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Psoriasis (young people)

Psoriasis treatments: bath oils/emollient, soap substitutes and medicated shampoos

Some shower gels, soaps and shampoos can irritate psoriasis. Damini finds 'normal' soaps or shampoos make her skin itchy. Megan’s “never been able to use bubble baths or bath bombs”, but can use ‘normal’ shower gel now that her psoriasis is less severe. As an alternative to ‘normal’ versions, some of the young people we talked to had tried:
  • bath oils and emollients (added to a bath)
  • soap and shower gel substitutes
  • medicated shampoos (prescribed and shop-bought)
Others found shop-bought brands of soap, shower gel and shampoo were fine for them. Zara likes fragranced shower gels and doesn’t notice a difference in her skin. Others opt for shop-bought versions which are “gentle”, “natural” and plain (less fragrance). Abbie and Louie use “dermatologically tested” bathing products in the hope these are less likely to cause a flare-up.

Bath oils/emollients and soap substitutes

Many people used a prescribed soap/shower gel substitute. Sometimes this substitute was the same as their leave-on emollient. These don’t tend to lather up or make bubbles as much as other soaps and shower gels.

Some people found using soap substitutes helped their skin. Louis’ shower gel substitute soothed and calmed his skin. Ella described the look of her soap substitute as “slightly thickened milk”. She likes the smell and finds it works well. Although Carys disliked things about her bath/shower gel substitute, she found it useful having a soap substitute for washing her hands at work.
 

Hannah finds a soap substitute helps her skin.

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Age at interview: 24
Sex: Female
Age at diagnosis: 16
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The soap substitute I have is like a moisturising cream that I got from the doctor, now I also get Aveeno on prescription. Which you can buy over the counter, but I sometimes get it over the counter, sometimes get it by prescription, it depends on how big the bottle is and how much you’d have to pay. But I used that a lot in the shower and the bath and I find that it's really nice and like it seems to work quite well for dry skin. But of course cos I'm on medication I don't know how effective-, if my psoriasis was at its worst I don't know that Aveeno would really be doing anything at all. But even with my skin completely fine, I always use dry skin products, cos I feel like I, you know, I always will have dry skin.
Others didn’t like using bath oils or soap/shower gel substitutes. Abbie’s skin felt oily when she moisturised afterwards. She didn’t like that she can’t wash her hair in the bath when using the bath oil/emollient “because it’s so oily”. Steven finds soap substitutes make the shower floor greasy. Megan finds having a bath emollient adds to the confusion of having so many different prescribed treatments.
 
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Carys’ water bills were high when she used a bath oil/emollient daily.

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Age at interview: 23
Sex: Female
Age at diagnosis: 22
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And although it sounds ridiculous, if you’re having a bath every day your water bill goes through the roof [laughs] because I was having to bath every day. Again it wasn’t, it was just for symptom relief like. And then they didn’t, they didn’t give me anything for a shower. I only had Oilatum for a long time. So I ended up having to bath just to, to kind of keep clean, cos I couldn’t use regular soaps, cos it irritated me. So I ended up going back to the GP again and asking for like something like a shower gel. So then I didn’t have to have a bath every day, but I could only really maybe skip one bath because the bath, you know, you soak in it and it did do, it was better. 
 

Steven says soap substitutes are part of his “everyday life”. He sometimes uses a fragranced shower gel as a “treat”.

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Age at interview: 22
Sex: Male
Age at diagnosis: 14
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You kind of get used to, I’ve had it for eight years, I’m used to like the shower gel and all the bits and pieces, the moisturiser like – unfortunately, you just have to like get used to the fact that the shower gel smells of nothing and is greasy [laughs] and you’re kinda like used to it. And occasionally, I kinda like treat myself by having like, using normal shower gel and then quickly doing it with the other shower gel again to kinda like balance it up. If I go away, I tend to kinda, volunteering for youth group, you kinda like tend to not wanna use your manky shower gel in front of like, cos it kinda like goes under, y’know, like gets on the floor and someone’s like, “Oh, that’s oily,” like, “Whose got oil in the shower with you?” So I kind of like tend to like do a naughty week and use like normal shower gel. And kind of moisturise double if I can, kind of like balance it out, which probably doesn't do anything, but it kinda like keeps me happy mentally. The stuff’s horrible.
 
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Carys found the bath oil/emollient made her skin feel greasy. She washed out the bath as it made the surface slippery.

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Age at interview: 23
Sex: Female
Age at diagnosis: 22
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Like I say, you know, and you get out the bath in the Oilatum and you dry off but you’d feel greasy. Then you’d have to put creams on, on top of that. You never felt you’d, I almost, it’s not that I didn’t feel clean but you didn’t feel refreshed, because you still felt covered in like something, like I say, all the creams and things you felt covered in them rather than. So, and if you, you know, if you had to put liberal amounts on you were, you kind of had to.

