Do you have psoriasis and an anxiety disorder? Does your anxiety trigger or worsen your psoriasis symptoms? If you answered yes to these questions, know that you’re not alone. Navigating psoriasis and anxiety can be difficult, especially if your anxiety triggers your psoriasis symptoms and vice versa.

Members of MyPsoriasisTeam have discussed the frustrations of living with psoriasis and mental health disorders like anxiety. One member said, “I’ve suffered with terrible depression and anxiety from the early stages of my childhood, and the medication I’m on can worsen my psoriasis.”

If you or someone you love has psoriasis and you’re wondering about the connections between anxiety, anxiety medications, and psoriasis, read on to find out.

Understanding Clinical Anxiety

Anxiety disorders are somewhat common in the United States. According to the Anxiety & Depression Association of America, anxiety disorders affect over 19.1 percent (40 million) of adults and 31.9 percent of adolescents between the ages of 13 and 18 in the U.S. every year.

There are different types of anxiety disorders. General anxiety is characterized by excessive worrying, fear, and going out of your way to avoid certain situations. Clinical anxiety can be debilitating and interfere with your daily activities like school, work, and sleep.

Some common anxiety disorders include:

• Generalized anxiety disorder (GAD)
• Social anxiety disorder
• Panic disorder
• Irrational fears (i.e., phobias)

Generalized Anxiety Disorder

People with GAD often have fears about everyday problems, such as finances, tardiness, job performance, or the well-being of loved ones.

Symptoms of GAD include:

• Feeling restless and irritable
• Having difficulty concentrating
• Having difficulty falling or staying asleep
• Worrying excessively
• Sweating, trembling, or feeling out of breath
• Experiencing unexplainable pains, headaches, or stomachaches

Social Anxiety Disorder

Someone may have social anxiety if they are very self-conscious around other people, have a fear of being judged, and have difficulty making friends. Social anxiety disorder is more than just being shy — it’s an intense fear of social interactions that can interfere with a person’s daily activities.

Panic Disorder

Panic disorder is characterized by sudden panic attacks that make a person feel out of control or have intense unexplainable fear. It’s possible to mistake a panic attack for a heart attack.

During a panic attack, a person may have:

• A hard time breathing
• Chest pain
• Cold sweat
• Trembling
• Dizziness

Phobias

Phobias are types of extreme or irrational fears. There are many types of phobias, such as fear of:

• Animals or other living things, such as dogs, cats, spiders, or particular people
• Situations, such as crowded or confined spaces
• Natural surroundings, such as heights or water

Phobias related to certain objects and situations are the most common types of anxiety disorder.

The Connection Between Anxiety and Psoriasis

Anxiety disorders and psoriasis can interact in several different ways. Feelings of anxiety may affect your psoriasis symptoms and flare-ups, and psoriasis symptoms may affect your levels of anxiety.

For example, if you live with social anxiety disorder, having visible psoriasis symptoms on your skin may increase your feelings of self-consciousness and fear of judgment. Increased social anxiety may increase your levels of stress, and stress is a common psoriasis trigger.

A systematic review (review of many different research studies) from 2022 investigated how common anxiety disorders are in people with psoriasis. Researchers found that among people with psoriasis:

• Fifteen percent had social anxiety disorder.
• Eleven percent had general anxiety disorder.
• Nine percent had an unspecified anxiety disorder.

The study also found that 34 percent of people with psoriasis experienced symptoms of anxiety.

Anxiety-Induced Psoriasis

There’s no evidence that anxiety can cause psoriasis. However, research has found that anxiety can trigger psoriasis flares and worsen symptoms. In one study, more than 50 percent of people with psoriasis reported that their psoriasis was made worse by stressful events. Another study found an association between diagnosed anxiety disorders and psoriasis.

Psoriasis-Induced Anxiety

The cause of anxiety disorders is complex, as many different factors may interact to cause an anxiety disorder. Some of these factors include:

• Environmental factors such as stressful life events like abuse and neglect, chronic illness, separation or divorce, and the death of a loved one
• Biological factors like family history — Research has found that anxiety disorders have an aspect of inheritability, or being passed from parent to child.

Environmental and biological factors may also interact to lead to the development of anxiety disorders in some people.

Systemic (bodywide) inflammation may be associated with anxiety. Psoriasis has also been associated with high levels of inflammation throughout the body. According to the National Psoriasis Foundation, high levels of inflammation from psoriasis can play a role in the development of other health conditions like anxiety.

