When someone says, “You look stressed,” it’s more than likely they’re commenting on the bags under your eyes, your frazzled hair, or the sluggish tone in your voice. But what if something else was giving away your heightened anxiety levels?
Though there are only a few evidence-based studies on the correlation between psoriasis and stress exposure, most patients are adamant that there is a link—and a strong one at that. In fact, Jo Eckler’s first symptoms of psoriasis didn’t even show up until she was in graduate school and under intense stress. “I was getting very little sleep and juggling way too many projects and responsibilities while being a thousand miles from home,” says the 43-year-old, who's a licensed clinical psychologist and yoga teacher in Austin, TX. “Since then, my skin has been like a mood ring: I can tell if I'm getting too stressed by looking at my psoriasis patches and seeing how inflamed they are.”
Small studies, including one published in the journal Comprehensive Physiology, have linked chronic inflammation with an imbalance in the hypothalamic-pituitary-adrenal axis (HPAA)—the central stress-response system where the brain and our hormone glands communicate with each other, explains Rina Allawh, M.D., a dermatologist at Montgomery Dermatology in King of Prussia, PA. “When working properly, our brain tells the glands that make certain hormones to release at appropriate times,” she explains. But in people with psoriasis, the messages may be mixed, leading to higher levels of cortisol in their blood and their skin. The result? More flares.
As a result of this research, as well as patient testimonials, Dr. Allawh always has a preliminary discussion about triggers for psoriasis, including medications, illness, and stress. “Psoriasis may contribute to one’s stress, but also many of my patients ask me: Does stress contribute to my psoriasis?” she says.
The short answer is, yes. Here’s what the stress response looks like from start to finish if you have psoriasis.
Step 1: Stress Happens.
The brain sounds the alarm that we are under attack and it’s time to get in defensive mode. Our heart pumps faster, our blood vessels begin to constrict, and our blood pressure rises. We often notice that we’re breathing faster when under stress, and this is because our body is working harder to keep all systems in order and prepare us to act quickly should we need to. This is nature’s way of protecting us in an incident—and our body’s way of alarming us that said incident may happen.
Step 2: Adrenal Glands Pump Out Cortisol.
Our central nervous system (CNS) is responsible for monitoring what’s known as our “fight-or-flight” response. This involves multiple systems and pathways. “A normal stress response activates the brain’s central stress-response system, the hypothalamic-pituitary-adrenal (HPA) axis, as well as the sympathetic adrenomedullary (SAM) axis,” explains Brendan Camp, M.D., a Manhattan-based dermatologist at MDCS Dermatology. But psoriasis patients may have an altered stress response, which leads to a sustained increase in the number of inflammatory cells in the body.
Step 3: Immune Cells Jump Into Action.
Inflammation is ruled by the immune system, and immune cells that play a big role in psoriass are known as lymphocytes and monocytes. The cortisol pumping through your body actually increases their numbers and spurs their production of cytokines, the proteins that fuel the development of plaques on the skin, says Dr. Allawh. Yep, it's basically a massive chain reaction.
Step 4: Flares Pop Up.
When stress acts as a catalyst for psoriasis, flare-ups are triggered. Many of the currently available biologic medications for psoriasis patients target molecules such as TNF-alpha, IL-17, and IL-23, explains Dr. Camp. “The increased levels of these cells are directly responsible for the development of psoriasis," he says. "For example, the normal process by which skin cells are produced and then shed takes about four weeks. In psoriasis, this process only takes a few days, which leads to the accumulation of silver-colored scales on the skin.” The cytokines are also responsible for the development of other symptoms of psoriasis, such as red, cracked areas of skin that bleed easily.
How to Reverse Your Skin’s Stress Reaction
Mike Miller, 34, an IT support specialist from Boulder, CO, didn’t think much of stress and its effect on his body—until he got psoriasis. He then recognized that it was damaging his mental health, physical health, and even his relationships. After this revelation, he started working diligently on lowering his stress levels and staying calm. “Once my routines were in place, I saw improvements within weeks. My sores were disappearing and I became less scratchy,” he says. “At this point I suspected lowering my stress was the remedy, but I wasn’t 100 percent sure until I had a big fight with my wife during which my psoriasis started breaking out like crazy.” Within days, he noticed his plaques coming back and recognized that his stress was the driving factor behind his psoriasis. “Since then, I began lowering my stress levels and have seen serious improvement,” he says. “I’m nowhere near having clear skin, but my sores are less numerous and less irritating now that I’m more relaxed.”
Wondering how to manage stress levels if you have psoriasis? Start here.
- Get more sleep. Don’t knock the seven-to-nine hours of recommended sleep per night—it’s important, especially if you have psoriasis. In fact, research has shown that people with psoriasis tend to have sleep difficulties. “I’m super committed to high-duration and high-quality sleep—I have blackout curtains in my bedroom and nothing that emits light (alarm clock, cable box, etc),” says Miller, who aims to get eight hours every single night. “If I can, I sleep more, either by turning off the TV early or sleeping in on weekends. I also use a SunBox, a high-powered light that you place in front of you when you wake up,” he says. Light boxes like this can help regulate your sleep cycle.
- Cut down on caffeine. While research has found little association between caffeine and an increased risk of psoriasis, it has found a correlation between caffeine and elevated stress levels. That’s why Miller cut his coffee intake from six to eight cups a day to just one. “This made me anxious, worried, antsy and it also wrecked my sleep quality,” he says. “Since cutting down to one cup a day first thing in the morning, my stress levels have gone way down, and my flare-ups have lessened.”
- Get moving. Exercise is probably the most effective natural antidepressant and the most under-utilized. When you exercise and raise your heart rate, your body produces an increased number of endorphins (chemicals that boost your mood and energy level). To reduce her stress levels, and therefore reduce her psoriasis flares, Blake makes sure to exercise or practice some form of yoga and/or meditation daily.
- Talk to someone. “When we feel more stressed and anxious, more often than not there will be some type of physical manifestations of those symptoms,” explains clinical psychologist Johanna Kaplan, Ph.D., director of the Washington Anxiety Center of Capitol Hill in Washington, D.C. Reducing stress with therapeutic techniques can help a lot. And so can just connecting with someone who really gets what you're going through.