Psoriasis and Skin Barrier Dysfunction: The Role of Gentle Cleansers and Moisturizers in Treating Psoriasis
August 2023 | Volume 22 | Issue 8 | 773 | Copyright © August 2023
Published online July 31, 2023
Leon Kircik MD FAADa, Andrew F. Alexis MD MPH FAADb, Anneke Andriessen PhDc, Collin Blattner MD FAADd, Brad P. Glick MD DO MPH FAADe, Charles W. Lynde MD FRCPCf, Linda Stein Gold MD FAADg
aIcahn School of Medicine, Mount Sinai, New York, NY, Dermatology, Indiana University Medical Center, Indianapolis, IN, Physicians Skin Care, PLLC, Louisville, KY, DermResearch, PLLC, Louisville, KY
bWeill Cornell Medical College, New York, NY
cRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
dDepartment of Dermatology, Clear Choice Dermatology LLC & Great Skin Medical Consulting LLC, Portland, OR
eAAD Board of Directors, Dermatology Residency Program Director Larkin Palm Springs Hospital PI, GSI Clinical Research, ASDS Advocacy Ambassador, Miami, FL
fDepartment of Medicine University of Toronto, Toronto, ON, Canada; Lynderm Research, Markham, ON, Canada gClinical Research, Department of Dermatology, Henry Ford Health, Detroit, MI
Abstract
Background: Psoriasis is a chronic immune-mediated dermatologic disorder with multisystemic comorbidities, which is effectively treated with a range of prescription therapies. Studies have reported epidermal barrier abnormalities in the lesional skin of psoriasis patients; however, there is currently insufficient information about skin barrier function in psoriasis patients. This review discusses the potential role of gentle cleansers and moisturizers in the management of psoriasis and in promoting a healthy skin barrier. Methods: A literature review was followed by the authors' discussions and agreement on 5 statements to provide expert guidance for gentle cleansers and moisturizer use in psoriasis patients.
Results: In a workshop, the authors provided feedback on 15 draft statements created prior to the meeting, and agreed upon 5 statements. The authors agreed that guidelines rarely mention skincare for psoriasis patients, demonstrating a potential knowledge gap. Skincare may play a role in managing psoriasis as an adjuvant treatment of acute psoriasis and for maintenance treatment of healing skin during asymptomatic periods. Studies of patients with psoriasis applying topical moisturizers (such as those containing salicylic acid or ceramides) showed softened plaques, enhancing the absorption of topical treatments such as corticosteroids. Studies applying ceramide-containing skincare showed an overall improvement in the appearance of the skin and provided relief for psoriasis.
Conclusion: The authors agreed that skincare and barrier restoration in treating psoriasis is a relatively new concept for most dermatologists. There is a need to develop a more robust body of evidence on skincare for psoriasis to influence clinical practice in a meaningful way.
Kircik L, Alexis AF, Andriessen A, et al. Psoriasis and skin barrier dysfunction: the role of gentle cleansers and moisturizers in treating psoriasis. J Drugs Dermatol. 2023;22(8):773-778. doi:10.36849/JDD.7411
INTRODUCTION
Psoriasis is a chronic, immune-mediated, multisystemic skin disease with an estimated prevalence rate of over 2% of the United States population.1 Adults are more frequently affected by psoriasis than children, and generally, there are 2 peaks of onset, the first at 16 to 22 years and the second at 50 to 60 years.2,3 About 70% to 80% of psoriasis patients suffer from a mild-to-moderate disease that can be successfully controlled with topical treatments.4 Moderate-to-severe cases are usually treated with ultraviolet (UV), oral, or biological therapies.4 Concomitant topical treatments and skincare can support the efficacy of systemic treatments.5
Psoriasis significantly negatively impacts a patient’s health-related quality of life (HRQoL).6,7 Psoriasis patients often experience difficulties with body image, self-esteem, and feelings of stigma, shame, and embarrassment regarding their appearance.6,7 Patients have reported the perception of being evaluated by others based on their skin condition.6,7 Psoriasis causes a more significant reduction in quality of life (QoL) than tumors or coronary heart disease.6,7 The median disease duration is about 50 years, especially when the onset is at a young age. Patients with psoriasis have significantly fewer employment opportunities.7 Effective short- and long-term management of psoriasis is crucial to ensure sufficient control
