Psoriasis (Part 2)
By Terry Everitt
The therapist may well be the first person a client will turn too for advice - particularly if you have an established relationship with the client.
Not only will the physical manifestations worry the client, so will emotional concerns, which you may have to deal with. Referral to a Dermatologist for treatment is the first step, although there is much that you can do.
Not only in some of the treatments you can provide, yet also the emotional support that you can give, as mentioned below.
Psoriasis patients would agree that there is nothing easy about taking care of their skin. The challenges include preventing dryness that can lead to painful cracking, reducing the persistent build-up of scales, and finding relief from the nagging itch. Good skin care can also maximise the effects of medical therapy.
This gives a very good insight as to what is required both from the skin care professional and the client as home care. Believe me, they are going to ask how to keep their skin looking good - it better be you who tells them, rather than the person at the supermarket or department store.
Depends on what products you have available, will determine how best you can help provide relief and even help keep the condition in remission. Basically you need to carefully exfoliate without damage and heavily moisturise with lots of sunscreen. Simply really!!
Would suggest an oil-based cleanser with gentle movement over the affected areas. Do not worry - it is not contagious. Note that the areas will be more sensitive than surrounding areas.
Warm, not hot water and gently pat, not rub dry.
Remove as much of the scaling as possible with out getting to the germinitivum or basal layer of the epidermis. Although you may think getting this deep this would be a good thing to do, it is not. The likely hood of extra trauma here would in fact contribute to an increase in cell production.
Personally would go with chemical exfoliation rather than manual as there is less friction concerned with this type of exfoliation. AHA, BHA or mixed matters not. What is important is that you know what you are doing with it.
Jessner is great for this, except do not expect to see "frosting" two - three layers only until you know how the client is reacting to it. Remember the total application amount if applying on body areas, as it is toxic in large amounts. (It is also true of Salicylic acid).
Could use a mud-based exfoliant and occlude the application with a warm towel, then cling wrap or such.
The various spa water treatments are great, although extra careful in the cleaning afterwards - may need to shovel the dead skin out.
Water vapour is great so use the steamer, although would keep it a little further away from the skin than usual.
Any of the wet wraps would be of help. Would be causing an occlusion where ever possible in the treatment.
Occlusion works best on stubborn lesions that are not widespread, in places like the hands, feet, elbows, knees and scalp.
The more advance techniques such as flash dose, rotation and alternation treatments I will not cover here.
Pressure point massage or manual lymphatic drainage. Lighter effluage movements are OK - don't bother with the friction or such.
Electrical machinery not contraindicated here. Remember that the lesions are dry, therefore conductivity will be reduced.
Use toner between treatment steps to keep the skin damp - do not let it dry.
Oil based moisturiser is best for this client - actually may need a heavier cream for the psoriasis lesions and a lighter one for the rest of the skin if you think this appropriate.
Essential Fatty Acids (EFA) are important to maintain in the skin. The use of Linoleic and Linolenic acids are of great use with this skin - Evening Primrose oil or lecthicin are high in these (better known perhaps as Omega 6 and Omega 3 oils).
Would suggest at least a SPF30, broad-spectrum (or total block)- no less for this type of client.
Essential oils that can be used:
Sedative - Ylang ylang, valerian, sandalwood, Melissa, Clary-sage
Inflammation - Yarrow, Tea tree, Chamomile, lavender, patchouli
Dry skin - Geranium, hyssop, neroli, rose, patchouli, bois de Rose, benzoin
Feel good (anti depression) -Bergamot, Bois de rose, jasmine, ylang ylang, frankincense
As mentioned, the client will present with emotional concerns along with the scaly skin.
People who have psoriasis tend to describe a number of common feelings and experiences, including:
Poor self-esteem and self-confidence
Increased social isolation
A tendency to minimise the emotional difficulties posed by the illness
Criticising oneself for an inability to control the illness
Feeling "defective" or less than whole
Psoriasis can have profound effects in both the social and professional arenas. It can make dating or starting relationships awkward or difficult and some people with psoriasis avoid social settings altogether.