I think the main thing was like you had to wash the bath out every time you used it. Which, and, you know, you know, you rinse it out after you use it every time, but I had to like properly like wash it and rub it, because otherwise the next person would just fall like slip, cos there was that much like oil in the bottom and you see you had to be like really careful to make sure that you properly cleaned it out otherwise somebody was gonna slip and fall and hurt themselves.
Steven’s doctors told him to be careful drying off after a shower and to avoid rubbing the skin with a towel which can also remove the emollient shower gel – instead he has “a bath robe that I now hide in for like half an hour afterwards, just to gently dry off”.

A few people talked about using exfoliating bath/shower products. They wanted to use something which would reduce skin flaking without irritating the skin. Abbie likes products containing sea salt (see also section on home remedies) but can’t use these if her psoriasis is severe: “[when] my skin was in a worse state, it stung quite a lot because you were pulling all that skin away”.
 
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Carys tried a body scrub to help reduce skin flaking and itchiness. The dermatology nurse she told about this was dismissive.

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Age at interview: 23
Sex: Female
Age at diagnosis: 22
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So my friend worked at Lush and I read in a magazine that somebody with psoriasis had used something called Angels On Bare Skin, I think. And I was like, I read it and it said, “It worked wonders for my psoriasis,” and I was grasping at straws by this point. So, I was like, “Oh, I’ll try that.” And I mean it, I got that and at that, that did actually help it. It was just like a natural like body scrub but it meant I could almost itch without causing any damage. So, and you could use it on a daily basis. So that was quite, quite a good one and it, like I say, cos it’s all natural and it has things in to help calm the skin down. It did, I found it helped. And I, when I told the dermatology nurse this, she just rolled her eyes at me and I was like, “Well you asked me what I’d used.” I said, “And I’ve been waiting for months.” I said, “I was grasping at straws by this point.” But I felt like it helped to, I didn’t like to replace my prescribed ones, but it, I added it in. So, like I say, I saw like that it worked and I have to agree I think for symptom relief it did, it did help. Like I say, it was like being able to itch without itching. 

Why do you think that the dermatology nurse had that reaction of rolling her eyes?

[Intake of breath] Probably cos she hears it all the time about, “Oh I used this and it worked wonders.” And I don’t and I never once said I think it was a treatment. I used it as symptom relief and I was fully aware that’s what I was using it for. And I think sometimes people are set in their ways and that in this, in that profession you think it should be prescribed and it should be you should follow, you know, prescribed medicines and things like that. But, she probably just thought ‘oh, you’ve been wasting your money’ or you know, ‘nothing’s gonna get rid of it.’ But like I say, I never used it to get rid of it. I used it as symptom relief and I told her that and I was like, “Well, if it helps it helps. I’m not-,” and like and I said to her I said, “And at the end of day, even if it was psychosomatic and all in me head, if it gave me symptom relief it gave me symptom relief.” 
Medicated shampoos

Many people had used medicated shampoos for scalp psoriasis (see also about: body parts and types of psoriasis). Some medicated shampoos can be prescribed by a doctor and be bought from a shop. Others found ‘normal’ shampoos were fine – Louis said it was okay using a ‘normal’ shampoo as long as it didn’t get on the rest of his skin too much. Hannah and Lisa said they only use medicated shampoos if the psoriasis on their scalp was severe.
 

Steven talks about medicated shampoos for psoriasis.

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Age at interview: 22
Sex: Male
Age at diagnosis: 14
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Shampoo I think is the best place to start. And the number one thing I always say is, just don’t expect any of the treatments to smell nice [laughs] whatsoever [laughs]. There is not one person somewhere that thinks like, ‘we’re gonna make a treatment, we’re gonna put like herbal essences in it or something to make your shampoo smell nice’. No. It’s just, just not gonna happen. Like, you have to be prepared for horrible coal tarry, smelly stuff and, I think living at home for me was quite helpful, because no-one was judgemental. If I was away living like with other people who might be a bit like [intake of breath] ‘uh, stinky cream day’, y’know like they might be a bit more whatsit. But, you just have to be prepared. The shampoo that I’m using at the moment is not, smells a bit like mothballs, I think is the best way of putting it. It’s not nice. Shampoo is a big thing. I stopped using shampoo-shampoo as I would call it every day quite a while ago to try and help my scalp. And I have tried every, almost every shampoo under the sun for psoriasis. And you tend to, the doctor tends to rotate you a little bit as well. Sometimes one’ll give you a bit of help for like six months and then six months later like ‘nah, go back to a different one’. And then you end up coming back round the circle again. I think fortunately or unfortunately, I was quite quick once I stopped being a student to kind of do prepaid prescriptions which, actually, for me was really good, because you know what you are gonna pay every month or over the year. And it means that if you wanna kind of try something, if the doctor says to you, “Oh, why don’t you try this and this?” You’re not worried that it’s gonna cost you £7 whatever it is, £8 whatever it is now and it be a waste of time. You’ve almost like paid your [laughs] loyalty card and I always say I’m a repeat offender. And you’ve paid your loyalty card and if you get like one that doesn't work so much, you’ve got the other one, the repeat prescription, the one that works. You’ve not like wasted your time doing it. Obviously, you need to look at, if you’re only getting cream once every three months or whatever then it’s definitely not worth it. But, for me like, three things a month like you know like what you’re gonna do. 
Those who had used special shampoos for psoriasis had often tried ones containing coal-tar, an ingredient also available as a topical treatment. There are various types of coal-tar shampoos. As Hannah explained, most have “a really specific smell” which Abbie found “horrific” and made some people feel self-conscious. Hannah used perfume and Adam added hair products to mask the coal-tar smell.
 
