drug, cyclosporin acts by reducing inflammation in the skin and reducing cell proliferation by blocking the immune factors (T-cell lymphocytes) that are likely causing the problem. The FDA approved cyclosporin for psoriasis in 1997, with the proviso that it not be used for more than one year at a time. Studies have shown cyclosporin to be highly effective and well tolerated for the short-term treatment of severe psoriasis, including on the nails. However, this medication has serious side effects, including such temporary effects as headaches, gingivitis, joint pain, gout, body-hair growth, tremors, high blood pressure, kidney problems, and fatigue. The National Toxicology Program’s Eighth Report on Carcinogens warns that cyclosporin is "known to be a human carcinogen based on studies in humans." You and your doctor must weigh and carefully consider all of these factors before deciding on this course of treatment.
  • Acitretin (Soriatane) and isotretinoin (formerly known as Accutane and now prescribed as a generic) are oral retinoids. Acitretin is similar to isotretinoin, but acitretin is the only retinoid approved by the FDA for use in the treatment of psoriasis; isotretinoin is approved by the FDA for use in treating acne. How retinoids work in the treatment of psoriasis is not completely understood, although they are thought to block the overproduction of skin cells. Neither of these retinoids are to be used if a woman is pregnant because all systemic retinoids present a strong risk of causing birth defects.

Biologic Treatments

Biologics are a relatively new category of treatment for psoriasis. According to the National Psoriasis Foundation (NPF), biologics differ from systemics in that they target specific areas of the immune system instead of the entire immune system. Biologics largely work by blocking the action of T-cells or blocking specific proteins in the immune system. The following are among the more common biologics approved for use for psoriasis:

  • Etanercept (trade name Enbrel): The anti-tumor medication Etanercept appears to be a promising agent that can be used in combination therapy for the treatment of psoriasis. Six months of treatment (one or two injections per week) typically leads to significant improvement in psoriasis symptoms.
  • 5-fluorouracil (brand name Efudex): Chemotherapy agents such as 5-fluorouracil may be effective in the treatment of psoriasis affecting the nails. Psoriatic-affected nails are quite common for those with psoriasis—up to 50% of those with psoriasis also have it on their nails.
  • Infliximab (trade name Remicade): Used to treat Crohn’s disease and rheumatoid arthritis, Infliximab also is used to manage some forms of psoriasis, and often shows excellent results within 2 weeks. The most serious side effects are reactivation of tuberculosis in patients who have had this illness and the potential development of lymphomas. Although a clear causative factor has not been established (and there is the possibility that the lymphoma is the result of the inflammatory process that causes psoriasis), the theory is that immune-suppressive drugs such as Infliximab "provide a biologic basis for concern and justification for the initiation of additional epidemiological studies to formally evaluate this possible association." It is best to consult with your doctor about the potential risks of this drug before beginning treatment, based on your medical history.
  • Alefacept (trade name Amevive): This drug works by reducing the number of immune-activated T-cells in the skin, thus significantly reducing the major cause of psoriasis. It is administered by a physician via weekly injections for a period of 12 weeks. The treatments are suspended after 12 weeks to observe changes in the skin. If the results are positive (meaning symptoms regress), further treatment is not needed until the symptoms return. Remissions of up to seven months are not uncommon.
  • Adalimumab (trade name Humira): Initially approved to treat rheumatoid arthritis, adalimumab works by blocking TNF-alpha, a protein that prompts the body to create inflammation. Studies have shown that psoriasis patients have an excess production of TNF-alpha in their skin. [13]
  • Apremilast (trade name Otezla): One of the newest treatments approved for psoriasis, apremilast is an oral medication considered a “small-molecule” treatment, meaning it selectively targets molecules within immune cells, thus affecting the inflammation processes within the cell. [14]

Combination Therapy

PUVA: The most typical combination therapy for psoriasis is the prescription medication Psoralen with exposure to UVA light (PUVA). Psoralen, which can be taken orally as a pill or applied topically, makes the skin more sensitive to UVA light with a wavelength of 320–400 nanometers (nm). This combination suppresses the production of abnormal skin cells. PUVA can eliminate or dramatically reduce psoriatic lesions for the majority of people who use it, and there is evidence it can provide extended remissions. [15] The catch? Psoralen and UVA light are carcinogenic and phototoxic. Getting rid of psoriasis can mean a lot, but putting your skin at risk for premature aging and cancer may be trading one problem for another.

