Psoriasis is an autoimmune condition that causes the life cycle of skin cells to accelerate, resulting in a rapid buildup of cells on the skin’s surface. This accelerated turnover creates the characteristic thick, silvery, or grayish-brown patches known as scales that adhere tightly to the skin. While these scales can be uncomfortable and impede the absorption of topical treatments, removing them incorrectly can irritate the skin and worsen the underlying condition.
Preparing the Skin for Scale Removal
The initial step in scale removal involves softening the thick plaques to prevent skin trauma during the process. Warm water soaks are effective for this purpose, as the water hydrates the scales, making them pliable and easier to lift. Soaking in a bathtub for about 15 minutes is recommended, and adding ingredients like Epsom salt or Dead Sea salts may enhance the soothing effects.
Immediately after soaking, apply a heavy emollient to trap the moisture absorbed by the skin. Thick ointments, such as petroleum jelly or creams based on mineral oil, are effective at creating a barrier that seals in hydration. This practice is essential because dry scales are difficult and painful to remove, while hydrated plaques are more cooperative. To maximize penetration, the treated area can be covered with a wet wrap or plastic film, a process known as occlusion.
Using Keratolytic Agents to Loosen Scales
Keratolytic agents loosen scales by dissolving the bonds that hold them together, preparing them for gentle removal. Applying these agents after the skin has been softened allows for improved penetration and efficacy. The use of these compounds helps topical medications reach the active layers of the skin where they can address underlying inflammation.
Salicylic Acid
Salicylic acid is a common keratolytic agent that works by breaking down the bonds between dead skin cells, promoting shedding. Products containing salicylic acid, typically 0.5% to 10%, are available in creams, ointments, and medicated shampoos. Using high concentrations over large areas carries a risk of salicylate toxicity, so usage must be monitored and limited.
Urea
Urea functions as both a moisturizer and a keratolytic depending on its concentration. At higher concentrations (20% to 40%), urea actively softens thickened scales by disrupting hydrogen bonds within the keratin structure. Lower concentrations (2% to 10%) primarily draw and hold water in the skin, keeping the treated area supple and reducing dryness.
Coal Tar
Coal tar is utilized for its mild keratolytic properties and its action in slowing down the rapid growth of skin cells. While effective for treating scale, it is often associated with a distinct odor and has the potential to stain clothing or light-colored hair. These keratolytic compounds must be used precisely as directed, especially since some combinations, like salicylic acid and Vitamin D analogs, can inactivate each other.
Gentle Physical Removal and Safety Warnings
Once the scales have been thoroughly softened and treated with keratolytic agents, they should be ready for gentle physical removal. The safest method involves using a soft washcloth or a damp sponge to gently wipe away the loosened scales from the skin’s surface. The goal is to allow the scales to lift easily without resistance.
It is important to avoid aggressive scrubbing, scraping, or picking at the plaques. Forcing scales off before they are fully loosened can injure the skin underneath, potentially leading to pinpoint bleeding. This physical trauma can trigger a phenomenon known as the Koebner phenomenon, where new psoriasis lesions form on previously unaffected skin at the site of the injury.
If the skin becomes irritated, painful, or begins to bleed during the removal process, the procedure must be stopped immediately. Recognizing these signs is important, as any injury to the skin can cause the condition to worsen or spread. Avoiding trauma, such as cuts, scrapes, or aggressive rubbing, is a central component of managing psoriasis and preventing new flares.
Long-Term Strategies to Prevent Scale Buildup
While the removal techniques address existing plaques, long-term management focuses on controlling the underlying condition to minimize future scale formation. Daily, consistent moisturizing is a fundamental strategy for maintaining skin barrier function and preventing the dryness that exacerbates scaling. Thick, oily ointments are better at retaining moisture and should be applied even when the skin appears clear.
The use of prescription topical medications is necessary to address the root cause of the rapid cell turnover. These treatments, which may include topical steroids or Vitamin D analogs, are formulated to slow the excessive skin cell growth. Following a prescribed treatment plan is the only way to achieve sustained control over the condition and reduce the frequency of scale buildup.
Environmental factors also play a role in scale prevention, requiring attention to the surrounding atmosphere. Using a humidifier, especially during cold or dry weather, helps to keep the air moist, preventing the skin from drying out and triggering flares. Avoiding known triggers like excessive stress and protecting the skin from injury are preventive measures that support overall skin health.