Jeremy S. Fenton, M.D., a dermatologist with Schweiger Dermatology Group in New York City, discusses the solutions to flakes and other more visible symptoms that can occur during a psoriasis flare. Although the condition causes a buildup of thick plaques on your skin, if you begin treating it early with a topical medication, you may be able to get flakes under control; systemic treatment may be needed if the condition progresses.

Jeremy S. Fenton: I think one of the keys to controlling a psoriasis flare is to recognize it as early as possible. The sooner you can get the topical medications on, the faster they'll start working and the faster you'll get things cleared up. The longer you let psoriasis build, the thicker the plaques get, the more difficult it is for the medication to penetrate. So getting those topical medications on quickly in order to control the flare, I think, is very important. We do have some specialized medications that we can prescribe that can help deal with very serious and acute flares, but those are generally reserved for people who have been hospitalized for very serious psoriasis. So for the average patient for a psoriasis flare, it's going to be going back to your regular medications, using them diligently right up front to try and get ahead of the problem.

So one of the issues in psoriasis is that there is a very rapid cell turnover that's going on, and so these cells are coming up to the surface, and then all the skin is sloughing off, and those plaques are sloughing off that dead skin off the top, and that's what's leaving behind the flakes and the scale.

So obviously trying to keep the psoriasis under control with your topical medications is helpful, but specifically regarding trying to minimize the amount of flaking, you can use certain products that help exfoliate off that top layer. For example, salicylic acid is something that comes in certain shampoos. It also can be used as a gel or a lotion on the skin. And that salicylic acid, leaving that on, say, overnight or washing your hair with it in the morning and letting it sit before rinsing it out, that helps to remove those flakes so then when you go out during the day, there's less flakes until they've built up again.

Now keeping those plaques thin and keeping those flakes down also helps the medication then penetrate, and then it makes everything more effective. If you have a lot of flaking in the scalp, I mean, little tips that I think most patients have probably figured out, trying to avoid scratching your head, that's going to generate more flaking when you're out in public. But generally, trying to avoid the flakes from forming in the first place or using a product that exfoliates and takes off that top layer. There's also retinoids that can be used that have been approved, and there are even formulations that combine retinoids as well as topical steroids. Retinoids are also stronger but also work similar to salicylic acid in that they help exfoliate off that top layer. So there's some products out there that you can use that can help.