What’s Triggering Your Psoriasis? These Methods Can Help You Find Out
The unfortunate truth is that we do not know nearly enough about what causes psoriasis and psoriatic arthritis. What we do know is that the likelihood of developing psoriasis is probably inherited but that an external factor—a trigger—may cause the disease to crop up. Doctors also believe that triggers can lead to flare-ups—those uncomfortable and downright painful periods of skin plaques, sore joints, fatigue, and/or other symptoms.
So, what if you could potentially reduce your psoriasis flares by identifying your own personal triggers? Here’s everything we know about triggers, including strategies for discovering yours.
The Unique Nature of Psoriasis Triggers
It would be great if there were known triggers that impacted everyone with psoriasis and psoriatic arthritis equally. If that were the reality, everyone with these conditions could simply avoid the same triggers to prevent psoriasis flares. But of course, it’s not so simple.
“Triggers vary,” according to Audrey Christie, a nurse and holistic wellness practitioner who frequently works with people who have psoriasis and psoriatic arthritis. “Thanks to bio-individuality, each patient is unique, although there can be some similarities categorically.”
Bio-individuality is a holistic health term that essentially means each body has its own individual needs. It’s believed that a person’s bio-individuality can be influenced by their age, gender, lifestyle, ancestry, blood type, metabolism, and other factors.
So the triggers that cause one psoriasis patient to flare may not impact you at all. And vice versa.
Where to Start: Common Psoriasis Triggers
The National Psoriasis Foundation identifies some of the most common triggers as:
- Skin injury
- Certain medications (including antimalarials, Inderal, Indomethacin, Lithium, and Quinidine)
Of stress, Christie says, “Ongoing, chronic, or significant short-term stress can trigger psoriasis by activating the immune system. This stress could be mental or physical.” So for example, a person could experience anxiety about an upcoming surgery, or it could be the surgery itself that stresses the body.
Each of these potential triggers has research backing up its link to psoriasis flares. But there are some unresearched (or under-researched) potential triggers, as well, things patients believe have caused their flare-ups but which haven’t been scientifically proven to do so.
Following the Gut
In her work with psoriasis patients, Christie has come to believe there are several potential triggers, one of which is leaky gut syndrome.
The term “leaky gut” is common in holistic medicine but still somewhat new or even controversial in medical communities. It refers to increased intestinal permeability, and the research surrounding it is pretty limited at this point. But a leaky gut is believed by some to be a possible risk factor for autoimmune conditions.
Board-certified dermatologist Rhonda Klein M.D., of Modern Dermatology of Connecticut says, “Skin and gut are tightly linked. The microbiome is critical to the function of our immune system, and psoriasis is categorized as an autoimmune disease.”
When a leaky gut is believed to be to blame for psoriasis flares, Christie says it is “usually in combination with bacterial overgrowth, candida, a parasite, or sometimes, just insufficient good guys in the gut bacteria.”
As far as causes of leaky gut, she says, “This is typically caused by medications (antibiotics, NSAIDS, antacids), toxins, stress, food choices, vitamin D levels, and of course there can be a whole host of other factors.”
According to Harvard Medical School, there is no one way to repair a leaky gut—different strategies may be recommended for different people and circumstances. Klein says, “When it comes to diet, I really try to coach my patients into identifying triggers in their diet. Some common ones are alcohol, sugar, dairy and gluten.”
The link between diet and psoriasis is a hot topic—many people wonder whether what they’re eating is causing them to flare-up.
The most commonly recommended diet for people with psoriasis is an anti-inflammatory diet, also known as a Mediterranean diet, which shows promise in medical studies but still hasn’t been proven to improve psoriasis. It involves eating omega-3-rich fish, nuts, seeds, fruits, vegetables and lean protein. It also involves avoiding so-called inflammatory foods, such as red meat, refined sugar, dairy, alcoholic beverages, and processed foods.
“Inflammatory foods can trigger an immune-system response leading to a psoriasis flare-up,” explains Lisa Richards, a nutritionist and author of The Candida Diet.
It’s important to note that research released in Jama Dermatology in 2018 provided the most comprehensive picture of the potential link between food and psoriasis flares to date, but the authors of the study were quick to point out that while diet modification may help to mitigate the disease, managing it is still best accomplished through medical treatments.
Some experts believe that some people might be triggered by a specific food because they’re sensitive to it. Christie explains that food sensitivities can vary widely from person to person. While some foods may be triggers for some patients, they won’t be for all.
Still, Richards says the most common foods connected to psoriasis flares include:
- Red meat
- Processed foods
- Nightshades (a category of fruits and vegetables including potatoes, peppers, tomatoes, and eggplant)
Christie says that in her work with patients, she’s come to view food triggers as being involved in psoriasis activation and exacerbation quite often. “Most common are gluten and dairy, and I see a fair amount of egg and sugar triggers here, too,” she says.
Other Possible Triggers
In addition to all that, Christie says the following could all potentially contribute to a psoriasis flare:
- Buildup of toxins in the body
- Nutrient deficiencies (low levels of certain nutrients, like vitamin D, zinc, copper, vitamin A, and folate)
- Hormonal fluctuations caused by stress or other life stages
But even if you’ve had a reaction to a particular trigger in the past, it may be different in the future, says Richards.
Only one thing is for sure: Anything that triggers psoriasis makes life harder for those most impacted. “Flare-ups can cause fatigue, skin conditions, and brain fog, among other things,” says Richards. “The extent of these symptoms range in severity from one person to the next.”
Identifying your Personal Triggers
If you’re ready to start exploring the different causes of your own psoriasis flare-ups, there are a few ways you can do so.
- Look deeply at your medical history and lifestyle. In her practice, Christie works with patients to complete a functional-medicine matrix to help identify what potential triggers they may be dealing with. This is essentially a road map of various aspects of your life that helps clinicians to get a more complete picture of the day-to-day things you may be exposed to.
- Track potential triggers and your symptoms. “If you are attempting to determine your food triggers, it is best to keep a food and symptom diary,” says Richards. “When you have flare-ups, it will be easier for you to identify foods you consumed that may have triggered an immune response.” A Harvard Health article suggests you can start to recognize patterns after just a week of food journaling and it provide some great tips for getting started.
- Try an elimination diet. This involves cutting the most common food triggers from your diet for about four to eight weeks (or longer) and then slowly reintroducing them one at a time and watching for symptoms. Christie says an elimination diet is the gold standard in determining food sensitivities.
- Allergy and sensitivity testing. Working with your general practitioner or an allergist may also help you to identify some of your personal food sensitivities and intolerances. “Unless you identify food triggers that are causing your flare-ups, you will continue to have them,” Richards says.
Once you’ve found your psoriasis triggers, you’ll be able to work to avoid them or learn to mitigate them. For example, if you lead a high-stress lifestyle, you may find that practicing stress-reduction techniques also reduces your flares. Or perhaps cold weather is a personal trigger for you; then you might consider moving to a warmer climate. Flare-ups probably aren’t usually completely avoidable, but they can sometimes be prevented or even reduced in severity.
Remember, individual triggers can be completely unique to you and your situation, which means it’s important for you to pay attention to what’s going on around you when you’re experiencing a flare and even right before that. Identifying your personal triggers not only can help you feel more self-aware but can also empower you to take charge of your condition, so you can live your best life possible.