5 Common Psoriasis Triggers—and How to Tame Them
In life, you cross your T’s. In psoriasis—an autoimmune disorder affecting more than 8 million Americans—they cross you.
Those T’s are T cells, a type of white blood cell charged with protecting you from illness and infection. When you have psoriasis, your T cells begin replicating at hyperspeed and shuttling themselves to the surface of your skin. There, they pile up faster than your body can shed old skin. The result: raised, silver-red, scaly patches of skin, most often on the elbows, knees, and scalp.
If you’ve been diagnosed with psoriasis, it’s something you’ll likely be dealing with forever—but symptoms come and go. Plus, by understanding your personal agitators, there are simple ways you can limit flare-ups and control your symptoms. Here are five of the most common psoriasis triggers, along with the best way to prevent each.
Trigger #1: Stress
Money problems, cray work deadlines, a tough commute: Stress sets off symptoms in up to 88% of people with psoriasis, found a recent meta-analysis in the International Journal of Dermatology. The analysis also revealed that people who had a single traumatic event within the previous year were more likely to have the skin condition. In other words, sudden stress may activate the disease in predisposed individuals. “Some of the worst cases of psoriasis I’ve seen were in 2012 after superstorm Sandy, when so many people were dislodged from their homes,” says dermatologist Jerry Bagel, M.D., director of the Psoriasis Treatment Center of Central New Jersey.
Stress: The Fix
Make time for zen. Per a review of 60 studies, published in JAMA Dermatology, stress-relieving practices like meditation and acupuncture effectively soothe psoriasis symptoms.
Try this simple mindfulness practice: Sit on the floor, close your eyes, and focus on your breathing for 15 minutes. When thoughts sneak in—and they will—acknowledge them without judging them. Alternatively, download this guided meditation app specifically for people with psoriasis created by mindfulness pioneer Jon Kabat-Zinn, Ph.D.
Trigger #2: Skin Injuries
Any trauma to the skin, from too much sun to skinning your knee, can provoke an outbreak. Even shaving nicks can cause lesions.
This reaction is called the Koebner phenomenon, and it happens to many people who have psoriasis, says Dr. Bagel. You may not even notice the cause-and-effect, as symptoms often show up 10 to 14 days after the injury.
Skin Injuries: The Fix
Treat any ouch promptly. Scratches should be cleaned with soap and water, then covered in an antibiotic ointment. If you get too much sun, slather on a moisturizer containing aloe vera—the sooner, the better.
After that, take a hands-off approach: Scratching may feel good, but it can spark an outbreak. You’ll probably want to skip the skin ink, too: Getting a tattoo can also activate a Koebner response.
Trigger #3: Winter
Dry air, short days, and cold temperatures can cause psoriasis flare-ups. Why? People tend to itch dry skin, setting off the Koebner phenomenon, says Dr. Bagel.
Colds and the flu also are more common in the winter months, and anything that challenges your immune system can trigger psoriasis, notes the National Psoriasis Foundation. When you catch strep, for example, your immune system responds by pumping out more T cells to fight the infection. One study found that this overabundance of T cells can initiate an outbreak as some migrate to the skin.
Winter: The Fix
Keep your skin hydrated. That means limiting showers and baths to 10 minutes and using warm rather than hot water. (Long, scalding showers can strip your body of its natural oil barrier, which you want intact because it helps trap moisture.) After you towel dry, slather on a fragrance-free ointment—scented lotions can irritate skin.
And if you live in a cold-weather climate, a whole-house humidifier is a great investment—in your health.
Trigger #4: Alcohol
As many as one-third of patients with moderate-to-severe psoriasis drink excessively, likely to help cope with painful symptoms, according to research in JAMA Dermatology. While we can understand why you might do this, know that it’s a vicious circle. Researchers say alcohol increases the production of inflammatory cytokines, which cause skin cells to multiply excessively.
Alcohol: The Fix
Drink in moderation, which is generally defined as no more than one alcoholic beverage per day for women and two for men. Women: When you do imbibe, go with light beer (bummer), red or white wine, or liquor. A study from Brigham and Women’s Hospital found that these were not associated with psoriasis risk in women, but two to three non-light beers per week spiked symptoms.
‘Fess up to your dermatologist if you drink, since alcohol doesn’t mix well with some psoriasis medications, such as methotrexate.
Trigger #5: Medications
Certain drugs can elicit a psoriasis outbreak, including steroids, lithium (often prescribed for bipolar disorder), and beta blockers, which treat arthritis and high blood pressure. If you’re sensitive to a specific med, you’ll likely notice the flare-up within a month after starting it, says Dr. Bagel.
Medications: The Fix
Before starting any new prescription, ask your doctor or pharmacist if it could make your psoriasis worse—that way, if something does happen, you’ll know the possible suspect.
If you’ve already begun a med and think it’s causing an outbreak, request an alternative that may not have the same side effects, advises Dr. Bagel.
Tatoos and Psoriasis: Canadian Medical Association Journal. (2013). "The Koebner Phenomenon: Psoriasis in Tattoos." ncbi.nlm.nih.gov/pmc/articles/PMC3626811/
Winter and T cells: Advances in Dermatology and Venereology. (2016). "Throat Infections are Associated with Exacerbation in a Substantial Proportion of Patients with Chronic Plaque Psoriasis." medicaljournals.se/acta/content/html/10.2340/00015555-2408
Beer and Outbreaks: JAMA Archives of Dermatology. (2010). "Alcohol Intake and Risk of Incident Psoriasis in US Women." jamanetwork.com/journals/jamadermatology/fullarticle/422554