Psoriasis Flare-Ups

One of the frustrating things about psoriasis is its unpredictability. Your skin may improve for weeks or months and then, seemingly without warning, the redness, scaling and irritation return. Sometimes there is an obvious explanation. At other times, it can be difficult to understand why a flare has happened at all.

Psoriasis is a chronic immune-mediated inflammatory condition. It causes skin cells to reproduce much faster than normal, resulting in the characteristic raised, scaly plaques. Treatments can settle these plaques, sometimes very effectively, but they do not necessarily remove the underlying tendency toward psoriasis.

This is why psoriasis often follows a pattern of improvement, remission and flare-up.

For me, one of the most useful questions is therefore not simply:

What can I put on psoriasis?

but:

What seems to make this particular person's psoriasis better or worse?

The answer can be very different from one person to another.

What Causes Psoriasis Flare-Ups?

A psoriasis flare-up occurs when psoriasis becomes more active. Existing plaques may become redder, thicker or itchier, or new areas may appear.

There isn't always one identifiable cause.

Psoriasis involves the immune system, genetics and the skin itself, and many different influences can affect its activity. Some people eventually recognise a very clear pattern. Others may have several smaller influences working together.

Here are some of the more common possibilities worth considering.

1. Stress

Stress is one of the most commonly reported psoriasis triggers.

That doesn't mean psoriasis is simply "caused by stress." It isn't.

But the nervous, hormonal and immune systems continually communicate with one another. Prolonged emotional strain can affect inflammatory processes and may contribute to flares in susceptible people.

There can also be a vicious circle.

Psoriasis itself can be stressful. Visible plaques, itching, discomfort or embarrassment can affect confidence and quality of life. The psoriasis creates stress, while the stress may make the psoriasis harder to settle.

For someone whose psoriasis repeatedly worsens during difficult periods, it may therefore be worth looking not only at the skin but also at what was happening in life shortly before the flare.

Were you under unusual pressure?

Had you been sleeping badly?

Had there been conflict, grief, anxiety, examinations, work pressure or some other sustained strain?

Sometimes the timing tells us something.

2. Infections

Certain infections can trigger psoriasis or make existing psoriasis worse.

One of the best-known examples is guttate psoriasis, which can appear following a streptococcal throat infection. Instead of the larger plaques associated with plaque psoriasis, many small, drop-shaped lesions suddenly appear across the body.

Other illnesses can also place additional demands on the immune system.

If psoriasis suddenly flares after being relatively quiet, it can therefore be useful to think back over the previous few weeks rather than looking only at what happened that day.

Had there been a sore throat, respiratory infection, fever or other illness?

The skin may sometimes be responding to events that have already passed.

3. Injury to the Skin

Psoriasis has a fascinating tendency to appear where the skin has been injured.

This is called the Koebner phenomenon.

A scratch, cut, burn, insect bite, tattoo or repeated friction can sometimes be followed by a new psoriasis plaque developing in exactly that area.

Even persistent scratching can potentially keep irritated skin caught in a cycle.

For this reason, gentle skin care is particularly important.

The objective is not to scrub scales away aggressively. It is usually better to protect the skin barrier, moisturise regularly and minimise unnecessary irritation.

4. Cold and Dry Weather

Many people find their psoriasis becomes worse during winter.

Cold air tends to contain less moisture, indoor heating dries the skin further, and people usually receive less sunlight than they do during summer.

The result can be increasingly dry, cracked and irritated skin.

Some people experience the reverse pattern, but if your psoriasis predictably worsens every winter, season may be one of your personal triggers.

Simple measures such as regular moisturising, avoiding excessively hot showers and protecting the skin from cold dry air can make a meaningful difference.

5. Alcohol and Smoking

Smoking is associated with psoriasis and may also be associated with more severe disease.

Heavy alcohol consumption can likewise aggravate psoriasis in some people and can complicate certain psoriasis treatments.

This doesn't mean that everyone with psoriasis must live an impossibly restrictive life.

Rather, it is another area where individual observation can be useful.

If psoriasis repeatedly worsens during periods when alcohol intake rises, for example, that pattern is worth noticing.

6. Medication

Occasionally, a medication can provoke or worsen psoriasis.

Medicines that have been associated with psoriasis include certain beta-blockers, lithium, antimalarial drugs and some other medications.

This does not mean you should stop prescribed medication because you have psoriasis.

Stopping some medicines suddenly can be dangerous, and medication changes should always be discussed with the prescribing doctor.

But if psoriasis begins or changes noticeably after starting a new medication, it is worth mentioning the timing to your doctor or pharmacist.

