Living with a chronic condition can be stressful. That’s especially true of any visible condition, like psoriasis.
Psoriasis is an autoimmune disease that causes inflammation in the body and red, scaly, itchy patches on the skin. Often, these patches are in visible places like the knees, elbows, and scalp.
While there’s no cure for psoriasis, treatments can prevent skin flares and relieve related stress.
The connection between stress and psoriasis is complex, and it goes both ways. Stress is a known trigger of psoriasis flares. And people who develop these patches may stress about the way psoriasis makes them look and feel.
Could stress actually cause psoriasis? “In and of itself, stress is not going to be something that causes psoriasis to develop out of the blue,” says Evan Rieder, MD, assistant professor of Dermatology at NYU Langone Health.
He adds, “But it could cause a flare of the disease in someone who is already genetically predisposed to having psoriasis.”
Researchers have discovered more than 80 genes linked to psoriasis. When your relatives have this condition, you’re more likely to get it. If both of your parents have it, your risk is 75 percent. If only one parent has it, your risk is 15 percent.
Exactly why stress causes flares, researchers don’t know. People with psoriasis seem to have a problem with the hypothalamic-pituitary-adrenal (HPA) axis, the system that controls their body’s reaction to stress.
They have lower levels of the stress hormone cortisol, which normally helps tame inflammation. So when they are under stress, inflammation starts, and psoriasis flares up.
The stress of living with psoriasis can escalate this process and make symptoms even worse. Psoriasis patches are itchy and cause discomfort. There is also a stigma from having plaques on your skin.
People you meet might react to the redness by making comments or by shrinking away from touching you. “You can imagine what that does to someone’s self-esteem,” Rieder says.
One effective way to manage stress is with relaxation techniques such as meditation and
Hypnosis and biofeedback are other techniques to help ease stress. It takes regular practice of relaxation techniques for them to be effective.
Self-advocacy is important when it comes to managing psoriasis, according to Rieder. Your dermatologist may focus only on your skin and not ask questions about your mental health.
“People with psoriasis can get depression and anxiety, and it doesn’t necessarily correlate with what’s going on with their skin. Their skin can look clear,” he says.
In addition to seeing your dermatologist, he recommends talking to a therapist. “Focus on whatever is getting in the way of you being able to live your best life,” he says.
You might want to consider seeing a therapist who has experience working with people with psoriasis or other chronic conditions.
A support group is a place where you can connect with other people who have psoriasis, and learn from their experiences. “I think they can be very helpful,” Rieder says. “Unless you’re living with the condition, it’s very hard to truly empathize.”
Support groups are held in places like hospitals, community centers, and churches. You’ll also find them online. The best place to start looking for a support group is through an organization like the National Psoriasis Foundation.
It may be hard to talk to people about your psoriasis, even those closest to you. But starting the conversation can help the people that love you most give you the support you need.
For people in your outer circle, your explanation can be brief and to the point. Say something like, “It’s not infectious and you can’t get it from me,” Rieder suggests.
Be more open and honest with friends and family. Help them understand what it’s like for you to live with this disease. Once they understand, they can be better allies.
Having clearer skin can go a long way toward emotional improvement. When you’re less stressed about your skin, you may find you get fewer flares.
At least one psoriasis treatment — biologic drugs — serves double duty. Biologics are genetically engineered medications that target certain molecules in the body involved in causing inflammation, helping your immune system to operate properly.
In the case of psoriasis, these medications help relieve depression and improve quality of life while they clear the skin.
You have many options for treating psoriasis. The treatment dermatologists usually try first is a topical steroid, which slows cell production and brings down inflammation in your skin. Other, nonsteroidal topicals include anthralin, synthetic vitamin D3, and vitamin A.
Phototherapy exposes your skin to UV light to stop skin cells from growing. You can get this treatment at your doctor’s office or at home.
Systemic (body-wide) treatments such as biologics, methotrexate, and cyclosporine stop your immune system from causing inflammation in your skin. You may get one of these treatments if your psoriasis is severe or it doesn’t respond to topical treatments.
The key to getting on the right treatment is to find a doctor you trust. “Make sure you see a board certified dermatologist and get the best recommendations,” Rieder says.
“Psoriasis is a difficult condition to live with, but there’s never been a better time to live with psoriasis. We can get people clear or almost clear in the majority of cases.”
These treatments “can really improve people’s quality of life and the way that they feel,” he adds.
Stress and psoriasis are closely linked. You’re more likely to have flare-ups when you’re stressed, and psoriasis can increase your stress levels.
Seeing a dermatologist and getting on the right treatment can lead to clearer skin and less stress. A counselor or other mental health provider will help you manage the emotional symptoms of psoriasis while your treatment goes to work.