The National Psoriasis Foundation lists stress as a psoriasis trigger, but exactly why stress can cause psoriasis to flare remains unclear.
However, a 2016 report from the International Psoriasis Council Workshop, published in the journal Frontiers in Psychology, may shed some light on the relationship between stress reactivity and psoriasis.
According to this report, the negative impact increased stress has on the disease may be related to “cortisol dysregulation within the hypothalamic-pituitary-adrenal axis.”
The hypothalamic-pituitary-adrenal axis (HPAA) is a complex set of relationships between three endocrine glands: the hypothalamus (the part of the brain that coordinates the autonomic nervous system), the pituitary gland (an important structure at the base of the brain, which controls many other hormone glands, like the adrenals and thyroid), and the adrenal glands, which produce vital hormones, such as cortisol (which helps the body respond to stress) and aldosterone (which helps control blood pressure).
“The HPAA regulates cortisol levels in the body,” says Florida dermatologist Todd Minars, M.D. “Cortisol is kind of like cortisone, which we use in creams to treat psoriasis. It regulates many systems in our body including our immune system and inflammation — and psoriasis is related to the skin's immune system and the skin's inflammation.
“If stress affects the HPAA, which affects cortisol, which affects the skin's immune system/inflammation, this is the chain of events that connects stress to psoriasis.”
Experts also believe that a genetic predisposition may be a factor in the relationship between stress and psoriasis.
“Our immune systems do not differentiate between a life-threatening imminent threat such as a lion about to attack us versus life, family, and love stressors. In all these cases, the immune system mobilizes and prepares to do battle,” explains Richard Fried, M.D. Ph.D., National Psoriasis Foundation board member.
“If we have a genetic predisposition to overreact, we will do so in the manner that we are pre-wired to do so. If we are pre-wired to increase cell turnover and inflammation, we will make psoriasis de novo or make a lot more psoriasis.”
In other words, some of us may simply be designed to respond to stress with psoriasis — what Dr. Fried calls our personal “immune irritability.”
While stress doesn’t cause psoriasis (so if you don’t have psoriasis in the first place, stress won’t give you the disease), it’s clearly a trigger for many people.
Juliette Michens, 45, has had psoriasis since she was a teenager, and for her, stress is the greatest trigger. “My psoriasis flares during any periods of stress, whether it is work-related or due to personal problems,” she says. “And when my life is relatively calm and stress-free, my skin is less inflamed and itchy.”
It’s hard to measure stress — meaning getting objective data on the number of people with psoriasis who find stress is a trigger is difficult. But the anecdotal evidence is there.
“My psoriasis patients certainly report flare-ups when they are stressed,” said Dr. Minars. He believes that the best way to manage stress is cardiovascular exercise, which is important for psoriasis patients for another reason — psoriasis comes with a slightly higher risk of cardiovascular disease. Also, a study published in Archives of Dermatology in 2012 found that women who regularly participate in vigorous exercise are less likely to get psoriasis than less-active women.
Dr. Minars recommends at least 15 minutes of cardiovascular exercise per day, four days per week.
Other things that may help people with psoriasis manage stress are yoga, Tai Chi, cognitive behavioral therapy, and transcendental meditation. If you’re a beginner to meditation, the National Psoriasis Foundation suggests spending 15 minutes per day sitting comfortably on the floor, with your eyes closed or barely open, and focusing on your breathing.
Carla Robertson, 28, noticed a difference in her skin when she started making anti-stress measures a priority. She took up yoga and mindfulness meditation, and over the past 12 months her psoriasis flares have been less severe than in previous years — regardless of other factors, like the weather.
“For years I stressed about my skin, without realizing that my stress levels could have been making my psoriasis worse,” says Robertson. “When I finally took steps to reduce my stress levels, I saw a difference. I still have psoriasis, but I feel more in control because I know I can do things to help with my symptoms and perhaps even avoid flares.”
Of course, having psoriasis is stressful in itself, so it’s important to follow your treatment plan to keep flares to a minimum. And if you need outside help to deal with stress, look for a therapist in your area who deals with stress management.