PUVA therapy brings with it an increased risk of a type of skin cancer known as squamous cell carcinoma, especially for those who have fair skin and have more than 200 treatments (not an unheard of number given that even with treatment, psoriasis is a chronic skin disorder). Despite large-scale international studies, evidence about whether or not PUVA therapy increases the risk of malignant melanoma (the most serious form of skin cancer) is inconclusive.

Given the risks, PUVA should be considered only for extreme or disabling psoriasis, and only after other treatments have failed. Although the risks to skin are considerable, it should be noted that compared to UVB phototherapy, PUVA treatments were shown (in a 100-person randomized study) to clear psoriasis symptoms in a greater number of patients and with fewer treatments (16 PUVA treatments versus 25 UVB treatments). In addition, six months after treatment, 35% of the PUVA-treated psoriasis patients were still in remission, compared with only 12% of the UVB-treated psoriasis patients.

All of the above treatments are often used in varying combinations for the best results. Frequently, several combination treatments are used in rotation to reduce the potentially harmful side effects of each. Determining if any of these treatments will work for you, alone or in combination, takes patience and a systematic, ongoing review and evaluation of the appearance of your skin and of your overall health. Successful treatment requires diligent adherence to the regimen and a realistic understanding of what you can and can’t expect. It also is important to be aware of the consequences and potential side effects of the varying treatment levels, which you should discuss with your physician.

For more information on the current status of available treatments, visit the National Psoriasis Foundation (NPF) website:

References Cited:

  1. Dawe R S, Ferguson J. History of psoriasis response to sunlight does not predict outcome of UVB phototherapy. Clin. Exp. Dermatol. 2004 Jul; 29(4): 413–414.
  2. Matsumura Y, Ananthaswamy H N. Toxic effects of ultraviolet radiation on the skin. Toxicol Appl Pharmacol. 2004 Mar 15; 195(3):298–308.
  3. National Psoriasis Foundation. Phototherapy. [Internet] [cited 2015 October] Available from:
  4. Tanghetti E, Gillis P. Photometric and clinical assessment of localized UVB phototherapy systems for the high-dosage treatment of stable plaque psoriasis. J Cosmet Laser Ther.2003; 5(2):101–106.
  5. Gerber W, Arheilger B, Ha T A, Hermann J, Ockenfels H M. Ultraviolet B 308-nm excimer laser treatment of psoriasis: a new phototherapeutic approach. Brit J Dermatol. 2003 Dec; 149(6): 1250–1258.
  6. Fernández-Guarino M, Jaén P. Laser in psoriasis. G Ital Dermatol Venereol. 2009 Oct; 144(5):573–81.
  7. Thami G, Sarkar R. Coal tar: past, present and future. Clin Exp Dermatol. 2002 Mar; 27(2):99–103.
  8. Ross J B, Guptill J. Treatment of psoriasis with the Ingram anthralin paste regimen. Can Med Assoc J. 1982 Mar 1; 126(5): 496.
  9. Trémezaygues L, Reichrath J. Vitamin D analogs in the treatment of psoriasis. Where are we standing and where will we be going? Dermatoendocrinol. 2011 Jul-Sep; 3(3): 180–186.
  10. Kim G. The Rationale Behind Topical Vitamin D Analogs in the Treatment of Psoriasis. Where Does Topical Calcitriol Fit In? J Clin Aesthet Dermatol. 2010 Aug; 3(8): 46–53.
  11. Soleymani T, Hung T, Soung J. The role of vitamin D in psoriasis: a review. Int J Dermatol. 2015; 54(4):383–92.
  12. Uva L, Miguel D, Pinheiro C, Antunes J, Cruz D, et al. Mechanisms of Action of Topical Corticosteroids in Psoriasis. Int J Endocrinol. 2012: 561018.
  13. National Psoriasis Foundation. Moderate to Severe Psoriasis and Psoriatic Arthritis: Biologic Drugs. [Internet] [cited 2015 October] Available from:
  14. National Psoriasis Foundation. New Oral Treatments. [Internet] [cited 2015 October] Available from:
  15. Situm M, Bulat V, Majcen K, Dzapo A, Jezovita J. Benefits of controlled ultraviolet radiation in the treatment of dermatological diseases. Coll Antropol. 2014 Dec; 38(4):1249–53.
plastic surgery