Treating Anxiety Disorders

Anxiety can be treated with different types of methods, including psychotherapy, medications, or a combination of both. It’s a good idea to talk to your doctor about different treatment options. You’ll also want to know if your psoriasis medications can interact with anxiety medication or if an anxiety medication may affect your psoriasis symptoms.

Psychotherapy

One type of psychotherapy, called cognitive behavioral therapy (CBT), is often a first choice for treating clinical anxiety. During a CBT session, a person will talk with a therapist about what’s been troubling them. They’ll work with the therapist to become more aware of their thoughts and learn to identify negative thinking patterns. Then, the person will be encouraged to reshape their thoughts into something more positive.

Other types of psychotherapy for anxiety include:

• Exposure therapy — Often used to treat phobias
• Acceptance and commitment therapy (ACT) — Focuses on accepting feelings rather than avoiding them
• Dialectical behavioral therapy (DBT) — A form of CBT that focuses on mindfulness, acceptance, and change

Psychotherapy May Also Help Psoriasis

Research has shown that psoriasis can be affected by psychological factors. A review of the scientific literature showed that cognitive behavioral therapy, mindfulness, and psychotherapy interventions can help to manage psoriasis symptoms.

One study found that cognitive behavioral therapy was effective at reducing symptom severity for people with moderate to severe psoriasis.

Medications for Anxiety Disorders

Anxiety disorders may also be treated with medication. The most common medications for treating anxiety disorders include:

• Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like escitalopram and sertraline, and selective serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine and duloxetine
• Antianxiety medications such as alprazolam
• Atypical antipsychotics such as aripiprazole and quetiapine
• Beta-blockers such as metoprolol

Doctors prescribe different anxiety medications based on your specific symptoms and how severely your anxiety affects your everyday life. They will also consider factors like other health conditions you have and other medications you take when deciding on the potential best anxiety treatment for you.

Anxiety Medications May Affect Psoriasis Symptoms

Some medications may trigger psoriasis flare-ups or worsen symptoms. When this happens, it’s called drug-induced psoriasis. Lithium, a drug typically prescribed for mood disorders like bipolar disorder, and some other mood-improving medications have been found to trigger psoriasis. However, that doesn’t mean that everyone who uses these medications will develop psoriasis or experience a worsening of their symptoms.

When seeking medical treatment for anxiety, make sure your doctor knows about your psoriasis. This information will help inform their decision of which anxiety medication may be the best for you.

Anxiety Medications May Interact With Psoriasis Medications

Some anxiety medications can interact with common medicines used to treat psoriasis. It’s important to talk with your dermatologist and health care team about what medications you’re taking.

For example, cyclosporine is an immunosuppressant drug for psoriasis that can interact with certain anxiety medications, such as sertraline. If your health care provider has a full list of the medications you take, they can check for potential interactions and prescribe you drugs that will be the safest for you.

MyPsoriasisTeam Members on Managing Anxiety With Psoriasis

Some MyPsoriasisTeam members recognize that psoriasis flare-ups may be caused by anxiety. They’ve shared their recommendations for managing these situations:

• “Breathe. Relax. Try and see your skin condition as part of who you are, a beautiful strong person.”
• “Don’t let flare-ups bring you down. It sucks but there’s nothing you can do.”
• “Try to keep your mind busy, and stay away from negative things and people.”

Seeking Professional Help for Anxiety

It’s important to seek help from a professional if you’re experiencing issues with anxiety and your mental health.

It’s normal to feel awkward or apprehensive, but most health care professionals are very understanding and can provide valuable resources and management options. The nonprofit PAPAA recommends the following points to prepare for a medical appointment:

• Plan and write down what questions you want to ask before the appointment.
• Try to be specific about what is making you anxious.
• Bring a friend or relative with you that could help ask questions and remember answers.
• Consider talking to a professional psychologist or psychiatrist if your doctor suggests it.

There are many different psychotherapies and medications available out there, and professionals are the most qualified to guide you to what works best for you. If you try any anti-anxiety medications, there are risks and side effects that should be discussed with your health care team.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 127,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Do you have an anxiety disorder and psoriasis? Do you have any other thoughts or questions on how psoriasis and anxiety may interact? Share your experience in the comments below, or start a conversation by posting on your Activities page.