5 Common Psoriasis Triggers—and What to Do About Them
Here’s the thing about psoriasis: The symptoms tend to come and go. You might find yourself enjoying days, weeks, or months of feeling well and then get sidelined by itching, flaking, sore joints and/or fatigue. Symptoms might seem to arise out of nowhere, when actually, they are flaring or worsening because of a trigger.
While triggers can vary from person to person, there are some common ones. Looking out for these could help you better understand your own triggers and, as a result, help you better manage your psoriasis symptoms. Here, we explain some of the most common triggers and how you can avoid them; and, if they’re simply unavoidable, how to manage them when you do flare up.
Stress: Identify and Fight It
“Stress is probably the most common trigger for psoriasis,” says Douglas J. Buethe, M.D., a board-certified dermatologist at Mercy Medical Center in Baltimore, Maryland. Stress, however, is hard to define because it’s experienced differently in each person. For example, one person stuck in traffic when they’re late might feel mildly agitated and another might get extremely anxious and irritable.
It’s impossible to avoid stress altogether. We all feel nervous when going on a first date, a job interview, or when faced with bad news. This type of stress, known as acute stress, is short-term but can still cause changes in your body. You might sweat, feel nauseous, feel your muscles tighten, develop a headache, or feel shaky. For people with psoriasis, the body’s reaction to stress can also include a psoriasis flare.
Chronic or long-term stress often has milder symptoms, but is seemingly constant or regular. It can lead to other health issues, such as headaches, insomnia, and heart disease. Health problems, especially those that affect your immune system, can cause your psoriasis symptoms to worsen or flare.
Identifying your stressors is the first step toward managing stress levels. Be aware of your body’s reaction to stress; for example, you might notice your neck and shoulder muscles tightening whenever you’re worried or stressed. You can use this awareness to help discover external and internal stressors in your life. Keep a journal and note anytime you feel stressed and what might have caused it. From there, you can find patterns and everyday situations that cause you to feel stress.
Once you know the causes of your stress, managing it will become easier. You can take proactive steps, such as listening to music, taking walks, meditating, or doing deep-breathing exercises, to calm your stress levels. There are also lifestyle choice you can make to help increase your resilience to stress. These include:
- Making exercise part of your daily routine. Regular aerobic exercise decreases overall levels of tension and can improve mood, sleep, and self-esteem, according to the Anxiety and Depression Association of America.
- Giving thanks. A positive outlook can lower levels of the stress hormone, according to Harvard Health. Practicing gratitude improves overall well‑being. It can also improve sleep, counteract depression, improve relationships, and make you happier, according to Berkeley Health. To do it, keep a gratitude journal. It’s easy: Just write down three to five things you’re grateful for each day.
- Using stress-relief strategies. Meditation, deep-breathing, taking walks outdoors, listening to music, spending time with loved ones, and participating in a favorite pastime can all help to lower stress levels according to Harvard Health. Make a list of ways you can combat stress and reach for it whenever you feel your body reacting to stressors.
Skin Injury: Protect and Encourage Healing
“Traumatic injury to the skin can cause new areas of psoriasis to develop through a process known as Koebnerization,” says Buethe. “For example, a new plaque of psoriasis [can develop] in a surgery scar.”
Trauma to the skin includes cuts, bruises, scratches, bug bites, vaccination injections, sunburn, piercings, and tattoos. Psoriasis symptoms might appear 10 to 14 days after the skin trauma, even after the injury has healed, so it might be tough to make the connection. That’s why keeping track of skin trauma, no matter how small, can help you determine if you’re experiencing the Koebner phenomenon.
Quickly treating the injury can speed up healing and prevent a flare according to a report on the Koebner phenomenon. Other ways to minimize flares from skin injury include:
- Avoiding piercings and tattoos. If you do plan to get either a piercing or a tattoo, talk to your dermatologist about ways you can care for your skin after to reduce the chance of developing new plaques.
- Using itch-relieving products and moisturizing frequently. Scratching psoriasis can worsen plaques and irritate the skin. Any skin trauma increases the chances of infection, which, if you get one, can worsen psoriasis symptoms.
