Feeling tired after physical exertion, a busy day, or a night of insufficient sleep is normal. Having fatigue, however, is different from simply being tired. Fatigue is an unbearable, perpetual sense of exhaustion. It doesn’t improve with rest, and it can affect a person’s cognitive (mental) and physical functioning. Many people with psoriasis and psoriatic arthritis (PsA) experience fatigue as a symptom.
This fatigue, in tandem with other psoriasis symptoms, can negatively affect a person’s overall well-being and quality of life. Understanding this fatigue, how it affects one’s physical and emotional state, and how to manage it can help minimize its effects. Here is what you need to know about fatigue in psoriasis, including how to manage it.
Fatigue is a significant and common symptom among people living with psoriasis. It’s often considered one of the most troubling symptoms of psoriasis, as well as other chronic diseases.
Everyone experiences fatigue differently, and psoriasis-related fatigue can range from mild to extreme and debilitating. However, most people with it find that it affects their daily lives. One MyPsoriasisTeam member wrote that fatigue is their “worst symptom,” while another shared, “This disease can make you exhausted. It’s more than just tired — sometimes, the fatigue can be so great it feels like your last day on earth.”
Fatigue can leave you with little energy to take care of daily tasks and responsibilities. As one member wrote, “The fatigue and pain are draining what little energy I had.” Another member explained that their spouse “gets so sleepy driving to work (an eight-minute drive) that he will doze off at his daily office meeting.”
Other members have shared how they feel when their fatigue is most extreme. “I get to the shutdown point,” one member wrote, “and I tell my family I have got to go. I have to rest!” Another member wrote that “The fatigue is the worst when it hits hard. I have fallen asleep at the table before. It’s like my body just says, ‘Stop now!’”
Some members find it challenging to determine what’s contributing to their fatigue. As one member wrote, “I have been feeling kinda low energy or a little fatigued. I am not sure if this is a psoriasis issue or an age issue. Maybe the expectations I have for myself are unrealistic. It could be a combination of factors.”
Psoriasis is an autoimmune disease, meaning it affects how the immune system functions. This leads to inflammation. Fatigue in psoriatic disease is often triggered by the interaction of two types of inflammatory processes: direct inflammation via inflammatory cytokines and indirect inflammation caused by physiological and psychological factors. These inflammatory processes can use up much of the body’s energy. Certain medications used to treat psoriasis can cause fatigue. So, too, can other complications associated with the disease.
Psoriasis medications — including methotrexate (sold as Otrexup, Rasuvo, and Trexall) and cyclosporine — can cause extreme tiredness and fatigue. Other medications, such as antidepressants and those for anxiety and pain, may cause fatigue in individuals with psoriasis. Biologic treatments can also cause fatigue.
One member described their experience with the medication secukinumab (Cosentyx): “I recently started the loading dose for Cosentyx to help with my psoriasis. I feel so exhausted that even getting out of bed is a struggle. I read on their website that fatigue is not a side effect of the medication. Before starting Cosentyx, I had insomnia. Now, I’m having problems waking up and getting out of bed.”
Another member shared that the medication apremilast (Otezla) caused them to feel fatigued: “I am on day three of Otezla. I feel extremely fatigued.”
Depression and other mental health conditions are major factors in fatigue for people with chronic inflammatory diseases like psoriasis. Depression and psoriasis can intensify each other, leading to a vicious cycle of worsened symptoms like fatigue.
Fatigue and depression in chronic inflammatory disorders and depressive diseases are associated with proinflammatory cytokines. Cytokines regulate your body’s responses to inflammation, immune responses, infection, and trauma. Some kinds of cytokines help your body heal (anti-inflammatory cytokines). However, proinflammatory cytokines worsen symptoms of inflammatory diseases.
Sleep disturbances are common in people living with psoriasis: Nearly 90 percent of people diagnosed with psoriatic disease have trouble sleeping. In many cases, this difficulty is due to “painsomnia” — insomnia (difficulty sleeping) due to chronic pain or discomfort. Psoriasis symptoms, including itching, burning, and soreness, can cause a person to have difficulty getting a good night’s sleep.
