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How Stress Affects Psoriasis and What to Do About It

By Claire Gillespie
June 10, 2021

If you swear that stress triggers your psoriasis, and your psoriasis also stresses you out, then you’re probably right.

“The link between stress and psoriasis has been well researched and demonstrates a bidirectional relationship,” says psycho-dermatologist Alia Ahmed, M.D, confirming that stress can worsen psoriasis, and that psoriasis itself can also increase stress levels.

Of course, it’s practically impossible to avoid stress altogether, especially when you’re living with a chronic, at times unpredictable, skin condition. But knowing a little about the stress/psoriasis relationship may help you take the right steps toward reducing anxiety and tension in your life and to better cope with flare-ups during times of unavoidable stress.

What Science Tells Us

At a biochemical level, the link between stress and skin can be explained by what’s called the hypothalamic-pituitary-adrenal axis (HPA axis). “This is a stress-activated pathway that starts in the brain and causes the release of various chemicals and hormones that drive inflammation, both in the body and in the skin,” Ahmed explains. Chronic stress can overstimulate this pathway, constantly aggravating inflammation. Plus, psoriasis is also driven by immune dysfunction and response, processes directly linked to the HPA axis.

Moreover, that connection between stress and psoriasis may help explain the mental-health risks that come with the condition. An August 2010 study published in the journal Archives of Dermatology found that people who have psoriasis have a 39 percent increased risk of being diagnosed with depression compared to those who don’t have the disease. They also have a 31 percent higher risk of developing an anxiety disorder. Other research suggests that having depression may actually increase the risk of developing psoriatic disease, including a study published in the Journal of the European Academy of Dermatology and Venereology in September 2013, which found that in severely depressed women in the U.S., the risk of developing psoriasis may be nearly double that for those who are not depressed.

The HPA axis is commonly activated in people with depression, Ahmed says. “It is very interesting, as a dermatologist, to hear from patients with psoriasis that they feel that stress caused by anxiety or depression may be a trigger. I always tell them that they are right—it is!”

The Importance of Stress Management

Of course, the stress/psoriasis connection doesn’t mean it has to be a constant vicious cycle. Managing your stress can be an important part of also managing your psoriasis.

“Stress management will vary from person to person,” Ahmed says. The first thing she suggests to her patients with psoriasis and psoriatic arthritis is to adequately treat their condition. “Having better control of symptoms and signs of skin disease generally has a positive impact on mood and stress levels,” she says.

Fight the Itch

Ahmed recommends addressing the itch—a common symptom of psoriasis that can be overlooked but can also cause stress. “Itch can be tackled with better treatment of the skin,” she says. This usually means using treatments your dermatologist recommends, such as emollients, steroid creams, phototherapy, and anti-inflammatory medications, as well as adjunctive treatments like antihistamines, she says. Habit-reversal therapy may be helpful to break the itch-scratch cycle, for people who just can’t stop scratching.

The Importance of Healthy Habits

Diet, exercise, and sleep are all major factors, too. “The positive effects of a healthy diet and exercise are well known, and can enhance mood or act as stress busters,” Ahmed says, explaining that a healthy diet includes a good mix of fresh fruits and vegetables, protein, carbohydrates, dairy, and fiber, plus at least two liters of water per day.

“I recommend at least eight hours of sleep a night and always discuss sleep-hygiene techniques with patients, including having no social media for an hour before bed, limiting caffeine intake, and sticking to the same bedtime routine,” Ahmed says.

Identify Triggers

To manage stress, it’s important to work out what the potential triggers are. Ahmed suggests keeping a diary or using an app to monitor feelings of stress or anxiety. This may help you identify triggers for your flare-ups.

Find Some Zen

Ahmed recommends several psychological and relaxation therapies to her patients with psoriasis. “People are less able to relax due to everyday pressures, and often this can build up to cause feelings of overwhelm,” she says. “Taking 10 minutes at the beginning and end of the day to practice relaxation through breathing exercises or muscle stretching—which can be done in bed—may have a positive impact.”

She also suggests practicing mindfulness meditation and making positive affirmations. “Having some positive thoughts can help you to overcome—or at least lessen—negative feelings,” she says. To elevate your mood and improve your coping strategies, repeat five positive statements about yourself daily at intervals throughout the day or at stressful times.

Ask for Help

If you’re unable to manage your stress by yourself, it’s important to talk to your healthcare provider. “It’s well known that dermatologists do not have the luxury of time when treating patients,” says Evan Rieder, M.D., board-certified dermatologist at NYU Langone Health, who is also board certified in psychiatry. “Often essential questions about depression, anxiety, and even thoughts of suicide are omitted from interactions when they shouldn't be. I recommend being very direct with your dermatologist, rheumatologist, internist or whomever else is treating your psoriasis if your condition is impairing you physically or emotionally. Even if pressed for time, your doctor will want to ensure that you have access to comprehensive treatment.”

Therapy sessions with a counselor or psychologist may be helpful, and if overwhelming stress leads to clinical levels of anxiety and depression, your doctor may recommend oral medication. “This is not unusual and can be extremely helpful for those people who are unable to overcome negative feelings,” Ahmed says.

There are resources out there to help people with psoriasis manage stress, Rieder adds. “Many academic university hospitals have psoriasis centers where multimodal treatment is available through a team of clinicians, for example, a dermatologist, along with psychologists, nurses, and physician’s assistants,” he says. “These places can be great resources and are often worth the extra trip.”

When to Step Up Treatment

Of course, sometimes, stress is simply unavoidable or unmanageable. If this leads to a flare-up of physical symptoms, Ahmed suggests stepping up current treatment. And if flare-ups are occurring often, consider a different treatment approach.

If you’re struggling to manage your symptoms, taking time off work may be a good idea—and if you feel comfortable sharing information about your condition with your employer or colleagues, it may help them support you in the workplace, says Ahmed. In fact, a strong support network is crucial to managing both stress and psoriasis. Joining a psoriasis support group is great for support, as is exchanging information and increasing your understanding of the condition.

“The more people with psoriasis understand their condition, and its relationship to stress or mood, the better we are able to control their symptoms,” Ahmed says. “Of course, this may not work for all people with psoriasis, but having a holistic approach to skin disease can help patients realize that there are a number of ways to manage their condition.”

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