7. Diet and Metabolic Health

There is no single "psoriasis diet" that works for everyone.

That is an important point because people with psoriasis are frequently given long lists of foods they supposedly must avoid.

In reality, psoriasis varies considerably between individuals.

What does appear increasingly important is the broader relationship between psoriasis and inflammation and metabolic health. Psoriasis is associated with a higher prevalence of conditions such as obesity, metabolic syndrome and cardiovascular disease.

For this reason, I prefer looking at the overall quality of someone's diet rather than immediately eliminating a long list of individual foods.

Questions I might consider include:

• Is the diet predominantly fresh, whole food or highly processed?

• Is the person getting enough vegetables, fruit and good-quality protein?

• Are omega-3-rich foods being eaten regularly?

• Is alcohol excessive?

• Is there an obvious food that consistently seems to precede a flare?

• Is the person's weight and metabolic health contributing to their overall inflammatory burden?

The goal is not dietary perfection.

It is to discover what supports this particular person's health.

8. Sleep and General Resilience

Sleep is sometimes forgotten when discussing skin health.

Yet sleep is closely connected with nervous-system regulation, hormones, immune function and our ability to cope with stress.

A few nights of poor sleep will not necessarily cause psoriasis. But months of inadequate sleep, exhaustion and constant pressure may be part of a much larger picture in someone whose health is struggling.

This is why I prefer to look at patterns rather than isolated factors.

Perhaps the flare followed an infection.

But perhaps that infection occurred after several months of poor sleep and excessive work.

Perhaps stress increased at the same time.

Sometimes there isn't a single culprit.

There is simply a point at which the person's resilience becomes overwhelmed.

Finding Your Personal Psoriasis Triggers

The internet can provide an enormous list of possible psoriasis triggers.

The problem is that a list isn't necessarily your list.

One person may notice that winter reliably makes their psoriasis worse.

Another may flare following throat infections.

Someone else may have relatively stable skin until a major period of emotional stress.

And another person may never identify a clear trigger at all.

This is why keeping a simple record can sometimes be surprisingly useful.

You don't need an elaborate diary. When your psoriasis changes, simply note what has been happening during the previous days and weeks:

Skin: Where is the psoriasis? Is it spreading, itching or changing?

Health: Have you recently been ill?

Stress: Has anything unusually demanding been happening?

Sleep: Are you rested or exhausted?

Diet and alcohol: Has anything changed significantly?

Skin irritation: Was there scratching, sunburn, injury or friction?

Medication: Has anything recently been started, stopped or changed?

Weather: Has the season or humidity changed?

After several months, patterns sometimes emerge that were invisible when each flare was viewed separately.

Treat the Psoriasis — But Look for the Pattern Too

There is an important balance here.

Looking for triggers should never mean withholding effective treatment while searching endlessly for a hidden cause.

Psoriasis can sometimes require medical treatment, particularly when it is extensive, painful or significantly affecting quality of life. Modern psoriasis treatment can include topical medicines, phototherapy and systemic or biological medications.

And anyone with psoriasis who develops joint pain, stiffness, swelling or persistent heel or tendon pain should discuss this with a doctor, because psoriasis can be associated with psoriatic arthritis.

But treating the plaques and understanding the individual are not mutually exclusive.

We can care for what is happening on the skin while also asking:

Why now?

What was different before this flare?

What seems to make it better?

What repeatedly makes it worse?

Those questions can sometimes reveal useful patterns.

Psoriasis Is Personal

Two people can have the same diagnosis yet experience psoriasis very differently.

Their triggers may be different.

Their lifestyles may be different.

Their stress levels may be different.

Their nutritional needs may be different.

Even the things that soothe their skin may be different.

This is one reason I favour an individualised, whole-person approach rather than assuming that everyone with psoriasis needs exactly the same programme.

We start with the obvious: the diagnosis, the condition of the skin, medical treatment where needed and practical skin care.

Then we look outward.

Nutrition. Sleep. Stress. Lifestyle. Recent illness. Emotional wellbeing. Individual triggers.

Sometimes a clear pattern emerges. Sometimes it doesn't.

But asking the questions can be worthwhile.

Could Something Be Contributing to Your Psoriasis Flare-Ups?

If your psoriasis keeps returning and you're wondering whether there may be a pattern behind your flare-ups, we can look at the bigger picture together.

In a free introductory call, we can discuss your psoriasis, when it tends to worsen, what you have already tried and whether factors such as nutrition, stress, lifestyle or other individual triggers may be worth exploring.

There is no obligation to continue.

Sometimes the first useful step is simply having the opportunity to tell your story and begin putting the pieces together.

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