Most people living with psoriasis
experience good days when their skin clears and bad days when
psoriasis flares. A trigger is usually needed to make psoriasis
appear — whether it is for the first time or the thirtieth. Common
psoriasis triggers are:
Studies show that some infections can trigger psoriasis.
Dermatologists have seen people with a family history of psoriasis
get strep throat and develop their first psoriasis lesions two weeks
later. Strep throat often precedes an outbreak of
Inverse psoriasis is frequently
aggravated by a thrush infection. Infections that can trigger
Candida albicans (thrush)
Human immunodeficiency virus (HIV)
Staphylococcal skin infections (boils)
Streptococcal pharyngitis (strep
Viral upper respiratory condition
Treating the infection in many cases
lessens or clears the psoriasis.
Reaction to Certain
Some people develop psoriasis for the first time or experience a
flare-up after taking certain medication. Medications that can
trigger psoriasis are:
Anti-malarial drugs. Dermatologists
have seen people develop psoriasis for the first time after taking
an anti-malarial medication.
Beta-blockers (medication used to treat
high blood pressure) and heart medication. These worsen psoriasis in
Corticosteroids. These medications,
which range in potency from extremely mild to very strong, are used
to treat psoriasis and can be very effective. It is important to use
these medications as directed. Overuse and sudden withdrawal of some
oral corticosteriods can aggravate psoriasis.
Indomethacin (non-steroidal medication
used to treat arthritis and other inflammatory conditions) worsens
psoriasis in some people.
Lithium (used to treat manic depression
and other psychiatric conditions) aggravates psoriasis in about 50%
of people who have psoriasis.
If you have psoriasis or a family
history of psoriasis, be sure to let the doctor prescribing any of
the above medications know. Other medications can sometimes be
People with psoriasis often notice new lesions 10 to 14 days after
the skin is cut, scratched, rubbed, or severely sunburned.
This is called the “Koebner phenomenon”
and is named after Dr. Koebner who in the 19th century observed that
a patient developed new lesions in areas where his horse bit him.
This relationship between skin injury and developing new psoriatic
lesions has been observed in many patients. Today, a wide range of
traumas and skin conditions are known to trigger Koebner’s
Research shows that about 50% of people
with psoriasis experience the Koebner phenomenon — developing a
psoriatic lesion at the site of a skin injury or in the same place
as another skin condition. About 10% of psoriasis patients develop a
new psoriatic lesion each time the skin is injured. The likelihood
of developing the Koebner phenomenon may increase when psoriasis
lesions are already present.
Ask anyone with psoriasis what triggers a flare-up, and stress is
likely to top the list. Scientific studies confirm that stress can
worsen psoriasis and increase itching. Some people can even trace
their first outbreak to a particularly stressful event.
Having psoriasis is, in itself,
stressful. When lesions are visible, people may stare and not want
to get near. They may ask, “What did you do to your skin?” Even a
spouse, parents, children, friends, and co-workers can be visibly
uncomfortable. Some people report that a spouse cannot bear to touch
them during severe outbreaks. Others say they feel embarrassed or
ashamed by their skin.
When psoriasis develops on the hands
and feet, it is often difficult for people to perform daily tasks,
such as picking up objects, typing, and walking. This can make
holding a job or caring for a child extremely challenging. The
itching and pain caused by psoriasis also makes daily life
Treating psoriasis can add to the
stress. Some treatments are time-consuming. Broadband phototherapy
requires three to five visits per week to a clinic, and narrowband
requires two to three. Topical medications can be time-consuming to
apply. After spending time and money to treat the psoriasis, a
person may find the treatment ineffective. Potential side effects
deter some people from opting for systemic medications, such as
methotrexate and cyclosporine. The cost of treating psoriasis adds
stress to many people’s lives. Some living with psoriasis find that
they cannot afford to pay for the newer treatments, such as the
When the everyday stress of living with
psoriasis is compounded by a stressful event at work, a personal
crisis, or an especially hectic time, such as the holidays, the
stress can feel overwhelming.
People may try to alleviate stress with
an herbal or natural over-the-counter remedy. However, some food
supplements and herbal remedies interact negatively with
prescription medications. People also turn to alcohol and others
drugs to reduce stress. Research shows that this actually increases
Dermatologists recommend that their
patients tell them if they feel overwhelming stress. There are many
healthy ways to relieve stress. Many patients find that
psychological counseling or joining a support group effectively
reduces stress. Your dermatologist may be able to help you find a
therapist or a support group. Some patients prefer to adopt a
popular relaxation technique, such as meditation. Exercise also can
help reduce stress.
Winter tends to be the most challenging season for people living
with psoriasis. Numerous studies indicate cold weather is a common
trigger for many people and that hot and sunny climates appear to
clear the skin.
Cold winter weather is dry, and indoor
heat robs the skin of needed moisture. This usually worsens
psoriasis. Psoriasis can become even more severe when the stress of
the holidays and winter illnesses combine to compromise immune
While hot and sunny may help clear
psoriasis, air-conditioning can dry out the skin and aggravate
psoriasis. Moisturizing can help prevent this.
Science has not uncovered all psoriasis triggers. Hormones, smoking,
and heavy drinking appear to trigger psoriasis in some people.
How hormones affect psoriasis is still
not well understood. Research shows that many people develop their
first psoriatic lesions just after puberty when hormone levels fall.
When hormones levels increase during pregnancy, psoriasis improves
for many women. A recent study showed that 55% of pregnant women
with psoriasis reported an improvement, 21% saw no change, and 23%
experienced worsening. After delivery, only 9% reported improvement
and 65% saw their psoriasis worsen. More research is needed to
understand these effects.
Research suggests that localized (on the palms and soles) pustular
psoriasis may be more common in people who smoke tobacco. Other
studies suggest a correlation between smoking and developing plaque
psoriasis. There also seems to be a link between smoking and
developing severe psoriasis.
Quitting smoking improves psoriasis for some; however, quitting does
not always clear the psoriasis. More research is needed in this
It is now believed that heavy drinking may trigger psoriasis in some
people. Heavy drinking also may make treatment less effective.
Again, more research is needed.
More Good Days than Bad
While there is no cure, psoriasis can be successfully managed so
that one experiences more good days than bad. Numerous treatment
options are available, and recent advances are revolutionizing the
management and care of psoriasis. A dermatologist considers a
patient’s overall health, age, lifestyle, and the severity of the
psoriasis in order to find a treatment option that will achieve
Behnam SM et al. “Smoking and psoriasis.” SKINmed. 2005
Bowcock AM et al. “Genetics of psoriasis: The potential impact on
new therapies.” Journal of the American Academy of Dermatology.
Murase, JE et al. “Hormonal Effect on Psoriasis in Pregnancy and
Post Partum.” Archives of Dermatology. 2005
All content solely
developed by the American Academy of Dermatology
For an overview, visit
the AAD pamphlet
Psoriasis and Psoriatic Arthritis.