Optimize Your Skin Care Routine Before Bed
Itching and pain are common reasons people with psoriasis struggle to sleep. That’s why dermatologists focus first on treating its root cause: your psoriasis. When it comes to nighttime psoriasis management, the goal is simple: Calm irritation and lock in moisture so you can rest more comfortably.
Adjust Your Treatment Plan
If plaques or rashes are keeping you awake, it may be time to review your medications. Your doctor may adjust your medications or introduce a new one, whether they’re topical creams, medicines taken by mouth, or biologics, says Chris Adigun, MD, a board-certified dermatologist in private practice in Chapel Hill, North Carolina. “As a dermatologist, I’m going to focus on the skin disease component of your care first. The best thing I can do in my role is optimize disease control,” she says.
When psoriasis is under control, it should affect 1 percent or less of your skin, says Steven Daveluy, MD, a professor and director of Wayne State University School of Medicine’s dermatology residency program in Detroit. He specializes in treating patients with skin diseases such as psoriasis and eczema. “We have such great options for psoriasis, that everyone’s skin should be clear or almost clear. The right treatment plan can significantly reduce nighttime itch and help you sleep better,” Dr. Daveluy says.
Take a Warm Bath or Shower Before Bed
A warm — never hot — shower or bath can help loosen and remove scales, which may otherwise make itchiness worse. This can be especially helpful if you have visible plaques or buildup on your skin, says Lawrence Green, MD, a clinical professor of dermatology at George Washington University School of Medicine in Washington, D.C.
Moisturize Immediately After Bathing
Timing matters, and you should apply moisturizer right after bathing, says Dr. Green. He recommends using thick, heavy creams or ointments — think jar-based products rather than pump lotions — to help seal in moisture and reduce itching overnight.
Petroleum-based moisturizers, like Vaseline, tend to work best for psoriasis, particularly on stubborn or itchy areas. “These heavier-cream moisturizers help prevent the scales from building up because that, again, can be causing a lot of itch,” he says.
Some people do well with using salicylic acid, lactic acid, or urea creams or lotions to help soften thick scales, says Mary Wu Chang, MD, an associate professor of dermatology and pediatrics at the University of Connecticut.
Look for “sensitive-skin,” or “fragrance-free” labeling, since these products have the least risk of irritation, too, Daveluy says.
Use Topicals That Target Itch Relief
Using prescription topical treatments, including topical steroids, should also help to soothe your psoriasis itch, Daveluy says. But for lingering itch, use of some over-the-counter anti-itch products may offer short-term relief, like pramoxine and menthol, he says.
Take an Oral Antihistamine or Sleep Aid if Needed
Antihistamines don’t treat psoriasis-related itch, because this itch isn’t driven by histamine, a chemical your immune system releases. But taking antihistamines can help some people fall asleep. Look for over-the-counter sedating antihistamines or natural sleep aids like melatonin, Dr. Chang says. “This would be more of an add-on medication to use from time to time, rather than a cure for problematic sleep from psoriasis,” she says.
Dr. Adigun says you can take an antihistamine for just a few nights as you bridge the gap with your new treatment plan, which could take up to two weeks.
Keep Fingernails Trimmed
As an extra layer of protection, wear cotton gloves if you find you’re scratching yourself at night, Daveluy says. “[Gloves] can also help keep creams or ointments on the hands, if you have psoriasis there,” he says.
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