One of the most frustrating aspects of psoriasis are the flare-ups that can happen unexpectedly. Even though flare-ups can often occur frequently and are associated with known triggers, they are difficult to manage or “plan” for. In our Psoriasis In America 2016 survey, we asked people what triggers they identified for their psoriasis flare-ups. Eight out of ten people (82%) who report psoriasis flare-ups have identified their triggers. The top five triggers that were identified by survey participants are, in order of frequency:
- Stress/anxiety (82%)
- Weather (58%)
- Dry skin (42%)
- Injury to the skin (26%), and
- In “5th place” there is a three-way tie (each at 22%) for diet, suddenly stopping psoriasis treatment, and infection.
Stress and anxiety
The chronic inflammation that is a hallmark of psoriasis (as well as psoriatic arthritis) means that inflammatory processes are not well regulated or controlled as a result of the underlying autoimmune disease.
Experiencing emotional stress can have the same effect as a physical injury or infection to the body – triggering inflammation. In people with psoriasis, this inflammation can cause a flare-up of symptoms. The flare-up of psoriasis symptoms can then cause a person to experience more stress, continuing the cycle.
Read more about how to manage stress and anxiety as a way to potentially prevent flare-ups.
Research shows that people with psoriasis often have symptoms that improve in the summer and get worse during the winter when humidity levels tend to be lower in the air is more dry. In addition to summer sun exposure, which can be therapeutic for psoriasis skin symptoms, the increased humidity levels help keep skin more naturally moist. Dry winter air tends to make symptoms worse since low humidity causes the top layer of skin to become more dry and thicken. This in turn, can trigger the production of substances in the immune system that cause inflammation.
Read more about how psoriasis symptoms can be affected by weather.
Plaques can appear anywhere on the skin, and they can crack because the skin affected by can become extremely dry. This dryness is caused by loss of moisture in the skin and makes the plaques prone to developing tiny cracks called fissures. The cracks can grow and deepen over time as the plaque develops and may also bleed.
Read more about symptoms of cracking and bleeding skin.
Injury to skin
Another common trigger for psoriasis is any kind of skin injury. Cuts, scrapes, and scratches are common types of skin injury triggers. When a skin injury triggers psoriasis, it is known as the “Koebner phenomenon.” In many cases, psoriasis that is triggered by a skin injury can be treated effectively if the person begins treatment quickly after the injury first causes psoriasis symptoms.
Read more about how injury to skin can be a trigger for psoriasis.
Certain foods can tend to cause or increase inflammation, while others can reduce inflammation. Avoiding “trigger” foods and eating more inflammation-reducing foods may be helpful for some people with psoriasis. Foods that can cause or worsen inflammation in some people include nightshade vegetables (tomatoes, peppers, and potatoes) among others.
Read more about how certain foods affect inflammation and psoriasis and how a healthy diet may help prevent some symptoms.
Because many of the medications used to treat psoriasis are at least partially effective in reducing inflammation, stopping a medication too soon can cause a rebound or flare-up. This is a difficult balance that unfortunately will most likely take you and your healthcare providers many times to figure out what combinations work best for you. As you probably already know, flare-ups are inevitable with psoriasis. The key is to minimize them both in terms of severity and length of time of the flare-up.
The type of psoriasis that is most likely to be triggered by infection is called Guttate psoriasis. The most common type of infection that can trigger an outbreak is strep throat, which is an upper respiratory infection caused by bacteria called “streptococcus.” Guttate psoriasis symptoms may not appear until a couple of weeks after the person has had the infection.
Although strep infections are the most common trigger, other types of infections can also trigger outbreaks of guttate psoriasis, including fungal infections, such as candida. Viral infections can sometimes be triggers as well, such as human papillomavirus (HPV), varicella-zoster virus, and retroviruses.
Read more about Guttate psoriasis and how psoriasis symptoms can be triggered by an infection.
While these are the most common triggers that were identified by people who took the Psoriasis In America 2016 survey, there are many other triggers that have been identified in other research. You can read more about the various psoriasis triggers here.
Editorial note: A large proportion of the Psoriasis In America 2016 survey participants also have psoriatic arthritis (50%), so the triggers identified by survey participants may be relevant to flare-ups of psoriatic arthritis symptoms as well.