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Psoriasis flares are caused by genetic and environmental factors that trigger inflammation in the skin. In psoriasis, dysfunction in the immune system leads to attacks that damage skin cells. When the disease is active, skin cells proliferate at up to 10 times the normal rate, causing thick patches of skin that flake off. The condition is chronic, and there is not yet a cure.
When psoriasis is flaring, symptoms worsen. Skin can become red or purple, scaly, itchy, cracked, and sore. Some people experience painful or swollen joints during flare-ups. Fatigue is also commonly associated with psoriasis flares.
Flares usually occur in cycles that can last for several weeks or months. When flare-ups subside, the condition may go into remission and skin will clear up. In more severe cases, symptoms may stabilize or cause scarring. Flares can relapse with a severity similar to previous flare-ups, or they may rebound and become more severe.
Psoriasis Flare-up Triggers
People with psoriasis may have different sensitivities from one another, and what triggers flare-ups in some people may not affect others. By understanding how flares happen, people with psoriasis can take actions that may help prevent flare-ups. Psoriasis research is providing new insights into the most common flare triggers, which ultimately may lead to new therapies for preventing and treating flare-ups.
Psychological stress is one of the most common triggers associated with flares in psoriasis. Stress causes neurological and hormonal changes that can affect the skin and trigger pro-inflammatory immune responses in people with psoriasis. In one study with 201 participants, 90 percent of children experienced a stressful event prior to a psoriasis flare.
Depression, stress, and sleep interruption occur more frequently among people with psoriasis than the general population. Self-consciousness, avoidance of social situations, and the burden of ongoing and time-consuming treatments are some of the factors that cause stress in people with psoriasis.
Some studies also suggest that inflammation itself may cause an increase in depression and anxiety in people with autoimmune diseases like psoriasis. Complex connections between immune disorders and emotion are not fully understood, but research in this area is aimed at treatments that may reduce stress caused by inflammation.
Exposure to tobacco is associated with psoriasis flare-ups — for smokers themselves, for those exposed to secondhand smoke, and even people using nicotine patches. Nicotine causes blood vessels to widen, which can cause skin irritation and provoke flare-ups.
Smoking tobacco is known to have adverse health effects and has been shown to affect the immune system’s defenses, leading to cell damage that can affect the skin. Smoking has been linked to the onset of psoriasis, severity of the disease, and poor response to treatments. In addition, people with psoriasis who smoke have been found to have less disease remission.
Research on alcohol consumption and psoriasis is limited. There is some evidence that alcohol may be a factor in causing and worsening inflammation, which increases risk of flares. Alcohol is also linked to weakening the skin barrier, which increases risk of exacerbation of psoriasis symptoms. Alcohol use has been associated with a decrease in adherence to treatment plans, which can lead to flares.
A number of drugs are associated with the onset of psoriasis and psoriasis flares. People with psoriasis who take medications for other health conditions should discuss potential risks with their dermatologist. Medications known to increase the risk of flares include:
Some foods have been linked to a worsening of psoriasis symptoms and triggering of flares. Data on food consumption and flares has largely been collected through reporting by people with psoriasis. Although much remains unknown about the specific mechanisms in foods that trigger flares, foods with unhealthy fats, refined sugars, and refined carbohydrates have been linked to inflammation.
The most common foods people with psoriasis have reported as flare triggers are:
Saturated fatty acids are also risk factors for psoriasis flares. Saturated fat is found in butter, fatty meats, cured meats like bacon and sausage, and cheese. Palm oil, which is used in many processed foods, is also a common source of saturated fatty acids. Saturated fats are often linked to high fat diets, which commonly cause obesity — another risk factor for psoriasis flares.
People with psoriasis have unusually sensitive skin, and even slight injuries can trigger flares. Skin injuries can cause a reaction called the Koebner phenomenon, in which previously healthy skin can develop new psoriasis lesions. Injuries such as bug bites, scratches, cuts, burns, or bruises can cause flare-ups and new lesions to form at the site of the injury.
Researchers do not yet understand what causes the Koebner phenomenon. It may be a particular immune reaction, a microvascular reaction, or another underlying dysfunction due to infection, genetics, or other factors. People with psoriasis who experience the Koebner phenomenon usually flare 10 to 20 days after the injury.
Other common occurrences that cause minor skin injury, such as sunburn or vaccinations, can also cause flares due to the Koebner phenomenon.
Cold and dry weather and low humidity are associated with psoriasis flares. Air tends to be dryer in cold weather, and dry skin can easily become aggravated in people with psoriasis. Heat sources like fireplaces and radiators can also cause skin to become dry and at risk for flare-ups. During warmer seasons, air conditioning can dry out the air as well.
Direct sun exposure can cause sunburn, which can trigger flares, although controlled sun exposure can improve psoriasis symptoms by providing skin with vitamin D.
Read more about weather and psoriasis flares.
Hormonal changes can trigger disease activity and flares in psoriasis, due to mechanisms in estrogen and androgen hormones that affect immune cells. Flares can be triggered by hormonal changes, particularly during puberty in adolescent girls, after pregnancy, and during menopause.
Androgen hormones, such as testosterone, affect hair follicles and skin condition, and are diminished by chronic inflammation in psoriasis. Drug therapies that replace androgens can exacerbate psoriasis and cause flares.
Bacterial and viral infections can trigger acute flares by causing dysregulated immune responses in people with psoriasis. Streptococcal pharyngeal bacteria, which causes strep throat, has been linked to flares — particularly with guttate psoriasis.
Upper respiratory viral infections are also a risk for flares. Influenza B and viruses that cause the common cold are some of the common viruses that have been linked to severe flares in people with plaque psoriasis and general pustular psoriasis.
Prevention and Treatment of Flares
Risks for psoriasis flare-ups can be reduced by adhering to skin care and treatment plans, managing stress, and making lifestyle changes. Avoid changing your treatment without consulting your doctor or dermatologist. Talk to your doctor about techniques for minimizing stress, adopting a healthy diet, quitting smoking, and moderating alcohol consumption. You may want to consult with a dietitian or mental health counselor for additional help.
Be aware of your environment and try to avoid situations that might injure your skin. Prepare for weather changes by using a humidifier inside and dressing appropriately for outside conditions. Some people with psoriasis find it helpful to keep careful track of what triggers their flare-ups.
Learn more about preventing psoriasis flares.
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