Cosmetic Surgery Facts

What you don’t know about plastic surgery (namely, the pros and cons and all your options) can hurt you—not just your appearance, but also your health and your pocketbook. To help you think about this, here’s an overview of what is available, along with what you need to know about the risks and benefits of different procedures.

In This Article:

Money not wisely spent can lead to expensive mistakes. Nowhere is this more true than with plastic and cosmetic surgery. We’ve often stated that just because a celebrity has a procedure done doesn’t mean you should jump in and do it, too. In fact, it’s almost a guilty pleasure to look at the before and after pictures of stars to see which ones have had cosmetic surgery that didn’t turn out so well. You know what we mean: Skin pulled too tight, overfilled with dermal injections and implants, or faces Botoxed to artificial-looking smoothness.

But when facial plastic surgery (such as face lifts, eye tucks, or forehead lifts) is done right and combined with cosmetic fillers and Botox, the results can be beautiful and look completely natural. In short, what you don’t know about plastic surgery can hurt your appearance and your budget.

Should You Have Plastic Surgery?

We are neither for nor against plastic surgery or cosmetic corrective procedures. What we are always for is knowing the facts—both the pros and the cons—rather than relying on the overhyped promises that some less-than-scrupulous cosmetic surgeons and dermatologists make. Information and realistic expectations are the only way to ensure you know what you are getting and what you’ll end up with.

Whether or not plastic surgery or cosmetic corrective procedures are right for you is a personal choice; each of us must make our own decision. You need to consider your expectations, the appearance-related issues you’re unhappy with, the alternatives, and your budget.

To help you make an informed decision about your options, we’ve prepared an overview of what is available, along with what you need to know about the risks and benefits of the different procedures. It all begins with finding the best doctor for the job—and then you and the doctor can discuss which procedure(s) are your best options!

How Do You Choose a Surgeon?

This may seem backward, but it’s often best to consult a plastic surgeon before you decide which procedures you want. You may not need a face lift or eye tuck when some type of laser or less invasive procedure can give you great results without surgery.

So, before you decide which procedure or procedures you want, the most important question is: Who should do your surgery? Given the growing number of doctors with cosmetic or plastic surgery practices, it is very difficult to know where to go, who to consult, and how to get started. And it certainly doesn’t help that there are so many doctors’ offices and facilities advertising their skills—via magazine, radio, and TV ads—and claiming that they’re the best!

Most people use one of four methods to select a cosmetic surgeon: (1) articles in fashion magazines, (2) finding out where celebrities went (everybody loves knowing where the “stars” are going for anything), (3) getting a referral from a friend or a friend of a friend, and, last but not least, (4) doing some research on the doctors who advertise their services.

These methods are not the worst plans of action, but they should be just the beginning of the process. You need to know more before you can make an informed final decision. Take the time to gather detailed information. Prepare a comprehensive list of questions on the following critical points:

  • Which procedures, both invasive and non-invasive, will meet your needs?
  • What are the pros and cons of each procedure (no procedure is 100% risk-free)?
  • Which doctors in your area are doing most of the procedures you’re interested in?
  • Are the doctors you’re considering using the latest devices, techniques, or tools, and, if so, are they using them because the tools really are superior or just because they’re new and exciting? The most recently developed method doesn’t necessarily mean it’s the best when it comes to surgery—you don’t want to be someone’s test case! That’s why, in most instances, you’re better off going with a more established procedure from a doctor who has had plenty of experience performing it.

