However, while there are some good reasons to remove scales, taking your fingernails to them isn’t one of them, as you risk damaging the skin they’re attached to. This “can trigger flares of more patches of psoriasis, a reaction known as the Koebner phenomenon,” says Steven Daveluy, MD, assistant professor and program director at the Wayne State University Department of Dermatology in Detroit.
The Benefits of Removing Scales
Scales do naturally exfoliate (shed), but it can take a while. And although the only way to safely get rid of psoriasis scales is to follow a treatment plan that addresses the inflammation at the core of psoriasis plaques, there are a few things you can do to help things along — and a number of potential advantages to doing that, according to Dr. Daveluy: 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’ll look better. Removing visible scales can help relieve self-consciousness and reduce social anxiety — both typical of people with psoriasis. A review published in Arthritis Care and Research in March 2019 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 triggering the Koebner phenomenon. Keeping layers of scales thin and flexible helps prevent unnecessary trauma to your skin.
5 Ways to Help Remove Psoriasis Scales
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, a study published in April 2022 in Psoriasis: Targets and Therapy 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 oatmeal and olive oil or Epsom salts to the water can make soaking even more effective by helping to exfoliate dry, dead skin. (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, a substance derived from coal or certain types of wood, for psoriasis for more than 100 years, according to the American Academy of Dermatology. 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 National Psoriasis Foundation. 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. 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. Valerie Callender, MD, in an address to the Skin of Color Society, recommends using a leave-on lotion, ointment, or foam containing topical corticosteroids and vitamin D in conjunction with a keratolytic shampoo. Coconut oil and sunflower seed oil are also good options for Black Americans with scalp psoriasis.
Living With Psoriasis Plaques
As long as you’re careful, it’s safe to manage psoriasis scales anywhere on your body. If you’re prone to mindlessly picking at them, however, Daveluy recommends covering problem areas with clothing (long sleeves, long pants) or even an Ace bandage. 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.
