• Stress can lead to changes in your brain and hormones that may trigger psoriasis flare-ups.
• Smoking, drinking alcohol, and eating a high-fat diet are common causes of flares.
• People with psoriasis often have sensitive skin, which may flare from minor injuries or changes in weather.

Psoriasis flares can happen when genetic or environmental factors trigger inflammation in the skin. In people with psoriasis, the immune system becomes overactive and mistakenly attacks skin cells, leading to damage. When the psoriasis is active, skin cells grow up to 10 times faster than normal, leading to thick, flaky patches. Psoriasis is a lifelong condition with no permanent cure.

During a psoriasis flare, symptoms can get worse. The skin may become discolored, scaly, itchy, cracked, and painful. Some people also experience painful or swollen joints. Fatigue is another common symptom during flares.

Flares often come and go in cycles that can last for weeks or months. When flare-ups subside, skin may clear, and the condition may go into remission (a period of reduced or no symptoms). In more severe cases, symptoms may stabilize or cause scarring. Flares can relapse (return) with the same level of severity or rebound with more intense symptoms.

Psoriasis Flare-up Triggers

People with psoriasis may react differently to triggers, and what causes a flare-up for one person might not affect someone else. By understanding how flares happen, people with psoriasis can take steps that may help prevent flare-ups. Ongoing research is uncovering more about common triggers, which could lead to new ways of preventing and treating flare-ups.

Stress

Psychological stress is one of the most common triggers of psoriasis flares. Stress causes neurological (brain) and hormonal changes that can affect the skin and trigger pro-inflammatory immune responses in people with psoriasis.

People with psoriasis experience higher rates of depression, stress, and sleep interruption compared to those without the condition. Feeling self-conscious about skin symptoms, avoiding social situations, and needing to carve out time for treatments can all contribute to stress.

Research suggests that inflammation may also play a role in increasing depression and anxiety in people with autoimmune conditions like psoriasis. Complex connections between immune disorders and emotion aren’t fully understood, but ongoing studies are exploring treatments that may reduce stress caused by inflammation.

Smoking

Smoking and exposure to secondhand smoke are both linked to psoriasis flare-ups. Even nicotine patches have been linked with psoriasis flares. Nicotine can trigger inflammation, which can irritate the skin and lead to flare-ups.

Smoking tobacco is harmful to overall health and can weaken the immune system, causing cell damage that affects the skin. Research shows that smoking may trigger the onset of psoriasis, make the disease more severe, and reduce how well treatments work. People with psoriasis who smoke also tend to have fewer periods of remission​​.

Alcohol

Although research on alcohol consumption and psoriasis is limited, some evidence suggests that alcohol can worsen inflammation raising the risk of flares. Alcohol can weaken the skin’s protective barrier, making psoriasis symptoms worse. Drinking alcohol has also been linked to poor treatment adherence, which can lead to more flare-ups​​.

Medications

Certain medications are known to trigger psoriasis flare-ups or even cause the onset of psoriasis. If you have psoriasis and are being treated for other conditions, it’s important to talk with your dermatologist about any potential risks. Medications known to increase the risk of flares include:

• Beta-blockers, which treat high blood pressure
• Lithium, prescribed for mood disorders such as bipolar disorder
• Antimalarial drugs, which are taken to prevent and treat malaria
• Imiquimod, a topical cream used to treat precancerous skin lesions
• Monoclonal antibodies, medications that treat cancer and other diseases

Diet

Certain foods may trigger psoriasis flares or worsen symptoms. Most of what’s known about diet and flares comes from people with psoriasis reporting their experiences. Although exactly how and why some foods cause flares isn’t fully understood, processed foods and refined sugars have been linked to inflammation.

People with psoriasis have reported various food-related triggers, such as:

• Nightshades — Vegetables like tomatoes, potatoes, eggplant, and peppers that contain a compound called solanine
• Sugar
• Processed snack foods
• Fried foods, such as french fries
• Gluten — A protein in wheat, rye, and barley that can cause inflammation in the gut

Saturated fatty acids are also risk factors for psoriasis flares. Saturated fat is found in foods like butter, fatty meats, cured meats such as bacon and sausage, and cheese. Palm oil, which is often used in processed foods, is also high in saturated fat. High-fat diets can contribute to a high body weight, another risk factor for psoriasis flares.

Injury to Skin

People with psoriasis have very sensitive skin, and even small injuries can trigger flare-ups. This reaction is called the Koebner phenomenon, in which previously healthy skin develops new psoriasis lesions. Injuries such as bugbites, scratches, cuts, burns, or bruises can cause flare-ups and new lesions at the injury site.

Researchers don’t fully understand what causes the Koebner phenomenon. People with psoriasis who experience this reaction usually flare 10 to 20 days after the injury. Minor skin injuries from common occurrences such as sunburn or vaccinations can also trigger the Koebner phenomenon, leading to new psoriasis plaques.

In the case of tattoos, the repeated needle punctures can trigger this response, causing psoriasis plaques to develop at the tattoo site. The already overactive immune system may react to the tattoo ink or the injury itself, setting off an inflammatory response that speeds up skin cell production, resulting in the scaly, discolored lesions of psoriasis​​​.

Changes in Weather

Cold, dry weather and low humidity, which cause dry, irritated skin, are associated with psoriasis flares. Heat sources like fireplaces and radiators can further dry out the skin, increasing the risk of flare-ups. During warmer seasons, air-conditioning can lower humidity and dry out the air, also affecting the skin.

Sun exposure is another factor. Although sunburn can trigger flare-ups, controlled exposure to sunlight may help improve symptoms by providing skin with vitamin D.

Read more about weather and psoriasis flares.

Hormonal Changes

Hormonal changes can lead to psoriasis flare-ups, especially during puberty, after pregnancy, and during menopause. These shifts in hormones can trigger disease activity, worsening symptoms for some people with psoriasis.

Androgens, such as testosterone, affect hair follicles and skin condition but can be reduced by the chronic inflammation seen in psoriasis. Some hormone replacement therapies, particularly those that increase androgens, may worsen psoriasis and cause flares.

Infection

Bacterial and viral infections can trigger acute flares by disrupting the immune system. Streptococcal pharyngeal bacteria, which causes strep throat, has been linked to flares, particularly with guttate psoriasis.

Viral infections such as the flu or common cold can also cause severe flares in people with plaque psoriasis or general pustular psoriasis. Upper respiratory infections like influenza B are among the common triggers​​​.

Prevention and Treatment of Flares

You can lower your risk of psoriasis flare-ups by following your skin care and treatment plans, managing stress, and making healthy lifestyle choices. Always talk to your doctor or dermatologist before making any changes to your treatment. Ask your health care provider about ways to reduce stress, eat a balanced diet, quit smoking, and limit alcohol. You may want to consult a dietitian or mental health counselor for additional help.

Be mindful of your environment and try to avoid situations that could injure your skin. Prepare for weather changes by using a humidifier indoors and dressing appropriately for outdoor conditions. Some people with psoriasis find it helpful to keep a record of what triggers their flare-ups so they can better manage the condition.

Join a Supportive Community

When you join MyPsoriasisTeam, you become part of a community of more than 131,000 people who are managing psoriasis and psoriatic arthritis. You can ask questions, share experiences, and find out how others reduce their risks for flares.

Have you identified any triggers for your psoriasis flares? What helps you get through a flare-up? Share your experience in the comments below or on your Activities page.