8 Psoriasis Triggers That Can Lead to Flares
It’s not always possible to avoid a flare, but understanding some of the common psoriasis triggers can help give you a little more control.
If you’re one of the 8 million people diagnosed with psoriasis in the US, you know that half of the battle can be simply managing the condition and what feels like a constant threat of flares.
This burden can be daunting given the litany of potential triggers, both internal and environmental, not to mention stressful — ironic given that stress itself may induce or make existing psoriasis flares worse.
But there’s hope. Learning more about psoriasis, how it works, and what factors can cause flare-ups is the first step in regaining some sense of freedom. Here, immunology and dermatology experts share more about common psoriasis triggers, plus what to do to protect your sanity and skin.
What is a psoriasis flare?
Psoriasis is a chronic, auto-immune disease that causes an overactive immune response and increased inflammation throughout the body, explains Erum Ilyas, M.D., a board-certified dermatologist at Schweiger Dermatology Group in King of Prussia, PA.
While the disease is always present, flares triggered by a sudden immune response can lead to red, scaly, and at times even painful skin plaques, explains Dr. Ilyas. For others, the chronic inflammation can even cause psoriatic arthritis in the joints.
These plaques are not dry skin, but rather a build up of skin cells that are multiplying so rapidly that the older, dead skin doesn’t have a chance to shed, she explains. This is a manifestation of the immune response.
What triggers psoriasis?
What triggers an immune response or causes inflammation is unique to each person, says Aly Cohen, M.D. an integrative rheumatologist based in Princeton, NJ, and founder of The Smart Human. “Everyone has their own set of inflammatory factors in terms of what people eat, how much they sleep, stress levels, daily chemical exposure, [or] medication, ” says Dr. Cohen.
While there’s a laundry list of catalysts, here are some of the factors that often play a role.
Stress
While stress is a common psoriasis trigger — one 2018 study found that as many as 88 percent of patients reported such — the mechanisms that kickstart this chain reaction aren’t entirely clear. Some science suggests that stress increases inflammatory markers in the body, which contribute to psoriasis. Frustratingly, psoriasis itself can be a stressful condition, so many people may find themselves in a never ending stress-flare loop.
Food
The foods you eat can have an inflammatory or anti-inflammatory response in the body, says Dr. Cohen. Potential psoriasis diet triggers include ultra-processed foods, as these contain additives such as artificial flavors and coloring as well as emulsifiers, which can disrupt gut bacteria and increase inflammation, she says.
Conversely, an anti-inflammatory diet would include more whole, nutrient-rich foods, seafood, plants, nuts and seeds, and very limited red meat. The Mediterranean diet is a good example of a common anti-inflammatory diet recommended for managing psoriasis, says Dr. Cohen.
You might also consider an omega-3 or fish oil supplement for the “anti-inflammatory benefits that can reduce active flare-ups and prevent new ones,” says dermatologist Deanne Mraz, M.D., F.A.A.D., assistant clinical professor of dermatology at Yale School of Medicine, and co-founder of Modern Dermatology in Westport, CT.
Alcohol and tobacco
Studies have shown a correlation between increased drinking and severity of psoriasis symptoms and progression. One theory is that alcohol suppresses the immune system and causes the inflammatory response that initiates a flare. If you are going to drink, Dr. Cohen suggests opting for “cleaner” or organic options without a ton of preservatives.
Smoking causes inflammation and stress in the body — a well-known bad combo when it comes to psoriasis, says Dr. Ilyas. Tobacco not only increases the severity of the disease if you have it, but it also increases your risk of developing the disease initially, according to the National Psoriasis Foundation.
Climate
If you notice your psoriasis improves on vacation, it’s not just the good vibes and the piña coladas. “Weather can definitely impact psoriasis flare-ups and symptom management,” says Dr. Mraz. “Cold, dry climates compromise the skin barrier, which is already very vulnerable in people managing psoriasis,” says Dr. Mraz. Warmer, humid environments can add needed moisture to the skin.