A lack of quality sleep can contribute to fatigue. Research in animals has suggested that losing sleep can worsen psoriasis. In this vicious cycle, poor-quality sleep causes the brain to become fatigued, reducing the central nervous system’s ability to dampen pain signals. In other words, existing pain and discomfort can feel even more severe, which can then make getting to sleep even more challenging.
There may also be a link between psoriasis and obstructive sleep apnea, which occurs when a person’s airway becomes blocked while they sleep. Although the link is not clear, you should discuss any potential symptoms of sleep apnea you experience — such as snoring or momentary lapses of breathing while sleeping — with your doctor.
Iron is a mineral that our bodies need but can’t make on their own. Humans get iron through a wide range of plant- and animal-based foods. Iron-deficiency anemia occurs when the blood lacks sufficient healthy red blood cells, which play a key role in the production of iron. People with psoriasis are more likely to develop iron deficiency. Extreme fatigue, weakness, and a feeling of lightheadedness are a few common symptoms of iron deficiency. This condition can be diagnosed by a simple blood test.
Living with other health conditions —including the PsA, fibromyalgia, or chronic fatigue syndrome — can affect your sleep quality and contribute to fatigue.
If fatigue is interfering with your daily activities, talk to your dermatologist or health care provider. Your doctor may need to run tests to determine if another issue is causing your fatigue. After determining the cause, your doctor may recommend certain changes — such as adjusting your psoriasis treatment or lifestyle habits — to help get your fatigue under control. Be sure to speak with your doctor before trying any new therapies.
If your doctor suspects that your fatigue is resulting from a psoriasis medication, they may recommend changing your treatment. Let your doctor know if you notice any changes in your fatigue levels after changing medications, adjusting your dosage, or starting a new psoriasis treatment. You can work with your doctor to find a medication or combination of treatments that keep your psoriasis under control while lessening fatigue.
Although fatigue may make physical activity seem impossible, getting regular exercise can actually boost your energy levels. A 15-minute walk can have a positive impact on your energy levels. The most important thing is to stick to it — rather than aiming for intense physical activity, start slowly and work toward building a consistent exercise routine. Weight gain from lack of exercise can worsen arthritis symptoms.
Eating a nutritious diet may help keep fatigue at bay. Try to avoid fatty foods as much as you can, instead opting for lean protein, whole grains, and fresh fruits and vegetables. Some foods such as tomatoes, olive oil, leafy green vegetables, almonds, salmon, and strawberries have anti-inflammatory properties.
Eating fresh, homemade food instead of prepackaged food is also a healthier option. Try not to eat food late at night, especially those that are particularly heavy or rich.
If dietary issues are contributing to your fatigue, your doctor may refer you to a licensed dietitian. This specialist can create a diet plan with the right nutrients for your needs.
Your doctor may recommend taking dietary supplements, like vitamin D, B vitamins, minerals, or multivitamins, to help manage fatigue. Some people with psoriasis have said that omega-3 fish oil supplements help them with severe fatigue.
Allow yourself to rest and take breaks when you are feeling fatigued. It may be helpful to spread out your daily chores and activities with planned rests in between.
One MyPsoriasisTeam member shared how they handle life when fatigue hits: “When I’m fatigued, I try to keep my daily routine but just go through the motions and get the basics done. I still go to Pilates but put very little effort in.”
Keeping a fatigue diary can help you identify what factors or situations may be contributing to your fatigue. In this journal, you can record the days and times when you’re fatigued and how long the fatigue lasts. Also record what you were doing at the time, how you slept, if you worked or exercised, what you ate and drank, and if your psoriasis was flaring up.
These notes can help you and your doctor uncover patterns in your fatigue and identify how to help prevent it.
The good news is that there are many steps you can take to help manage and reduce fatigue related to psoriasis and PsA. As always, check with your doctor before starting a new exercise program, making changes to your diet, or adding supplements.
MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 112,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.
Have you experienced fatigue with psoriasis? How have you managed it? Share your experiences and tips in the comments below or by posting on MyPsoriasisTeam.