Most important: Ask What can go Wrong!

Shockingly, many physicians downplay any risks. A quick review of several cosmetic surgery websites reveals a scarcity of information regarding what can go wrong during or after a procedure—yet each and every medical or cosmetic corrective procedure has risks.

It’s true that only a small percentage of negative outcomes result from such procedures, only about 0.5%—4% (depending on whose statistics you use and what the procedure is) of all patients have some sort of problem or don’t like the results. But, when you consider that almost 15 million procedures were performed in the United States in 2013, that means there were at least 600,000 patients with problems, and potentially many more.

We don’t want to scare you—we just want you to know the facts, because it’s unlikely that someone at a doctor’s office will tell you, and facts are the only way to make a wise decision. You are the one who must decide your risk tolerance for these kinds of elective procedures and surgeries.

Cosmetic Surgery or Plastic Surgery?

The terms “plastic surgery” and “cosmetic surgery” are often used interchangeably, but they are not the same thing. Cosmetic surgery is subset of plastic surgery. The difference between a cosmetic or plastic surgeon and a “board-certified” plastic surgeon matters a lot! Training and credentials in surgery are the issues. Although a doctor may offer cosmetic, plastic, or aesthetic surgery, he or she may not be board-certified to perform that type of surgery. The person could be a gynecologist, pediatrician, or dermatologist with no training in cosmetic surgery whatsoever. Scary, huh?

“Board-certified” means the doctor has gone through very specific and extensive training in a specialized field and has passed a difficult examination administered by a board of experts in that field.

A non–board-certified cosmetic or plastic surgeon may be self-taught and may lack formal training in that field. Board-certified plastic surgeons, on the other hand, as mentioned above, have specific training and have passed rigorous qualifying exams.

You may hear those who are certified as plastic surgeons say why would you go to anyone but a board-certified plastic surgeon? They’re right, why would you? “Would you want your cosmetic corrective surgery performed by someone who has never had any formal plastic surgery training?” And that’s the issue; cosmetic surgeons may not have the training which is why the certification is so important. We can’t stress that enough.

One clear distinction that sets board-certified plastic surgeons apart is that they have privileges to perform plastic surgery at an accredited hospital. Although most cosmetic surgery procedures are performed in a doctor’s office, you want to be assured that your surgeon has a level of skill that is accepted by an accredited hospital.

It is completely fair to ask any doctor you see for a cosmetic surgery consultation whether he or she is board-certified, and, if so, which hospitals he or she is affiliated with. But that’s not the end of it! With that information in hand, the onus is on you to check to be sure the hospital is accredited and that the doctor’s certification is current and recognized by the American Board of Plastic Surgery (ABPS). That’s the only board recognized by the American Board of Medical Specialties (ABMS) to certify physicians for the full range of plastic and reconstructive procedures. To verify a surgeon’s certification status, contact the American Board of Plastic Surgery (phone: 215-587-9322; website: or the American Board of Medical Specialties (phone: 866-275-2267; website:

Of course, there are great dermatologists and there are lousy board-certified plastic surgeons practicing plastic and cosmetic surgery. However, finding out first if that person is board-certified significantly reduces the odds of getting someone who is inexperienced. To be certified by the ABPS, a physician must have at least five to six years of approved surgical training, including a two- to three-year residency in plastic surgery. He or she must also have been in practice for at least two years and pass comprehensive written and oral exams dealing specifically with plastic surgery.

To obtain more information about physicians in your area who provide these kinds of services, visit the American Society for Dermatologic Surgery or call the American Society of Plastic Surgeons (phone: 888-475-2784).

What to Ask

After you’ve confirmed that the doctor is board-certified, you should continue to ask lots of questions, and listen carefully to the answers, until you feel comfortable and the answers make the most sense to you in light of your research.