- Applying cool compresses to affected areas. These can ease discomfort from plaques and prevent you from scratching.
- Protecting your skin. When you’re outdoors, wear clothing that covers your skin to avoid irritants, bug bites, and cuts. Use bug repellent. If you do get an injury or bug bite, treat it immediately with cold compresses, over-the-counter ointments, and itch-relief medications, as recommended by your doctor.
Diet: Choose to Eat Healthfully
“Many people have seen significant improvement of symptoms with changing their diet; however, research does not support a specific diet to help reduce psoriasis symptoms, “ says Alexis Newman, RD, LDN, a Philadelphia-based dietician. So while some people find success following a specific plan or cutting out certain foods, the goal for everyone should be to keep an overall healthy diet.
“Typically, meals should be well balanced using the USDA My Plate as a guide,” says Newman. “This ensures you are eating enough vegetables, fruits, protein, and carbohydrates. Fruits and vegetables are full of nutrients that can reduce inflammation.”
If you’re overweight or obese, weight loss can help too. A 2018 review of studies found that some people who were overweight experienced a significant reduction of symptoms after losing weight. It can also help your medications work effectively.
“Patients who are overweight do not respond as well to systemic medications,” explains Lisa Stirling, M.D., a board-certified dermatologist in Encinitas, California and medical advisor for eMediHealth.
“In addition, insulin resistance is correlated with inflammatory states in the body,” Stirling adds. She suggests that low-glycemic diet plans—ones that limit refined sugar and carbohydrates can be beneficial. “Diets such as Whole 30 and the autoimmune protocol might be good for patients that are worsening despite treatment.”
You also might want to take a look at your vitamin D intake. “Some research shows vitamin D might help with improving symptoms,” says Newman. “This comes from sun exposure, but you can also add vitamin-D-rich foods to your diet, such as eggs, yogurt, milk, Swiss cheese, and oily fish.”
Of course, everyone’s different, and some people have food sensitivities that contribute to their flare-ups. If you suspect you might be reacting to foods you’re eating, keep a food journal, in which you track food intake and symptoms to determine which foods, if any, contribute to your psoriasis symptoms.
Medications: Keep Your Doctor Posted
Some medications can trigger psoriasis flares, according to the National Psoriasis Foundation. Some of these include:
If you’re taking any of these medications and experiencing psoriasis flares, talk to your doctor about the option to substitute other drugs. Discuss the risks and benefits of taking the medication and whether making substitutions could risk health complications or a resurgence of other health conditions. Never stop a medication without first talking to your doctor.
Some people find their psoriasis symptoms worsen during the winter months. “This is primarily due to a reduction in ambient UV intensity relative to spring and summer months,” says Buethe. The winter months also have lower humidity levels, which can dry skin.
Others find that warm weather causes problems, such as an increased risk of sunburn and dry skin from spending a lot of time in air-conditioned spaces.
To combat weather-related psoriasis flares, keep skin hydrated. Do this by:
- Moisturizing skin often.
- Using a humidifier at home during the winter months.
- Removing wet clothes as soon as you come indoors.
- Avoiding sitting too close to heat sources, such as fireplaces and radiators.
- Using warm water when showering and limiting showers to 10 minutes or less.
Also, protect your skin when you spend time outdoors. Wear a hat, gloves, and a winter jacket during the cold months. During the warm months, don’t spend long periods in direct sun, and use sunscreen every day.
If you’re paying close attention—and even tracking your psoriasis symptoms—you may find that one or several of the above factors can trigger your psoriasis. Or you may find other causes. Alcohol consumption and smoking, for example, can cause flare-ups in some people. Women especially can find that fluctuating hormones trigger symptoms.
Some things, like the alcohol and cigarettes, can be avoided. But others, like hormone changes, are unavoidable. For those, Buethe says he may adjust a patient’s medication until their symptoms are better managed.
“We never ‘cure’ psoriasis, so the goal is always making sure the condition is adequately controlled,” says Buethe.
Understanding your triggers not only can help control your symptoms, but can make you feel more in control of living with psoriasis.