Conversely, “UV light can help treat and improve psoriasis,” says Dr. Ilyas. That doesn’t mean you should lay out at the beach with no SPF or head to the tanning bed. “A trigger for psoriasis can be trauma to the skin,” she says. “Sunburns, or excess UV exposure that results in cell damage, can trigger an immune response and flare psoriasis in some cases.” Any UV light treatment for psoriasis should be done in your doctor’s office in a controlled setting that limits the exposure to only what’s necessary, she adds.
Some Medications
There are two ways that medications can impact psoriasis: induce a flare or make an existing flare worse, says Dr. Ilyas. Two big players that may trigger a psoriasis flare are interferon-style drugs and PD-1 (programmed cell death protein-1), both of which alter the immune response in some way, she says. Interferon drugs work by triggering your immune system to attack unwanted or “unhealthy” cells and are used to treat hepatitis C, some cancers, and autoimmune diseases, including multiple sclerosis. PD-1 medications are another type of immunotherapy typically used to treat certain cancers by inhibiting the immune system’s response. Additionally, beta-blockers, antimalarials, lithium, and terbinafine drugs may all trigger a flare, says Dr. Ilyas.
There is some thought that oral or topical steroids could make an existing psoriasis flare worse, but research indicates the risk and severity are low. Lastly, anti-TNF medications, which, ironically, work to reduce inflammation in the body may worsen psoriasis plaques or skin lesions, though the mechanism for why this happens is unclear, says Dr. Ilyas.
Infections and illnesses
As if getting sick with a cold wasn’t frustrating enough, this and other viral infections like the flu can trigger psoriasis. What’s more, bacterial infections including strep throat can also increase your risk. Strep has specifically been linked to guttate psoriasis, a form of the disease that causes small red lesions on the chest, back, arms, and legs. Overall, the immune response in an attempt to fight off these infections is what can trigger a psoriasis flare.
Skin trauma
Open wounds and other skin abrasions not only increase the risk for infection but can also trigger a psoriasis flare as a response, says Dr. Cohen. This response, when skin trauma causes lesions, can also be referred to as Koebner’s Phenomenon. Keeping wounds clean and covered will help prevent infections as the skin heals, she says.
Chemical exposure
Routine exposure to harmful chemicals, such as those found in plastics, beauty products, and cleaning solutions, has an impact on your immune system over time, says Dr. Cohen.
“Your body is like a sponge,” she says. “You absorb chemicals in products you use every day that are known to cause inflammatory responses.” Science is ongoing to better understand exactly how these unregulated chemicals may impact your health, including auto-immune diseases like psoriasis, but you may want to speak with your doctor about limiting exposure when possible, says Dr. Cohen.
How to manage psoriasis triggers
Living with the threat of psoriasis triggers can make dealing with the chronic condition difficult, but it’s important to show yourself kindness, says Dr. Mraz. “While there are lifestyle factors that can trigger psoriasis flares, there is a misconception that it’s self-induced,” she says.
Still, you may find stress-reduction techniques, such as meditation or low-intensity exercise, helpful in managing the stress-psoriasis cycle. And while you may choose to avoid specific triggers that seem to exacerbate your psoriasis, for most people, it comes down to reducing inflammation, says Dr. Illyas. This might look like quitting smoking, cutting back or eliminating alcohol, and making changes in your diet.
While preventative measures like these can help keep psoriasis flares at bay, it’s impossible to avoid them entirely, says Dr. Cohen. If you are dealing with an ongoing flare, there are a few things you want to avoid to find relief faster.
Although it might be tempting, you never want to exfoliate or pick skin plaques, says Dr. Ilyas. “Exfoliating or peeling the scaling away will be met with pinpoint bleeding in these areas. Focus on treating the underlying inflammation and not making it worse.”
You also want to avoid tanning beds. “Tanning beds provide unfiltered UV in excess that can potentially flare psoriasis if enough inflammation is triggered,” she says. Not to mention, they come with an increased risk of skin cancers. The phototherapy your doctor provides as an in-office treatment uses controlled doses of narrow-band UVB light, she says.
Lastly, opt for lukewarm baths opposed to hot showers, which can dry out and irritate the skin, says Dr. Mraz. Try adding Epsom salts or colloidal oatmeal to the bath water to boost the skin-soothing effects and add healing moisture.
