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Fact Checked

A Look into Five Established Triggers for Psoriasis

August is National Psoriasis Awareness Month, allowing for the perfect opportunity for you to learn more about this disease.  A recent study estimated that 7.4 million adults within the United States have psoriasis.  

Psoriasis is commonly recognized by the cracked, itchy patches of skin associated with the condition. Symptoms of psoriasis range from mild to severe and can be aggravated and flare at times. 

What is Psoriasis?

Psoriasis is an autoimmune disease where your body experiences a rapid buildup of cells, which leads to scales forming on the skin.  An autoimmune disease is where your body’s immune system becomes overactive and starts to attack normal healthy tissues.  The scales that form are typically seen on the joints but can also be found on your hands/feet, scalp, neck, nails, mouth or genitals.

Common symptoms associated with psoriasis include itchy patches of skin, dry and cracked patches of skin that may bleed, thickened nails or stiff and swollen joints.  These symptoms can range from mild to severe.

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Types of Psoriasis

There are five different types of psoriasis:

  • Plaque psoriasis: is the most common type of psoriasis, and it is characterized by silvery buildup over red/irritated skin
  • Guttate psoriasis: is characterized by tiny dot-like lesions
  • Inverse psoriasis: is typically found in the folds of the skin
  • Pustular psoriasis: is characterized by white pustules on the skin
  • Erythrodermic psoriasis: is the most severe and rare form of psoriasis where most of the skin is covered in redness.  The skin can also flake off in sheets.

Approximately 10-20% of people with psoriasis also have psoriatic arthritis.  This is an inflammatory type of arthritis, and when it is seen with psoriasis, it may be classified as psoriatic disease.

Psoriasis Triggers

There is not a “one size fits all” set of psoriasis triggers.  What may affect one person could have no effect on another.  According to the National Psoriasis Organization here are some established psoriasis triggers:

Stress: is a highly established trigger for psoriasis and can cause it to flare for the first time or exacerbate existing psoriasis.  Learning how to manage and cope with stress can play an important role in reducing flare-ups and calming symptoms. Yoga, meditation, breathing exercises, and journaling are all great stress-relief options to try.

Injury to skin: you may notice psoriasis patches appearing in areas of the skin that have been injured or traumatized. This is known as the Koebner phenomenon, which describes the formation of skin lesions on parts of the body where psoriasis typically does not occur for that person.  Everything from a cut or scrape to a vaccine or sunburn can trigger this response.  It is best to take the proper precautions, such as wearing gloves or long sleeves when gardening or applying sunscreen when you plan to be outside.

Medications: certain medications are associated with being a trigger for psoriasis:

  • Lithium: is used to treat psychiatric conditions and can worsen psoriasis in about half of the people with psoriasis who take it
  • Antimalarial: medications such as Plaquenil or Quinacrine may cause flare-ups of psoriasis (usually a few weeks after the drugs are taken)
  • Inderal: about 25-30% of people with psoriasis who take this high blood pressure (beta-blocker) medicine experience aggravated psoriasis.  It is not known if all beta-blockers have this effect, but there is that possibility.
  • Quinidine: in some cases, this heart medication may worsen psoriasis
  • Indomethacin: there have been some cases where this anti-inflammatory medicine has worsened psoriasis.  If appropriately taken, the effects are typically minimal.  Since this medication is used to treat arthritis, it still may be beneficial to use in people with psoriatic arthritis.

Before starting any new medication, it is best to speak with your primary care doctor or pharmacist and inform them of all of your health conditions.

Infection: your immune system mistakenly attacking healthy skin cells is partially what leads to psoriasis.  So if you are sick, your immune system is working harder to fight the infection, which can lead to a psoriasis flare-up.  A strep throat infection is a common trigger, especially for guttate psoriasis.

Alcohol: some research has demonstrated that there may be a connection between alcohol use and psoriasis.  The findings show that people with psoriasis should limit or exclude alcohol from their diet as alcohol may cause:

  • Drug interactions with medications used to treat psoriasis, such as methotrexate
  • An increased risk of liver damage
  • An increase in psoriasis flares or severity of symptoms

At this time, there is no scientific support for food-related triggers for psoriasis.  If you have any questions about dietary changes, please speak with your primary care provider.

The Bottom Line

Psoriasis is an autoimmune disease where your body produces a rapid buildup of skin which forms scales.  Common symptoms of psoriasis are itchy patches of skin, dry or cracked patches of skin, and stiff or swollen joints.  

Psoriasis triggers are not “one size fits all,” as each person may experience a different combination of triggers.  It is not possible to avoid every trigger for psoriasis, but if you learn your specific triggers, you can take the proper steps to prevent and lessen flare-ups.

References:

Rachakonda, TD, Schupp, CW, Armstrong, AW.  Psoriasis prevalence among adults in the United States. JAAD. 06 January 2014;70(3):512-516. doi:10.1016/j.jaad.2013.11.013

Psoriasis. Centers for Disease Control and Prevention website. https://www.cdc.gov/psoriasis/index.htm. Updated October 25, 2018. Accessed July 29, 2020.

August is National Psoriasis Awareness Month.  Chronic Disease Coalition website. https://chronicdiseasecoalition.org/august-is-national-psoriasis-awareness-month/. Updated August 1, 2019. Accessed July 29, 2020.

Psoriasis Causes and Triggers.  National Psoriasis Foundation website. https://www.psoriasis.org/about-psoriasis/causes. Updated April 16, 2020.  Accessed July 29, 2020.

Sanchez DP, Sonthalia S. Koebner Phenomenon. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 20, 2019.

Cassano N, Vestita M, Apruzzi D, Vena GA. Alcohol, psoriasis, liver disease, and anti-psoriasis drugs. Int J Dermatol. 2011;50(11):1323-1331. doi:10.1111/j.1365-4632.2011.05100.x

Published August 17th, 2020 by Dr. Kaylea Swearingen, PharmD
Fact Checked by Chris Riley

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