What Causes Psoriasis to Flare?

Most psoriasis sufferers know that the condition can flare and improve, sometimes seemingly for no reason. The unexpected nature of the flares can be particularly frustrating, you can be doing well one minute and then poorly the next. Certainly, not all flares can be predicted. Controlling the known triggers of psoriasis in your life, however, can help prevent some of them.

Stress is a common trigger of psoriasis. Emotional stress can come in many forms, including issues at your job, challenges at home like divorce or raising children, and anxiety about current events. Sometimes emotional stress is not just one thing but a collection of hectic issues that prevent you from relaxing.

Although not all stress can be prevented, taking some time every day to help control stress can help prevent flares of psoriasis. Exercise, like yoga, jogging, or weight lifting can reduce stress. Healthy eating habits and meditation can also be helpful. 

Physical stress on the body is also a common trigger. A major illness, surgery, or childbirth are all common causes of a psoriasis flare. Infections are particularly common sources of a flare-up, especially streptococcal infections like strep throat. See your doctor for new symptoms to try to prevent a minor illness from becoming major and wreaking havoc with your psoriasis.

Medications for other health problems can cause unexpected flares of psoriasis. Whenever you are being prescribed a new medication, let your prescribing doctor and pharmacist know that you have psoriasis. Never stop a medication without first consulting with the doctor who prescribed it, since some medications can be dangerous if stopped suddenly.

• Beta-blockers. These medications are commonly used to treat high blood pressure and certain heart problems. Their generic names usually end in the letters -lol, like atenolol, metoprolol, or propranolol.
• Lithium. It is used for bipolar disorder and some other psychiatric problems.
• Anti-malarials. Some older medications to treat malaria, like hydroxychloroquine (Plaquenil) cause psoriasis flares. These medications are not commonly used for malaria anymore but are sometimes used for lupus and related conditions.
• Indomethacin. It is a non-steroidal pain medication that is sometimes used for sore joints, which may be a sign of psoriatic arthritis.
• Oral steroids. Medications like prednisone and prednisolone can temporarily make psoriasis better but then cause flare-ups, sometimes severe, when they are finished.

Dry winter weather or travel to dry climates can cause psoriasis to flare up as the skin dries out and splits. Using a gentle soap to bathe (like Dove or Cerave Cleanser) can help. Avoid the soaps in hotels which usually are very drying and have a heavy fragrance. Be sure to moisturize the skin with a fragrance-free cream daily.

The sun typically makes psoriasis better, so traveling to darker and colder climates can also cause a flare. Too much sun can be a problem too, though, as sunburn can cause psoriasis to arise in the sites of the burn. Make sure to wear a hat and sunscreen with an SPF of 30 or higher when traveling to sunny climates.

It has long been known that cutting or injuring the skin can cause a flare of psoriasis in the same spot. Dermatologists call this effect the “Koebner Phenomenon”. Psoriasis can often arise along the incision line after surgery or on the arms after a burn or bite wound. Protect yourself with long-sleeves and thick clothing when working in the yard or other places where minor injuries are common. When a minor injury does occur, clean the area with soap and water and then apply an antibiotic ointment and cover with a bandage until it heals. See your dermatologist for any wounds that are slow to heal or for signs of infection like unusual pain, heat, or redness around the wound.

Although these triggers are all common reasons for psoriasis to flare, others have been suggested by scientific evidence like smoking cigarettes, being overweight, and drinking too much alcohol. It is important to keep track of how your skin is doing so you can develop a list of your own psoriasis triggers. If you suspect something is triggering your psoriasis, be sure to discuss it with your doctor to see if there are ways to control the trigger, or calm the flare-up.