"Every dermatologist has been told stories by patients with psoriasis that it started—or got worse—after a stressful life event,” says Mark G. Lebwohl, M.D., professor and system chair of dermatology at Mount Sinai in New York City.
It is true, anecdotes abound, and there's some research to back them up: One report confirmed that psychological stress precedes the onset of disease in 44% of patients with psoriasis and initiates recurrent skin flares in up to 88% of patients. Other studies estimate rates of stress-related psoriasis ranging from 26% to 88%.
But for the three women below, no scientific studies are needed. They've learned first-hand what a major life change can do to their skin. Even more important? They’ve also learned how to manage those big-time flares and get on with living life on their terms. Read on for their stories.
The Skin Transition: When a Loved One Dies
Reena Ruparelia, 39, Toronto
When Reena Ruparelia's father passed away in March 2018, it was one of the most devastating losses she'd ever experienced, she says. Her psoriasis had been quietly minding its own business, in remission for 18 months. That meant no active red spots or flaking, just the memories of past breakouts.
After her dad's death, a few little "spots" appeared on her legs and then a few months later, the little spots became big spots and began to spread. She thought, "Something is definitely up."
She'd had some lesser flares in the past—teeny, tiny plaques or a bit of redness—but Ruparelia, 39, of Toronto, says, "This one was a stunner. It really showed me how connected our mind and our emotions are to our bodily responses. I know anxiety really causes me to flare more, and then my skin gets boiling hot and bright red."
Those initially small, seemingly innocent, dots and plaques joined together, she recalls, forming huge blobs the size of her palm. They covered her shins, tops and bottoms off her feet, ankles, and fronts and backs of knees. They attacked her upper body with a fury, too, including her hands and elbows.
"It got really scary, with more spots creeping up on me each day, and I'd think, 'This is getting worse, getting bigger, and oh, no, here's another one!'" she says. "Our minds can go there, and mine did, and that aggravated the flare in a kind of weird cycle."
Ruparelia, who was diagnosed with psoriasis at age 14, was understandably grief-stricken for a long time, after the initial shock of losing her dad. "I was in a flight-or-fight mode and a haze for about five months. I knew my body was really upset with it all, and it showed me with all those breakouts."
Over the years, Ruparelia tried a variety of treatments, everything from steroids to phototherapy to biologics. But when her dad died, she wasn't actually using any medication. Ultimately, she decided to let the flare diminish on its own, which took several months. For her, she knew that as she processed her grief, her skin would respond in kind. "The spots cleared from the inside, with more brown color appearing instead of red," she says. "That also always means I'm in a better, calmer state of mind."
What's she learned? The healing process requires patience and plenty of self-love. She says to herself, "Sweetheart, you're obviously struggling. What do you need right now?" It's about giving herself permission to just be wherever she is in the journey. Ruparelia is a mindfulness coach and trainer, blogger, and skin-positivity trainer, and she shares her lessons with her clients and with the world @psoriasis_thoughts on Instagram.
"Remember to have patience because things take time, especially to heal and grow, and always, to change," she says.
The Skin Transition: When You Go Through a Divorce
Jennifer Kerner, 35, Washington, DC
No one wants to have a flare, but for Jennifer Kerner, understanding and managing them has made her wiser than she might have been otherwise, and she's grateful. "They've been a big part of my positive attitude and my success because of what they've revealed to me about myself and my interactions with the world around me."
She has no doubt that stress has been the fuse that lit some of her worst flares, with one being far worse than the rest. "The flares kept me company during my doctoral studies, my first marathon (Hey, Chicago!), moving across the country, working in conflict zones in Eastern Africa, and the dissolution of my marriage," she says.
Those events were understandably highly significant in her life, and apparently her psoriasis thought so too. That was especially true when she went through her divorce in late 2018. The stress of that prolonged event—particularly the last eight months or so—fostered the mother of all her flares.
"That flare felt like my skin, which was so red, was also on fire," she says. "It was so traumatic that it kept me from doing the things I enjoyed. I was constantly feeling uncomfortable and so tired, and not feeling psychologically good about myself at all. Plus, the patches showed up in places I'd never had them, like on my face and hands. My face hurt too much to put makeup on, and it was uncomfortable to wash my hands and wear gloves, particularly when riding horses, which I love to do.”
Over the years, she tried all kinds of treatments, things like cold tar, creams, lotions, foams, then oral medications, all for naught. "My skin was always kind of simmering, with little patches that you still feel a little gross about," she says. But with this outbreak, she knew she'd need something different. Sometimes a big change, requires big-time medication. So after a very fruitful discussion with a new dermatologist, she made 2019 her year of the biologic, and started on her first one. With the divorce finally behind her, she had a new and promising life ahead of her, and she felt free—something her skin probably "felt," too.
Kerner hasn't had any flares since she started her new medication. "I feel like I gained decades back, making up for lost time," she says. "My energy is back, my skin feels great, and I can wear regular makeup again." And get this: She ran her first 30-mile ultramarathon in September 2019 on behalf of the National Psoriasis Foundation with no problem, no flares.