Not all cosmetic surgeons will come up with the same game plan for you. Much like a chef has cooking methods they prefer, each surgeon has techniques he or she prefers, sometimes regardless of whether they represent the best or most current technology.

One of the most important questions you can ask a surgeon you interview is how often per month they perform the specific procedure or procedures you are considering. It is best (but not essential) to get a doctor who specializes in the procedure you want, as opposed to a doctor who performs many different procedures in an attempt to do it all.

Likewise, it is also imperative to ask how many surgeries the doctor performs per day. If the doctor schedules more than three procedures per day, it’s most likely that another doctor or a nurse will do the prep work and/or the finishing work. That may not mean poor results, but it does mean that there is the possibility the doctor will not always be the one who is doing the work. Make sure the doctor you are consulting will be the only person working on your face or body, and that he or she will never leave the operating room during your procedure.

It is also valid to ask if the doctor charges for redo’s and touch-ups. Although it’s obvious that plastic surgeons don’t want to admit it, it’s common for patients to make a return visit to fine-tune or to correct a mistake. You don’t want to be charged to have the doctor repair what you don’t like.

When to Do It

The options for changing your body or your face are almost limitless, and the results can be stunning. Traditional surgical procedures that cut off leathery, thick, lined, or sagging skin long abused by the sun can subtract years from a person’s appearance. Laser resurfacing can create baby-smooth skin and remove skin discolorations. Dermal fillers can plump up wrinkles and acne scarring, and undereye or underbrow bags can be de-puffed, making you look years younger.

In the past, most people waited until they were in their late 50s or 60s, and had noticeably aged skin, before they seriously considered cosmetic surgery. All that has changed with the advent of relatively noninvasive, low-cost procedures such as laser resurfacing, Botox, and dermal fillers, as well as new and more advanced surgical techniques that leave barely noticeable scars.

Obviously, having procedures performed at a younger age, before you “need it,” means having healthier-looking skin for years as opposed to an abrupt change when you finally decide you can’t take it anymore and seek a plastic surgeon. Besides, why wait until your skin is drooping and leathery before you do something about it? (In fact, you should be “doing something about it” in the way of a daily anti-aging skincare routine.)

If your friends and family say you don’t need surgery or a procedure, but there’s something about how you’re aging that really bothers you (and is beyond the reach of a great skincare routine), then it’s better to do something about it sooner rather than later. It’s your face and neck, your decision!

Women in their early 40s and 50s may want to undergo cosmetic surgery to deal with sagging corners of the mouth, slight pouching or sagging of the chin and jawline, and folds along the forehead. These irksome signs of middle age are easy to modify. Plus, having cosmetic surgery at this relatively young age slows the way the skin shows its age. Statistically, the most common age range for cosmetic surgery is 35–50, followed by the ages 19–34. People over age 65 account for the fewest cosmetic surgical procedures, so clearly, we’re not waiting too long!

Keep in mind that cosmetic/plastic surgery does not do it all as there are limitations as to what face lifts and eye tucks can achieve. For example, facial surgery cannot address crows feet, acne scaring, deep lines by the mouth, surfaced veins, skin discolorations, unwanted hair, and skin smoothness. A talented plastic surgeon will know how to combine surgery along with fillers, Botox, or lasers to achieve the results you want.

Does Starting Younger Help?

Some cosmetic surgeons suggest that laser resurfacing (such as Fraxel), Botox, and mini-tucks (doing a section of the face as opposed to an overall face-lift) performed when you are younger is the best way to delay the need for a full face-lift or eye tuck until you’re much farther along the road.

Having minor procedures performed as signs of aging crop up means there’s less trauma, better healing, and, because younger people generally have more elasticity and fat in their skin, the results last longer. Whether or not less invasive procedures or minor procedures decrease the need for eventual major surgery is not yet known, but there is something to be said for having the face you want now as opposed to later.

