The Cycle of Psoriasis and Anxiety

There is a well-established link between psoriasis and anxiety. They are known to have a cyclical relationship, in which one can exacerbate the other, leading to flares. Managing and treating psoriasis may help reduce anxiety and vice versa.

Read on to learn more about the link between psoriasis and anxiety and how to manage it.

What’s the Link Between Psoriasis and Anxiety?

Studies have found that than anywhere from 7% to 48% of people with psoriasis have anxiety. Researchers are still trying to determine the exact relationship between them, but it is believed to be bidirectional, meaning that anxiety can trigger or worsen psoriasis flares, and psoriasis can worsen anxiety.

Studies have shown that when a person has more severe psoriasis symptoms, their anxiety symptoms increase. The opposite is also true. Anxiety can increase the severity of psoriasis.

However, while psoriasis and anxiety can make each other worse, treating one also has the potential to improve the other. Biologic treatments for psoriasis (drugs containing substances of living organisms that target specific parts of the immune system) can improve anxiety symptoms, and anxiety treatment can also improve psoriasis symptoms.

Social Stigma

Anxiety—particularly social anxiety—could be due, in part, to the shame, stress, and social stigma that a person might experience due to their psoriasis.

This theory is supported by research that has found that the location of psoriasis lesions can contribute to a person's anxiety. For instance, psoriasis lesions or plaques on the head and neck are associated with the highest levels of social anxiety, perhaps because they are most visible and perceived to be scrutinized in social settings.

Inflammation

Some scientists believe that there are biological factors at play in the relationship between psoriasis and anxiety. In particular, it is believed that the inflammatory cytokines (proteins secreted by certain immune system cells that affect other cells) produced in a person with psoriasis can lead to anxiety and depression.

This is a relatively new field of study, called psychodermatology, and is an ongoing area of research.

Tips for Managing Anxiety

Managing anxiety on top of psoriasis can be overwhelming, but there are effective options. These may include relaxation techniques, therapy, and lifestyle changes.

Relaxation Techniques

Relaxation and mindfulness techniques may help manage both your anxiety and psoriasis.

A 2020 study examined the effects of relaxation therapy on people with psoriasis. The study found that after two months, 70% of the relaxation group experienced a reduction in their Psoriasis Area and Severity Index (PASI) score by 50%, compared to only 13% of the control group.

Some examples of relaxation techniques are:

• Deep breathing, such as diaphragmatic breathing
• Meditation
• Gentle yoga
• Yoga nidra ("sleep yoga")
• Tai chi
• Progressive relaxation

Cognitive Behavioral Therapy (CBT) 

Cognitive behavioral therapy (CBT) is a type of psychotherapy that is widely used to treat anxiety. In CBT, a person learns how their maladaptive (negative) thoughts impact their behavior. Once a person understands this link, they can work toward changing their thoughts and, subsequently, their behavior.

Not only is CBT proven to help with anxiety, but it can also improve psoriasis symptoms. A 2019 review found that CBT could reduce area and severity of psoriasis, particularly in people with moderate to severe psoriasis.

Getting Enough Sleep

People with psoriasis often have sleep problems, which can worsen anxiety.

It's important to get enough sleep to manage your anxiety and let your body rest and heal overnight. Unfortunately, painful, itchy lesions or sore joints may make sleep more difficult.

Some tips to getting better sleep include:

• Practice sleep hygiene (consistent habits surrounding sleep).
• Keep a regular bedtime and wake-up time.
• Don't keep electronics in your bedroom.
• Use blackout curtains and a white-noise machine.
• Use hot or cold therapy for sore joints.
• Avoid caffeine and alcohol.
• Talk to your healthcare provider about medications or supplements to promote sleep.

Exercise

Getting regular exercise can improve your anxiety. Exercise also produces endorphins, which are neurotransmitters that help reduce the pain and stress that you might have from psoriasis.

Additional Support

Because people with psoriasis are more likely to have anxiety, screening for anxiety and any other mental health conditions is important. People with psoriasis who are most at risk of developing anxiety include:

• Women
• Those with more severe disease
• People with co-occurring psoriatic arthritis (a type of inflammatory arthritis linked with psoriasis)
• History of other mental health conditions
• Early onset (younger than 20 years old)
  

Visit your healthcare provider for a proper diagnosis and treatment for anxiety, as well as to get a referral to a mental health professional. Confiding in loved ones about your experience or joining an in-person or online psoriasis or anxiety support group may also help.

Summary

People with psoriasis are more likely to have anxiety than the general public. Psoriasis and anxiety have a cyclical relationship, meaning that one can worsen the other, but treating one may also improve the other.

Research shows that treating psoriasis can improve anxiety. Therefore, following your medication and psoriasis treatment plan is an important part of managing anxiety.

A Word From Verywell

Having psoriasis is undoubtedly stressful. In addition to pain and discomfort, you may experience feelings of lack of control over your body and shame over the visual evidence of your condition. Know that co-occurring anxiety is common, and you're not alone. Talk to your healthcare provider about treating your anxiety and psoriasis flares, because getting one under control can help the other and vice versa.