Along with her medication, Kerner also sees a psychologist for cognitive- behavioral therapy to help temper her anxiety and depression. It's helped her frame the way she approaches situations and to know that flares tell her that something in life isn't right—maybe even toxic.
"When I'd get sick, I'd disappear from social situations and work situations and be licking my wounds," she says. "After all, having a psoriasis flare is not something you necessarily want other people to be aware that you're going through, and you don't want them to pay attention. Retreating a little helped give me some emotional space to re-acclimate and now, I don't get so anxious."
Now she's all in to share her experiences and her feelings, and plans to do some public speaking soon, flares or not. She encourages others to get out there, too.
"If you have psoriasis, don't hide, even though this can be an isolating disease," Kerner says. "Allow your body to sigh and chill out, and your anxiety can dissipate. Remember there is actually nothing 'wrong' with you. Try not to focus just on your skin, but think about how to use what you've learned from having psoriasis to build more resiliency in all the facets of your life."
The Skin Transition: When You Go Away to College
Tikeyah Varner, 26, Atlanta, GA
For Tikeyah Varner leaving home for college when she was 18 was enough to incite her "first huge flare," she says. Diagnosed at 15, she says the transition up-ended her psoriasis, which until then had been visible but manageable.
"I'd had a bad breakout around my hairline in high school, but this one affected my whole face—my forehead, cheeks and neck—for almost my entire freshman year," she says.
She'd moved 300 miles away and struggled to find her way. "It was all so new, living on my own in a new environment. And I lived too far to go home every weekend," she says. "The social aspect, on top of the educational aspect, was stressful enough." Dealing with what she felt was an impossible-to-ignore skin condition made it all 10 times harder.
To try to manage her flare, she tried different lotions labeled simply "for dry skin," and when those didn't help, she turned to thicker creams, cocoa butter, and African black soap as a homeopathic, medicated cleansing bar. She also used prescribed corticosteroid creams and ointments, but nothing really changed things for her skin.
Thankfully, summer vacation came just in time, and when she went home to her familiar environment, and got outside more in the sun, her plaques subsided—just like they do for some other people with psoriasis. For the next few years, all was well in terms of major flares, that is, until her senior year, when another unwelcome outbreak on her face disrupted her life.
"It's so hard, because if it's on my arms or legs, I can wear a long-sleeved shirt or long pants, but when it's on my face—I would honestly do anything to hide it and I couldn't," Varner says.
For her, it wasn't just being a senior that caused stress to pile on. It was also the "It's my ‘last year’ syndrome, figuring out what to do next: take a break, go to work, or go directly to graduate school," she says.
That flare was a disrupter and Varner felt so low. "It made me feel extremely sad and discouraged at first, sometimes not even wanting to be around my friends," she says. "It was worse for me because I'd gotten so used to my face being clear and then suddenly, I had this horrible breakout had to re-adjust to living with dry patches on my face."
Realizing that the connection between her mindset and her psoriasis was very real, Varner says she reflected on how the flare her freshman year made her feel so out of control, and she'd had enough of that. She decided to take some positive action.
"My senior year, I really tried to get out in front of my psoriasis by living healthier," she says. "I stopped eating unhealthy foods like candy. I drank more water, and I did lots of research about my condition."
She also tried a new treatment, which she's stuck with since: Varner uses in-home ultraviolet or UVB light therapy, with her doctor's guidance, and tries to enjoy sunlight in minimal, safe doses when she can. Sunlight emits both UVA and UVB radiation and can improve psoriasis symptoms.
Varner supplements her diet and light-therapy regimen with deep breathing exercises, which help take a bite out of stress. Her senior year, she got in the habit of going to the gym to relieve stress when she had a breakout. She also likes to write poetry and she blogs at PlaquePsoriasis.com, adding that writing is a wonderful creative outlet for her in general.
She couldn't stop that senior year flare, but she could sure stop thinking about it as something she had to just live with. For her, knowledge really was power and she's much more informed than when she went away to college.
Doing all these things for herself and being proactive about her health has made her feel in control, and that squashes her worry quotient. She tries not to panic when she has a flare, remembering that at some point, her skin really will clear again. Like, really.
Now pursuing her master's degree in childhood education and being a mom to a three-month-old, she's learned so much about how to deal with so much.
"It's easy to feel like it's the end of the world, but it's not going to be a lifelong flare," she says. "Just think that relief will come again. You'll have good days and bad days, but nothing will last forever. Knowing that has really put me in a better headspace. I know that I can be strong, and that I can keep doing what I'm doing that's right for me."
She's right on track on her journey to self-awareness. "It took me years to learn how to balance," she says. "It started with acceptance first. I accepted that I am beautiful, even with my psoriasis. I accepted that I don’t need people to tell me that either. I must believe it first."
Study about Link between Autoimmune Diseases and Gastrointestinal Problems: "Population based study: atopy and autoimmune diseases are associated with functional dyspepsia and irritable bowel syndrome, independent of psychological distress." (2019) Alimentary Pharmacology & Therapeutics.
Report on Collegiate Mental Health: (2018) ccmh.psu.edu/files/2019/09/2018-Annual-Report-9.27.19-FINAL.pdf