The term ‘exfoliate’ means “to throw off scales or flakes; peel off in thin fragments.” For anyone who battles psoriasis, this definition likely triggers an unpleasant visual of the thin, silvery scales that can appear anywhere on the body but are most noticeable to the outside world when they appear on the hands, elbows, knees and face.
Psoriasis is “… a chronic, autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells.” It affects approximately 7.5 million people in the U.S. Of those affected, 80% will present with the most common and uncomplicated form known as plaque psoriasis, however; psoriasis should always be diagnosed and evaluated by a physician or other qualified medical professional before any treatment is considered or begun.[Read More: A Look at What Psoriasis Is and How to Treat It]
Common Treatments for Psoriasis
People who experience plaque psoriasis are familiar with the host of medical solutions available, including coal tar applications, steroid creams and UV light therapy. Systemic treatments have generally been reserved for anyone whose condition rises to a more medically complex level, and does not respond to the traditional topical therapies. For the rest of us, the emergence of hydroxy acids in over-the-counter cosmetics is a multiple blessing, and makes for a merrier holiday stocking stuffer! (Let’s see,…coal tar treatment vs. luxurious body cream? No contest!)
And while some physicians recommend alpha hydroxy acids, it’s not necessarily as common as some of the aforementioned treatments.
Alpha Hydroxy Acids: How They Work
Hydroxy acids are available in several forms, including alpha-hydroxy acids, beta-hydroxy acids, polyhydroxy acids, and bionic acids (Green, Yu and Scott, 2009). The most recognized today are the alpha- and beta- hydroxy acids. While both perform by exfoliating the top layers of the skin, they work in slightly different ways. Alpha-hydroxy acids (AHA’s) are water-soluble, while beta-hydroxy acids are soluble (this means that they dissolve) in oil. If you use a face cream that lists salicylic acid as an ingredient, you are applying a beta-hydroxy acid to your skin (Bissett, 2009).[Read More: Spotlight On: Alpha Hydroxy Acids]
While it may seem that skin care beyond simple emollient moisturizing is a modern phenomenon, salicylic acid has been in use as a keratolytic agent (kerato- refers to the protein matrix in skin; -lytic refers to the action of lysing, or breaking down) since the early part of the last century (Fluhr, Cavallotti, and Berardesca, 2008) and is considered a viable OTC option for treating psoriasis. By comparison, alpha-hydroxy acids emerged as everyday products within the last 30 years and revolutionized the way that women (and men) think about anti-aging and skin care.
Dermatologists often use AHA’s in higher concentrations as a “chemical peel” to address skin problems that include fine lines, wrinkles and sun-damaged skin (Liu, Lin, Feng and Chen, 2012). In cosmetic applications, alpha-hydroxy acids have become a staple, and the success of the earliest AHA’s have led to an explosion of similar products in the market.
Using Alpha Hydroxy Acids to Treat Psoriasis
In common plaque psoriasis, the overgrowth of skin cells that collect at elbows, knees, hands, scalp, face and other areas can cause embarrassment and in some cases can be painful as clothing catches and pulls on the dry skin patches.
During a particularly hard-to-manage outbreak in my late 20’s, I was desperate to avoid the greasy and expensive steroid cream ($50 for a small tube) and smelling like the back end of a large coal truck wasn’t working for me either. My particular case was cosmetically disturbing but not medically-complicated so I decided to stop buying the $50 prescription cream and turned to the beauty industry which was just beginning to offer face cream with AHA’s.
I quickly became a fan as I discovered that the flaky psoriasis patches on my face disappeared with a skin care regimen that included a daily application of the AHA face cream. Those were my stay-at-home-with-babies days, and I was as far removed from research or academic writing as one could be, but I didn’t need the denial of a null hypothesis to tell me that this was working. I used it twice daily on my face and then started rubbing it in to my elbows and knees. I still laugh remembering the cosmetic rep who finally asked how much face cream I was using (I ordered a lot of this stuff!).
And, yet, the research is in my favor. One study of 12 patients found that a creams with 15% glycolic acid, as well as .05% betamethasone, respectively, were helpful in reducing erythema, transepidermal water loss (TEWL), and lowering Laser Doppler values (Dry Skin and Moisturizer). And alpha hydroxy acids mixed with betamethasone were found to be even more effective in treating psoriasis in a double-blind, split-face, single site clinical study (JEAVD).
I have experienced mild outbreaks of psoriasis since that period but have continued to treat them with AHA-based lotions with consistent results.
Products with AHA’s
Shopping for an AHA-lotion today is easy as there are a plethora of options available at every price point and in formulations for the face, hands, feet and body overall. Philosophy’s ® Hope in a Jar – Body Lotion ($18.45, amazon.com) includes moisturizers as well as a lactic acid AHA for gentle exfoliation. Their Hope in a Jar ® — Face Cream ($23.50, amazon.com) is best-seller and provides similar benefit for the face. National drug-store brands like Eucerin, Nivea, Jergens, Olay, Neutrogena and others offer AHA body lotions of varying concentration and even white label store brands sport AHA formulations.
If you have psoriasis, one of the treatments you can try is alpha hydroxy acids. While there aren’t as many clinical studies for this as there may be for others, the way the product works should help psoriasis and several studies have confirmed that AHA’s, particularly in combination with betamethasone, can help alleviate symptoms of psoriasis.
One note of caution: AHA’s can be harsh, and if you have sensitive skin, you should test a small amount on the inside of your elbow area (where they take blood) before applying to your entire face. Similarly, if you have raw or non-intact skin, avoid the application of these creams until the area is healed. I have found that the lower-price-point, or “generic” AHA face creams work well for spot application to elbows, knees and other body areas when I have an outbreak, while for my face, sticking to the higher-price-point facial creams tends to avoid stinging or irritation. Each person will have a unique tolerance and preference level, so if you’re considering this as an addition to your skin care regimen, start small, experiment often and keep looking until you find a combination that works for you!
Post by Rebecca Harmon
Bissett, D. (2009). Common cosmeceuticals. Clinics in dermatology, 27, 435–445. doi: 10.1016/j.clindermatol.2009.05.006
Fluhr, J., Cavallotti, C., & Berardesca, E. (2008). Emollients, moisturizers, and keratolytic agents in psoriasis. Clinics in dermatology, 26, 380–386. doi: 10.1016/j.clindermatol.2008.01.015.
Green, B.A., Yu, R.J., & Van Scott, E. J. (2009). Clinical and cosmeceutical uses of hydroxyacids. Clinics in dermatology, 27, 495–501. doi: 10.1016/j.clindermatol.2009.06.023.
Liu, P., Lin, Y., Feng, C.H., and Chen, Y. (2012). Determination of hydroxy acids in cosmetics by chemometric experimental design and cyclodextrin-modified capillary electrophoresis. Electropheresis, 33, 3079–3086. doi: 10.1002/elps.201200213.
National Psoriasis Foundation. (2012). Education Center: About Psoriasis. Retrieved from http://www.psoriasis.org/about-psoriasis.
National Psoriasis Foundation. (2012). Education Center: About Psoriasis. Retrieved from http://www.psoriasis.org/about-psoriasis/treatments/topicals/over-the-counter.
National Psoriasis Foundation. (2012). Education Center: About Psoriasis. Retrieved from http://www.psoriasis.org/about-psoriasis/types.
U.S. National Library of Medicine. (2011). PubMed Health: Plaque psoriasis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001470/.
WebMD. (2012). Healthy Beauty: Chemical Peels and Your Skin. Retrieved from http://www.webmd.com/healthy-beauty/guide/cosmetic-procedures-chemical-peel-treatments.