Those with more severe psoriasis may find it difficult to work, or may feel acutely self-conscious in public situations. Psoriasis also can be notoriously unpredictable. Plaques may worsen seemingly without reason, even with treatment, just as they may improve without explanation. At times, the sufferer may feel as if they are on an emotional roller coaster over which they have little control. This can be demoralising, potentially leading to anxiety and depression.
Moving Toward Self-Acceptance
People often blame themselves when they experience unfortunate situations over which they have little or no control. Ultimately, the result of this process is a kind of self-criticism. To counter this tendency, it is important to remember that psoriasis is not the person's fault. They did not cause it.
Over time, people with chronic illnesses come to experience their illness differently than they did when first diagnosed. They may be likely to go through various stages in coming to terms with psoriasis, such as:
Denial. This is the tendency to believe that psoriasis simply is not affecting them.
Anger. When the denial breaks down, anger enters, as do questions of "why me?"
Bargaining. They may find themself thinking, "If I can have good clearing for just a few more months, I I would be so thankful."
Acceptance. At this stage, they will feel more at peace with psoriasis and the limitations it imposes.
What helps people cope with psoriasis? In one study, patients experienced less depression and anxiety - and better physical health - if they did the following:
Sought social support
Openly expressed their feelings and emotions about their illness
Understood that the disease was not curable
Sought more distractions/activities
Connecting with other psoriasis patients - through an online buddy program or bulletin board, or a local support group - provides validation and relief to many. It can be a powerful experience to see that your feelings and fears are common to the psoriasis illness experience.
Home Care Instructions
Short, lukewarm showers are better for your skin than longer, hot ones. Perfumes and astringents can be irritating to sensitive skin, so use a mild, fragrance-free cleanser to wash.
The more you can remove the dry, top layer of scale, the better topical and light therapies will be able to penetrate the underlying plaque. Be careful to remove only the top layers - not all the scaly skin. This could make the condition even worse than it is.
Use the exfoliants as described and recommended by your skin care professional. Do not overdo it - More is not better in this case.
Salicylic Acid if used should not be applied to more than 20% of the body surface. The body can absorb the acid leading to toxicity if too much is used at the same time.
There are good reasons to keep moisture in the skin. It maintains a healthy skin barrier, while softening scale and reducing the possibility of painful cracking due to dry skin. It also leaves the top layer of skin more permeable to many medications.
(In case you are wondering) There are two types of moisturisers: Occlusive agents, such as petrolatum, mineral oil and cocoa butter, coat the skin, slowing moisture loss. Humectant agents, which may include glycerin, urea, gelatine and such, draw water from the lower levels of skin, up to the surface. The best moisturisers contain both occlusive and humectant agents.
For psoriasis, a heavier, 'greasier' moisturiser is best. Apply to a damp skin - pat, don't rub with the towel.
Skin is usually itchy because it is dry. The best remedy is to apply a moisturiser often, especially immediately after a bath or shower. If you have the urge to scratch, try not to. You may irritate the psoriasis, or break the skin, which could lead to infection. Try applying a cold, wet towel to the spot. If the itching persists, or keeps you awake at night, ask your doctor for advice.
Many patients also find relief by soaking in a warm colloidal oatmeal bath or use some of the essential oil blend in the bath for relief.
Do not forget the sunscreen. Many treatments can leave your skin extra-sensitive to the sun and at risk for burning. For example, if you are using topical or systemic retinoids, I recommend that you wear at least SPF 15 or higher sunscreen when you go outdoors. If you are undergoing light therapies, particularly PUVA, protect your face or other body parts that are free from psoriasis and be careful about getting sun exposure after the treatment.
Terry Everitt is one of Australias leading educators in the Aesthetics and professional skin care industry who holds a B.A Ed. and a Dip. Training & Assessment and is a CIDESCO Diplomate. He is also a Nationally Certified Medical Aesthetic Specialist (USA), and Nationally Certified Aesthetician (USA), Clinical Aesthetician.
Terry has many years of experience as a international educator, and is the Director of Aesthetic Educators, an independent training and curriculum development organisation.
Terry is a former CIDESCO examiner and also represents the APAA on the board of the NSW Retail, Wholesale and Associated Services Industry Training Council Ltd.