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Psoriasis is a chronic condition that can come and go in cycles. People with psoriasis can go for extended periods of time with few or no symptoms, and then experience a return of uncomfortable or painful symptoms. These periods are referred to as “flares.”
Treatment and management of flares is a common topic of discussion on MyPsoriasisTeam. “How do you stop the itch?” “Any advice for flare-ups and swelling while traveling?” These and other questions come up as members attempt to deal with psoriasis flares and their common triggers.
What Are Some Causes of Psoriasis Flares?
Psoriasis flares may seem to come on randomly, but research has shown that certain things make flares more likely and are considered common triggers for the skin condition. Triggers aren’t universal and what affects one person living with psoriasis may not bother another at all. Still, there are some events that are more triggering than others. Most of these events are associated with the inflammation that triggers the immune response that makes the skin grow faster and causes the symptoms of psoriasis.
Stress is often associated with both a first psoriasis outbreak and with later flares. Inflammation is associated with stress, and that inflammation contributes to psoriasis flares. The flares can cause even more stress, which leads to a worsening of symptoms.
The immune system responds to physical stress by increasing inflammation, and some doctors suspect that emotional stress may have the same effect. Inflammation is the classic sign of autoimmune conditions such as psoriasis.
Injury to the skin
Injury to the skin can bring on psoriasis symptoms, and the phenomenon even has a name: Koebner response. Cuts, scrapes, scratches, bug bites, and sun exposure are all common causes of flares.
Certain medications are associated with an increased risk of flares. Here are some drugs considered common psoriasis triggers:
- Lithium is used to treat bipolar disorder and other mental health conditions. About half of lithium users with psoriasis will have a flare triggered as a result of using the drug.
- Inderal (Propranolol) is used for high blood pressure. A quarter to a third of those using the drug who have psoriasis will experience flares. Inderal is a beta-blocker and while it has been speculated that other beta-blockers may trigger flares, there is no definitive link.
- Indocin (Indomethacin) can be used to treat psoriasis arthritis. Talk to your doctor about alternative treatment options if Indocin is triggering psoriasis skin symptoms.
Both smoking and being around others who smoke can trigger psoriasis flares. Smoking can also reduce the effectiveness of some drugs used to treat psoriasis. If a person with psoriasis smokes, they’re usually advised to stop smoking. Some methods of smoking cessation, like nicotine patches, can also trigger flares. Because of this, it’s best to consult a doctor about how to best quit smoking.
Like smoking, alcohol use can reduce the effectiveness of some psoriasis medications. If it does, it can make flares stronger and prevent them from receding.
Changes in weather
Some people with psoriasis find that dry, cold weather triggers psoriasis flares. Others find that sunshine and warm weather causes flares, especially when around air conditioning. Warm weather can also increase the chance of sunburn - a type of skin injury - that triggers a psoriasis flare.
Excess weight can be a factor in psoriasis flares. Most doctors recommend losing weight if a person with psoriasis is overweight or obese. It is worthwhile to note that fat is thought by researchers to contribute to inflammation.
Some people with psoriasis are also sensitive to gluten, the protein found in wheat products. One study found that people with psoriasis were three times more likely to have celiac disease than those in the general population. If you suspect you may be sensitive to gluten, ask your doctor to consider testing for celiac disease.
An anti-inflammatory diet is believed to avoid foods that increase inflammation (fatty red meat, refined sugars, and dairy products) and focus on foods that decrease it (colorful fresh fruit and vegetables and coldwater fish). Some people with psoriasis report feeling better while eating this type of diet, and it may be beneficial for overall health.
The hormonal changes of puberty can be a factor in triggering psoriasis flares in adolescent girls. Many people with psoriasis report their first diagnosis was during or shortly after this period. In women, pregnancy and its hormonal changes often lead to a decrease in flares during the pregnancy and an increase in them in the period immediately after pregnancy. Similarly, menopause can worsen flares in some women. Other women experience an improvement in their psoriasis after menopause.
Strep bacteria in the throat are often connected to a type of psoriasis called guttate psoriasis. Guttate psoriasis appears after or during infection and looks like small raised red spots on the skin. In some cases the person with the rash doesn’t even realize they have a strep infection until the rash appears. While strep throat is the most common infection associated with this condition, upper respiratory infections, tonsillitis, and the other triggers listed above can also cause it.
Psoriasis Flare Triggers for MyPsoriasisTeam Members
Members of MyPsoriasisTeam discuss many of the most common flare triggers:
- “When I am hurting from all the flare-ups [most] is when the weather changes and the pain makes me very depressed.”
- “I was fighting off a cold and my almost healed hands and feet flared; I was limping around.”
- “Being older my skin is thinner and bruises and tears more easily. As [cuts and bruises] heal, psoriasis develops.”
- “I first started with [a] psoriasis [flare] when the consultant told me my dad had lung cancer.”
- “I had the flu and a bad throat infection, which triggered my most recent aggressive attack.”
- “Winter time makes [flares] worse, with no sun.”
MyPsoriasisTeam members also shared some less common flares:
- “Every time I travel, my feet flare up and swell.”
- “Hard water [contributes to] my psoriasis flare-ups.”