Still, we’re skeptical of the risk of having too many surgeries over the years. Aging doesn’t stop just because you’ve undergone some procedures, and if you have too many procedures it can make things look a bit unnatural and/or over-pulled. However, carefully performed non-surgical procedures can go a long way toward helping you look better and smoother even as the years march on.

It’s Up to You!

We are in a new era where cosmetic surgery is widely available. Some people are pleased to know their face doesn’t have to reflect their real age, and that they have a choice about what to do about it. As long as the results are impressive (and they often are), most people will want to maintain their youthful appearance via procedures that are relatively low risk and relatively permanent.

Wondering about that word “relatively” above?  We used it because cosmetic surgery has duration limitations; that is, having a procedure will not keep your skin age-free forever. That’s neither bad nor good, but some of these processes are legitimate options for creating the look you want. Plus, it beats wasting money on creams and lotions that might do nothing for the wrinkles or sagging or pouching that bother you the most.

body care

Dry Hands: Causes and Treatments

Struggling with dry hands can be painful. Even if you are diligent about keeping them protected when doing housework or gardening, and unfailingly apply moisturizer whenever the opportunity arises, you can still suffer from bone-dry, cracked, parched hands. Learn what you can do to get (and keep) super-smooth hands.

In This Article:

Struggling with dry hands can be painful. Even if you are diligent about keeping them protected when doing housework or gardening, and unfailingly apply moisturizer whenever the opportunity arises, you can still suffer from cracked, parched hands.But there are solutions within reach! Here are fixes that will work for even the most bone-dry hands.

Protect Your Hands Whenever You Can

It is of vital importance to protect your hands from dish detergent, laundry detergent, excessive washing, and irritating ingredients, and also when doing potentially irritating manual activities such as yard work or sports. Wearing gloves to prevent contact with these types of products and ingredients is of the utmost importance. However, a significant number of women may find they are allergic to latex gloves. About 10% of the population have negative reactions, ranging from mild to severe, if they come in contact with latex. If this turns out to be a problem, ask your physician or pharmacist where you can find nonlatex gloves.

Whenever You Think of It, Moisturize!

The faster you get an emollient moisturizer on your hands after washing, and the longer you can keep it on, the better. (Note: Any good, emollient moisturizer will work—it does not have to be labeled “hand cream” to be used on the hands.) It helps to keep small tubes or bottles of moisturizer all over the house, including near the kitchen sink, in the bathroom, at the bedside, and in the garage. Keep more in your car, purse, briefcase, and desk drawer.

That way it is never out of reach for a quick application. The best moisturizers for daytime are moisturizing sunscreens whose active ingredient is avobenzone, titanium dioxide, or zinc oxide. As an added benefit, titanium dioxide and zinc oxide provide an occlusive barrier that can act as a protective layer to retain moisture in the skin while keeping the sun’s rays off the skin. (Bear in mind that brown “sun spots” on the back of hands and arms are a direct result of relentless, daily, unprotected sun exposure.)

Over-the-Counter Options for Dry Hands

Paula’s Choice Lip and Body Treatment Balm and Aquaphor by Eucerin, to name a few are bothexcellent moisturizers to use at night. The best approach is to apply moisturizer every chance you get. It is also incredibly helpful to purchase an over-the-counter cortisone cream such as Lanacort or Cortaid to help treat cracks and fissures that may occur, but cortisone creams should only be used intermittently, not on a regular basis (and it would be applied before your hand cream).

Severely dry hands can also benefit from overnight treatment with moisture-infused gloves. These unique gloves are lined with a synthetic material that slowly releases moisturizing ingredients as they are worn. Several companies offer this type of product; a quick online search will show you the options!

Cuticles Need Love, Too

If your cuticles are also dry and/or cracked, make sure to moisturize them often with a balm or oil-rich product. Those that come with a brush-on applicator so you can easily coat the cuticle and nail are brilliant, not to mention convenient and portable! Keeping cuticles in top shape will automatically make your nails look better and should help them grow better, too!