Can Stress Cause Psoriasis Flare-Ups?

Stress can cause a flare-up of psoriasis, an autoimmune disease that affects the skin. The complex relationship between stress and psoriasis can make it difficult to treat.

Studies show stress is the most common trigger for a psoriasis flare-up. At the same time, a worsening of psoriasis symptoms can cause further stress.

Fortunately, research shows you can break the psoriasis-stress cycle with relaxation techniques. Effective stress-management strategies for people with psoriasis include meditation, exercise, cognitive behavioral therapy, and other relaxation techniques. 

This article discusses the complex relationship between stress and psoriasis. It includes types of stress that can trigger psoriasis flare-ups. It also explains how stress-management techniques can help minimize psoriasis flare-ups.

How Does Stress Cause Psoriasis Flare-Ups?

How stress affects psoriasis is not fully understood. One theory is proinflammatory cytokines—immune-system molecules that increase inflammation—play a role in both.

Chronic stress has long been associated with elevated blood levels of proinflammatory cytokines. These same cytokines are involved in causing psoriasis.

Studies of skin samples show elevated cytokine levels in psoriatic plaques compared to healthy skin tissue. There is also a connection between blood levels of cytokine and the severity of a psoriasis flare-up.

Researchers theorize psoriasis symptoms are caused by a cytokine storm that prompts an over-production of new skin cells. Elevated cytokine levels from chronic or acute stress may trigger the altered immune response behind a psoriasis flare.

How Psoriasis Causes Stress

Psoriasis flare-ups can also cause psychological stress. Research shows psoriasis flare-ups are associated with negative feelings, including:

• Anxiety
• Depression
• Feelings of embarrassment or shame
• Fear of rejection due to social stigma
• Lack of confidence
• Low self-esteem
• Negative body image

These negative emotions prompt the release of inflammatory cytokines, perpetuating the psoriasis-stress cycle.

Stressors Linked to Flare-Ups

Research shows stress can trigger psoriasis flare-ups and worsen existing flares. Unfortunately, stress is a common experience for many people.

A 2020 survey by the American Psychological Association found that almost 78% of Americans said that the coronavirus pandemic was a significant source of stress, while three in five people stated that the number of issues in America has overwhelmed them. 

Different types of stress that may trigger a psoriasis flare-up include:

• Financial stress
• Illness
• Parenting
• Relationship problems
• Social isolation
• Work stress

Stress-related inflammation may also play a part in neuropsychiatric disorders that alter the metabolism of norepinephrine, serotonin, and dopamine (molecules involved in nerve cell transmissions), which can lead to depression.

Studies also showed that administrating cytokines or cytokine inducers in healthy volunteers and laboratory animals induced symptoms of depression and anxiety, which increases cytokine levels. The use of anti-inflammatory therapies in patients with inflammatory disorders like psoriasis is linked with significant improvement in symptoms of depression.

Manage Stress, Manage Psoriasis

Research shows that stress-management techniques can effectively break the psoriasis-stress cycle. In fact, mind-body therapies like meditation have been shown to reduce itching, irritation, and rash severity in people with psoriasis and other skin conditions. 

Methods that can help manage stress and psoriasis symptoms include:

• Relaxation techniques: Activities like deep belly breathing, guided imagery, a daily meditation practice, yoga asanas, or tai chi practice trigger the relaxation response. This helps lower your blood pressure, heart rate, and breathing rate, and decreases the levels of stress hormones like cortisol. 
• Cognitive behavioral therapy (CBT): A therapist who practices CBT will help you identify negative and unhealthy thinking and replace it with healthy and positive thoughts. One common practice in CBT is keeping a gratitude journal. Studies show that gratitude is linked to happiness and helps improve health. 
• Setting goals: When you set goals to achieve, it allows you to be in control. Make a goal to meditate daily for 10 minutes or start a hobby, like painting or a creative project, that allows you to move the focus away from the stress trigger.
• Exercise: Spend at least 30 minutes a day moving. Go for a walk and surround yourself with nature; dance or do any type of activity that increases your heart rate as well as your endorphin levels (chemicals the body produces that relieve stress and pain). 

Find Support

If you need support from others who are affected with psoriasis, speak with your dermatologist and ask whether they know of any support groups within your area. The National Psoriasis Foundation has branches that provide support in several cities across the United States and also offer an online community.

Some social media platforms, like Facebook, also have dedicated psoriasis groups that offer support and personal tips. However, be aware that some of these groups may be open to the public and not private, or may offer products to sell.

Summary

Psoriasis is an autoimmune disorder in which inflammation leads to symptoms such as skin plaques and scaly areas. Stress is a trigger for flare-ups of psoriasis. Managing your stress may help prevent flares.

A Word From Verywell

Living with psoriasis can be uncomfortable and sometimes even painful—emotionally and physically. But it’s key to manage your stress so that it doesn’t trigger flare-ups. By managing your stress through cognitive behavioral therapy, meditation, yoga, or tai chi, you’ll be able to learn to avoid the triggers and enter into remission that may lead to no symptoms and clear skin.