When the red, itchy patches of psoriasis flare up, it interrupts daily life until you can get your symptoms under control. We know genetics plays a role in psoriasis, but you can’t change your genes. Knowing and learning what triggers your flare-ups, however, can empower you to do what you can to avoid them.
“Psoriasis results from a combination of genetics and the environment,” said Alex Ortega Laoyza, MD, an assistant professor of dermatology at Oregon Health & Science University in Portland. If you can learn the environmental factors triggering your psoriasis, it could help you prevent flare-ups or reduce your symptoms’ severity.
Try to tamp down stress
It’s no surprise that stress can trigger psoriasis flare-ups. Worse, it becomes a vicious cycle. The flare-up causes more stress, which worsens symptoms, and so on. Since you can’t avoid daily stress completely, develop stress management strategies that work for you. Two of the best are physical activity and practicing mindfulness-based meditation. Physical activity not only relieves stress, but also boosts your overall health. Mindfulness practice also has evidence backing its health benefits. And be sure you’re getting enough sleep each night. The National Sleep Foundation recommends seven to nine hours a night for the average adult. It’s not clear if insufficient sleep can increase stress, but a small amount of evidence suggests sleep deprivation could make it harder to manage the stress you already have.
Drop excess pounds
Research has shown that weight gain and obesity are associated with a higher risk and greater severity of psoriasis. “Obesity increases the inflammatory state, and that might trigger other medical conditions,” Dr. Ortega said. “When patients are obese, they are sometimes more resistant to treatments as well,” he added.
When patients lose weight, their psoriasis often improves, Ortega said. Research backs him up. A 2014 research review in the Journal of the American Academy of Dermatology found that weight loss may help prevent and treat psoriasis and psoriatic arthritis in some patients, though we need more research to know how much weight loss might help. Another study in the British Journal of Dermatology in 2014 found almost twice as much improvement in psoriasis symptoms among those who followed a diet and exercise plan to lose weight.
We know less about gastric bypass surgery, but some studies suggest surgical weight loss can reduce symptoms in some patients too, though, again, we still need more research. Losing weight can be tough, but slowly improving your diet and doing more physical activity pays off even if you don’t reach your perfect weight.
Soothe dry skin
Keeping your skin moisturized may not prevent skin plaques, but thick creams, ointments and even oils may help prevent and relieve itching, one of psoriasis’s most unbearable symptoms, according to the National Psoriasis Foundation. Moisturizers are even more effective if you use products with salicylic acid, lactic acid, urea or phenol that soften the scaliness of skin plaques and reduce cracking and flaking.
Still itching? The NPF recommends using cold packs on the skin and skipping hot baths for cool showers instead. Hot water irritates and dries out the skin. Over-the-counter products that treat itching include benzocaine, calamine, camphor, diphenhydramine hydrochloride (HCl), hydrocortisone and menthol. But keep in mind: these products affect people differently and may worsen symptoms in some people.
Quit smoking
“People who are smoking or are alcohol-dependent are more prone to develop psoriasis with the appropriate genetic background,” Ortega said. In a 2012 study of more than 185,000 people in the American Journal of Epidemiology, smokers had nearly double the risk of developing psoriasis, and the risk increased with the number of daily cigarettes smoked. Although past smokers had a higher risk too, it wasn’t as high as current smokers. An earlier study in the American Journal of Medicine found a similar increased risk—but it dropped to almost the same as nonsmokers’ risk 20 years after quitting smoking. And according to a study in 2005, the more cigarettes someone with psoriasis smoked, the more severe their symptoms were. Quitting smoking may not make psoriasis go away, but it may reduce flare-ups and more severe symptoms.
Consider dietary factors
We don’t know a lot about diet and psoriasis, but it’s worth looking at whether your diet could be worsening your symptoms. Is your diet helping you lose weight or maintain a healthy weight? Small improvements over time go a long way, such as eating small portions at each meal and only when you’re hungry. Also avoid high-calorie snack foods that don’t offer substantial nutrition, or make them only infrequent treats. The key components of a healthy diet include eating more whole foods and grains, vegetables, vegetable-based oils, low-fat dairy and lean meats like poultry and fish while avoiding processed foods.
Be mindful of changing seasons and weather
Changes in the seasons can trigger or weaken psoriasis symptoms, said Doris Day, MD, a dermatologist at Lenox Hill Hospital in New York City. “Some find their psoriasis is worse in the summer,” Day said. “Others have it worse in the winter and find that sunlight helps reduce skin lesions.” You can’t control the seasons or weather, but you can be prepared when new seasons arrive and use the sunlight if it helps.
Accept what you cannot change
Just like you can’t control the seasons and your genetics, you can’t control all possible psoriasis triggers. So, focus on what you can control. “Maintain a great skin care regimen, use a great moisturizer twice a day, manage stress as well as you can, get a good night's sleep and eat as healthy a diet as possible,” Day said. “Weight management and quitting smoking if you're a smoker are also very important.”