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Adam prefers T-Gel over other coal-tar shampoos.

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Age at interview: 24
Sex: Male
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So like coal tar is like the main ingredient in like the shampoos. There’s T-Gel, which doesn’t smell terrible. And then there’s the one that you tend to get prescribed to you. I don’t know. It’s in a brown bottle, in a brown tub. That smells horrendous. I don’t use that one, purely because I’d rather, it would cost me the same price to get a bottle of T-Gel by myself than it would to pay for a prescription. So I use T-Gel. I don’t particularly worry about the smell. I mean in terms of, I shower in the mornings and then I put it in. And you can use T-Gel like a normal shampoo. You can put it in, just like rub it in for like two minutes and then wash it all out. So I tend to, when I put it on, I tend to do it, it’s the first thing I do when I have a shower, I put it in. And I do everything else like I brush my teeth and then I do-. And then I leave it in, so it’s probably in my hair for about 15 minutes. And then I wash it out. 

And I don’t think it has a very strong smell. I know that if someone just came up to smelled my hair though after using it, they would smell the coal tar and something like that. But it’s not like the other one where it’s like, takes over the room or something like that. And, but then usually after I’ve showered then I get ready for the day, and then before I leave I put some product in my hair anyway. So I know that would mask it. So it’s not something I particularly worry about, purely because I have a routine. I probably, even if I went out with it afterwards, and I think T-Gel’s very good, so I wouldn’t be worried unless someone come up and like put their head in my hair, [laughs] or something like that. So, which never happens.
 
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Louie stopped using a medicated shampoo because he was worried about it drawing attention to him at school.

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Age at interview: 16
Sex: Male
Age at diagnosis: 13
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So I’ve had Cocois on my head which was smelly. The shampoo, Capasal – it’s a tar shampoo, tar based shampoo – that is a bit smelly as well but it’s not as bad but still it can be, people could say, “Oh, what’s that smell?” and for someone with psoriasis and you being noticed that you’ve got something wrong with you, it really does dent your confidence. And if someone asks, you don’t wanna say, “Ah, it’s me – sorry,” and you don’t wanna explain the whole story, so. When I first had psoriasis I kept myself to myself a little bit and so obviously you don’t want people asking questions.

But stuff like they gave me certain treatments for my hair like Cocois which is a smelly substance and I just said to them, “Look, if I’m going to school in the morning I’m not gonna want my hair stinking of something,” and I just stopped using it off my own back cos I don’t want to be at school and have people going, “Oh, what’s that smell?” and me having to explain. So I just stopped using that which probably if I did use it would have helped me but it’s just one of those things that I don’t think doctors realise that you have to be practical, the medicines have to help and they have to be practical with what you do in your everyday life.
Medicated psoriasis shampoos worked well for some people, but were disappointing for others. Lucy didn’t find coal-tar shampoos helped and one “burned” her scalp when she used it. Lucy and Louie prefer using a menthol shampoo, like Head & Shoulders. Lucy says it “soothes the scalp”. Simon’s GP gave him a coal-tar shampoo as his first treatment when diagnosed with psoriasis on his scalp. Simon hoped it would completely “clear up” the psoriasis but found “if anything, it made my scalp a lot more irritable” and his psoriasis “spread”. Simon thinks he should have been given a topical steroid instead or in addition. Other issues include medicated shampoos being expensive/an added cost and time-consuming.
 

Hannah’s found there are downsides to using medicated shampoos.

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Age at interview: 24
Sex: Female
Age at diagnosis: 16
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The T-Gel I did try at the beginning and like they are, they're all like kind of tar based and like kind of smelly and like don't really make your hair smell nice at all. And I found that the scalp is really stubborn and none of those things have really effectively worked. The only thing I've found is that like maybe if you leave something on overnight, it will take of a lot of the plaque the next day. And then you, when you've got thick hair it's difficult as well to just kind of get it all out and get your scalp looking like reasonable again. 

And things just multiplying so quickly that you're just finding yourself doing, you know, I found myself doing like two hour routines, or three hour routines like every time I want to wash my hair and that is just so time consuming that you just basically don't really wanna go out. Like it's fine if you’re gonna stay at home, but yeah, it was just a long process to like do anything.
 
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Simon has a routine for his scalp psoriasis treatments, including using medicated shampoo.

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Age at interview: 22
Sex: Male
Age at diagnosis: 17
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When I have a shower I use Capasal. The doctor mentions, and when I’ve had it that you have it pretty much twice every shower session so you put it on and you rinse it off and about 10 minutes later or five minutes you put it back on and you rinse it off again and that’s fine. And when you get out and you first of all you use Sebco and you use that for you put that on and you can leave it on your scalp for about an hour, two hours at the most, and then you wash that off and then you move on to Betnovate.
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