In this article, I review what we currently know about the factors that may trigger psoriasis flare-ups and how we can try to maintain better disease control.
Psoriasis is a chronic inflammatory skin disease affecting millions of people worldwide. Although it is common, many questions remain about its underlying causes and why, at certain times, the disease appears to become more active, leading to what we know as psoriasis flare-ups.
The psoriasis ‘switch’
Research is continuing into the exact mechanisms that cause psoriasis. What we do know is that psoriasis is a complex disease involving multiple genetic and environmental factors. This means that an individual may have a genetic predisposition to developing psoriasis, but whether and when the disease becomes clinically apparent can be influenced by different environmental and biological triggers.
One way of visualising this is to imagine that someone is born with a psoriasis ‘switch’ that may be activated under certain circumstances. So what factors may contribute to activating that switch? This is where our current understanding of psoriasis triggers becomes useful.
Factors that may trigger a psoriasis flare-up
Although much remains to be understood, several factors are known to be associated with the onset or worsening of psoriasis flare-ups.
Infections and respiratory illnesses
Infections may trigger psoriasis flare-ups in some patients. Certain respiratory infections, particularly streptococcal throat infections, are well recognised in association with some forms of psoriasis, while other infections may also influence disease activity. The immune response generated during an infection can contribute to inflammatory activation in people who are predisposed to psoriasis.
Certain medicines
Some medicines may aggravate psoriasis or trigger a flare-up in susceptible individuals. Examples include certain beta-blockers, lithium and some antimalarial medicines. Patients with psoriasis should inform the prescribing doctor about their condition. However, medication should never be stopped or changed without medical advice, as the balance of risks and benefits needs to be assessed individually.
Stress
Many patients report that periods of significant stress coincide with worsening psoriasis. The relationship is complex and scientific studies have not always produced consistent results, but stress may influence inflammatory and immune pathways and can also affect sleep, treatment adherence and other behaviours relevant to disease control. Approaches such as relaxation techniques, physical activity and mindfulness may help some patients manage stress and improve general wellbeing.
Environmental factors and climate
Changes in climate and environmental conditions can affect psoriasis in some people. Cold weather, dry air and reduced sunlight exposure during the winter months may contribute to increased skin dryness and worsening symptoms. The response to sunlight varies between patients, and ultraviolet exposure should always be approached cautiously because excessive exposure and sunburn can damage the skin and increase the risk of skin cancer.
Diet and alcohol consumption
There is no specific diet that cures psoriasis. However, some dietary patterns and lifestyle factors may be relevant to overall health and to the comorbidities associated with psoriasis. Excessive alcohol consumption has been associated with poorer psoriasis outcomes in some studies. A balanced diet rich in fruit, vegetables, whole foods and healthy fats can support general health. Among dietary patterns studied in psoriasis, the Mediterranean diet has attracted particular scientific interest.
Trauma and skin injury
The Koebner phenomenon describes the development of psoriasis lesions in areas of skin injury. Cuts, burns, friction and other forms of trauma — including tattoos in some patients — can lead to the appearance of new psoriasis lesions at the affected site. For this reason, people with psoriasis should take appropriate care to minimise unnecessary skin injury.
How can psoriasis flare-ups be managed?
Although it is impossible to control every potential trigger, there are measures that may help reduce their impact and improve overall psoriasis management.
Maintain good communication with your dermatologist
If you are receiving treatment for psoriasis, make sure your dermatologist is aware of all medicines you are taking and of any new symptoms that develop. Follow the treatment regimen prescribed by your doctor and discuss any concerns before making changes.
Look after your general health
Maintain a balanced diet, avoid excessive alcohol consumption and do not smoke. These measures can support not only psoriasis management but also overall health and the prevention of associated comorbidities.
Manage stress
Set aside time for activities that help you relax and manage stress effectively.
Care for your skin
Use appropriate moisturisers and sun protection, particularly when environmental conditions make the skin dry or irritated.
Remember
Psoriasis flare-ups may be associated with a variety of factors, including infections, certain medicines, stress, skin injury and lifestyle-related factors. Although not every trigger can be eliminated, understanding which factors may be relevant in your particular case can help support better long-term disease management.
Always consult a dermatologist for an individualised treatment plan appropriate to your clinical situation.
