How to Safely Remove Psoriasis Scales

Removing psoriasis scales can have benefits, but don’t pick or peel them, which can trigger flares. There are several safe and effective ways to free your skin of flakes.

When you have psoriasis, your immune cells become overactive, producing skin cells at a rapid rate. This creates scales, the gray or silvery flakes of dead skin that collect on the surface of the inflamed plaques that characterize plaque psoriasis.

These scales can be itchy, uncomfortable, and embarrassing — so much so you may be tempted to pick, peel, or scrape them off.

There are potential benefits and risks of removing scales. Before you try to remove them yourself, talk to your doctor to find out the best way to manage your psoriasis scales.

The only way to safely keep scales from forming in the first place is to follow a treatment plan that addresses the inflammation at the core of psoriasis plaques. Scales do naturally exfoliate (shed), but it can take a while. There are a few things you can do to help things along — and a number of potential advantages to doing that, according to Steven Daveluy, MD, associate professor and program director at the Wayne State University Department of Dermatology in Detroit.

Your medication will sink in better. If you use a topical treatment such as a prescription-strength steroid, a thick layer of scales can block the medication from being absorbed fully. Removing scales allows topical psoriasis medications to reach their target more easily.

You may be less self-conscious. Removing visible scales can help relieve self-consciousness and reduce social anxiety — both typical of people with psoriasis. A review of research found shame and fear of being viewed as unclean or contagious were among the top six quality-of-life issues many people with psoriasis deal with.

This may be especially true of scalp psoriasis, which can shower shoulders with white flakes that are easily mistaken for dandruff.

Your body will feel better. Psoriasis scales can be itchy and painful. A buildup of scales around joints can make it hard to move freely. Removing scales can help ease discomfort and improve range of motion.

You may have fewer flares. Thick, unmanaged scales are more likely to crack, tear, or rip away before they’re ready to flake off naturally, injuring skin and possibly triggering a psoriasis flare. Keeping layers of scales thin and flexible helps prevent unnecessary trauma to your skin.

While there are some good reasons to remove scales, it’s important to do so safely and hygienically. Picking at them with your fingernails risks damaging the skin they’re attached to. This “can trigger flares of more patches of psoriasis, a reaction known as the Koebner phenomenon,” says Dr. Daveluy.

Note too that although forcefully removing scales usually only results in minor bleeding and discomfort, it can lead to an infection.

If you accidentally dislodge scales and expose the skin underneath, Daveluy says to go ahead and apply your prescription topical medication as usual.

If you’re prone to mindlessly picking at scales, Daveluy recommends covering problem areas with clothing (long sleeves, long pants) or even an Ace bandage.

If you’re looking to get rid of patches of thick scales or to at least minimize their appearance, the key is to be gentle and work slowly. You want to target only the topmost layer of scales — not those still attached to the plaques beneath them. The safest way to do this is to dissolve — rather than pick or tear — them off, using a product formulated for that purpose.

Exfoliating Acids

These include salicylic acid, glycolic acid, lactic acid, and urea, each of which can help to gently remove scales without traumatizing skin, research shows. For example, one study found that application of a gel containing salicylic acid and turmeric followed by shea butter and a salicylic acid exfoliating moisturizer daily for 12 weeks significantly reduced scales without serious side effects.

Exfoliating acids come in creams, ointments, and gels. Besides minimizing scales, they can serve as a “primer” for topical prescription treatments so skin can absorb them easily.

Bath Soaks

Submerging skin in a warm (not hot) tub can soften and loosen scales. Adding Dead Sea or Epsom salts to the water can make soaking even more effective by helping to exfoliate dry, dead skin, notes the National Psoriasis Foundation (NPF).

(Steer clear of heavily scented bath products, as they can irritate skin.)

Limit tub time to 15 minutes and, when you get out, gently wipe away loose scales with a damp washcloth. Don’t try to rub or pry off scales that aren’t ready to come off, as this can cause pinpoint bleeding and trigger flares. With a towel, soak up excess water still on your skin, but leave it slightly damp, then slather on a thick cream or ointment to seal in moisture.

Moisturizing Creams and Oils

Both water and oil can make scales more transparent and less noticeable, says Daveluy, so when the goal is to simply minimize scales, he recommends applying a moisturizer, petroleum jelly, or coconut or sunflower seed oil to them. Be aware these oils can make it easier for UV rays to penetrate skin, so use caution if you’re going out in the sun.

Coal Tar

Doctors have recommended coal tar for psoriasis for more than 100 years, according to the American Academy of Dermatology.

It comes in shampoos, creams, lotions, and gels.

Besides reducing scaling, coal tar has anti-inflammatory properties. It can be highly effective but does have potential drawbacks, including an unpleasant odor and staining of clothing and bedding.

Keratolytic Shampoos

Around half of people with psoriasis have it on their scalp, according to the NPF.

If you’re among them, a keratolytic shampoo — one containing salicylic acid, lactic acid, or urea — can be an effective way to wash those scales right out of your hair. One study shows that a keratolytic and hydrating shampoo containing 2 percent salicylic acid, 5 percent urea, and 1 percent glycerin, when used daily for two weeks and then three times per week for another two weeks, significantly improved signs and symptoms of mild-to-moderate scalp psoriasis, and was well-tolerated by those who used it.

After shampooing, gently brushing or combing should remove loosened scales, but don’t scrape your scalp or try to force scales to come away before they’re ready.

For these shampoos to work most effectively, however, they need to be used frequently. For Black Americans with scalp psoriasis, especially women, this can be problematic, as their hair dries out quickly if washed too often. For them, Daveluy recommends applying a moisturizing cream to the scalp and avoiding tight braids, heat styling, combs, or chemicals that can traumatize the scalp.

While there’s no way to prevent psoriasis entirely (though your psoriasis can go into remission), you can manage the condition and avoid triggers that can lead to flares.

Follow your treatment plan to keep your psoriasis under control.
Manage stress, which can trigger flares.
Make certain dietary changes to reduce inflammation.
Wear loose, breathable clothing, laundered with gentle, fragrance-free detergent, to stay comfortable and minimize skin irritation.

Psoriasis scales can be itchy and irritating, but removing them should be done with care to prevent skin damage and flare-ups.
You can gently reduce these scales with safe methods like moisturizing creams or warm baths with Epsom salts.
Don’t pick at psoriasis scales. Instead, use dermatologist-recommended treatments to manage your psoriasis effectively without risking skin irritation.

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Exfoliating Acids

Bath Soaks

Moisturizing Creams and Oils

Coal Tar

Keratolytic Shampoos