- “Gluten and sugar have been the biggies!”
- “I stay away from tomatoes and any nightshade vegetables, such as peppers and eggplant, and any type of tomato sauce. Oranges also.”
- “If I bathe or wash the dishes [flares occur]. Any contact with water makes mine worse.”
- “I work in the metals department. So I am touching metal all day that’s nickel plated. We use gloves, but they make my hands sweat and itch. But if I don’t wear them my hands instantly flare up.”
How Do MyPsoriasisTeam Members Manage Flare-ups?
Members have tried a wide variety of treatments for flares, and have reported a number of them to be effective. They include medication (both oral and injected), light therapy, and natural therapies. Keeping skin in good condition with moisturizer and using a humidifier helps some stave off flares. Sunscreen and wearing long sleeves helps prevent sunburn as a trigger. Others swear by diet changes, although there’s no one diet that works for everyone.
- “[Light therapy is] very effective. Cleared up [my skin] totally and stayed clear for three years.”
- “Skyrizi cleared me 99 percent within three weeks. I take my third dose in three weeks and am still clear.”
- “Mine was behind my ears, and in my ear canals. My doctor prescribed Daivobet gel and it worked where dozens of other lotions or potions had done nothing.”
- “I’ve been on a keto diet for a year [and] 90 percent of my symptoms are gone including psoriatic arthritis, and I’m off all meds and creams.”
- “I’m on Humira injections. My psoriasis has cleared up.”
- “For itching I use Gold Bond cream for psoriasis.”
- “I'm taking Skinesa Probiotics daily plus prescription creams. My flare ups/cracks/bleeding have been reduced.”
- “Taltz saved me from surgery! It took about six to eight weeks and all of the sudden two days before surgery I was able to walk so I cancelled it!”
- “Moisturizers, Benadryl gel, and coal tar gel.”
- “Stress is one of my triggers, so I go to yoga type meditation classes to help me stay grounded.”
- “I use a homemade coconut oil sugar scrub.”
When Is It Time to See Your Dermatologist?
Since flares are unfortunately part of living with psoriasis, every flare doesn’t necessarily merit an automatic call to the doctor. That being said, it may be time to call the doctor if you notice symptoms of a particularly severe flare:
- New or unusual signs on the skin
- Periods of extreme stress or anxiety
- Unrelievable itching
More Tips for Avoiding Psoriasis Flare Triggers
While everyone’s flare triggers are different, there are some practical steps you can take to avoid some of the more common causes of flares.
- Minimize stress. Stress management techniques like yoga, meditation, and journaling can be a good place to start.
- Take care of skin injuries like cuts and scrapes promptly and avoid scratching bug bites.
- Reduce alcohol consumption.
- Talk to your doctor about smoking cessation support if you smoke, and avoid second-hand smoke.
- Keep your skin moisturized. Shorter showers or baths in warm, rather than hot, water and a moisturizer recommended for psoriasis can help.
- If medication seems to be a trigger, see if a doctor can prescribe a different one.
By joining MyPsoriasisTeam, the social network and online support group for those living with psoriasis and psoriatic arthritis, you gain a support group more than 75,000 members strong. Psoriasis flare-ups and common triggers are two of the most discussed topics.
Here are a few question-and-answer threads about flares:
Here are some conversations about flares:
What triggers psoriasis flare-ups for you? What is the best way you’ve found to manage a psoriasis flare? Share in the comments below or post on MyPsoriasisTeam.
- Psoriasis Causes & Triggers - National Psoriasis Foundation
- Life with psoriasis: Stress - National Psoriasis Foundation
- Koebner phenomenon - DermNet New Zealand
- Psoriasis - Symptoms and causes - Mayo Clinic
- Psoriasis Causes & Triggers - National Psoriasis Foundation
- Lithium: Drug Uses, Dosage and Side Effects - Drugs.com
- Inderal: Uses, Dosage & Side Effects - Drugs.com
- Quinidine Uses, Side Effects & Warnings - Drugs.com
- Indomethacin Uses, Side Effects & Warnings - Drugs.com
- Healthy diet and other lifestyle changes that can improve psoriasis - American Academy of Dermatology
- Are triggers causing your psoriasis flare-ups? - American Academy of Dermatology
- Smoking makes psoriatic arthritis drugs less effective - National Psoriasis Foundation
- How cigarettes and alcohol affect psoriasis - National Psoriasis Foundation
- FAQs: Psoriasis in spring, summer, fall and winter - National Psoriasis Foundation
- Dietary Recommendations for Adults With Psoriasis or Psoriatic Arthritis -JAMA Dermatol
- Psoriasis and Diet- National Psoriasis Foundation
- Poor diet and psoriasis flares often intertwined - Dermatology Times - Mayo Clinic
- Anti-Inflammatory Diet - National Psoriasis Foundation
- Psoriasis: Female Skin Changes in Various Hormonal Stages throughout Life—Puberty, Pregnancy, and Menopause - Biomed Res Int
- What women need to know about psoriasis - National Psoriasis Foundation
- About Guttate Psoriasis - National Psoriasis Foundation
Annie specializes in writing about medicine, medical devices, and biotech. Learn more about her here.