Stress and psoriasis have a complicated relationship. Psoriasis flare-ups can increase feelings of stress, while stress can be associated with the onset or worsening of psoriasis symptoms. The interaction between stress and psoriasis creates a cycle that can be difficult to manage.

Fortunately, doctors and researchers are actively working to better understand the connection between stress and chronic diseases, like psoriasis. With increased attention and research, scientists are also exploring how stress reduction could help to lessen symptoms of psoriasis, like flare-ups, plaques, and itching. For people with psoriasis, stress-management techniques provide options to potentially disrupt the stress-psoriasis cycle.

The Cycle of Stress and Psoriasis

Psoriasis is caused by abnormal immune-system reactions that result in inflammation of the skin. Symptoms include an overproduction and buildup of thick, scaly patches or lesions that can become itchy and sore. People with psoriasis also commonly experience stress.

Although researchers are still exploring the relationship between stress and psoriasis, past studies and personal accounts have suggested associations between the two. A study in the International Journal of Dermatology compared 169 people with psoriasis to 169 people with other skin diseases. Those with psoriasis were more than four times as likely to have experienced a stressful event. Another study showed that 72 percent of 179 people with psoriasis had experienced a significant stressful life event in the one month period prior to their psoriasis appearing.

The National Psoriasis Foundation notes that stress is a common trigger for psoriasis flare-ups, and this may be due to the effects of stress on the immune system. Furthermore, stress can result from psoriasis itself — as well as the fear of psoriasis flare-ups. People with psoriasis may also feel embarrassment or self-consciousness about their condition, resulting in additional stress.

MyPsoriasisTeam members are familiar with the troubling cycle between stress and psoriasis. Many relate to the feeling that stress may worsen their psoriasis and vice versa. “It’s very hard to not stress, and then you flare up. It’s a vicious cycle and I’m trying to work out how to beat stress,” wrote one member.

Another member noted how stress triggers specific symptoms, stating, “I think stress triggers my itchy skin.”

A third member said they believe stress caused their onset of psoriasis: “I didn't know I had psoriasis until my job became very stressful. That's when I had a terrible outbreak on my scalp."

There are a wide variety of practical tools and techniques that may help to reduce stress-related psoriasis flare-ups and symptoms. Stress-management techniques are tangible lifestyle habits that can improve your quality of life and overall well-being.

Stress-reduction Techniques

There are several practical tools for stress management. Here are just a few.

Exercise

Exercise is an effective stress-management technique. Exercise may be difficult if you experience pain from psoriasis or psoriatic arthritis, but you don’t need to exercise intensely in order to feel its benefits. The National Institutes of Mental Health suggests that just 30 minutes of walking a day can help to improve your mood. You can tailor the style and intensity of exercise to your liking.

MyPsoriasisTeam members have recommended swimming as a gentle form of exercise. “I started a pool exercise at the YMCA,” one member wrote. “I would encourage everyone to try it.”

Members suggest first testing whether chlorine makes you itchy before you start swimming in a pool.

Practice Relaxing

Relaxation techniques like meditation and mindfulness are very useful tools for reducing stress and managing chronic disease. They help you to calm your body and mind, organize your thoughts, and feel an increased sense of peace. Meditation and mindfulness are also low-cost and relatively easy to incorporate into your daily life. “Trying to keep focused and taking at least 10 minutes of the day for reflection and relaxation for ME,” one MyPsoriasisTeam member posted.

Mayo Clinic suggests meditation, guided imagery, visualizations, and even deep-breathing techniques as ways to produce feelings of peace and balance that will benefit your mental and physical well-being. Some relaxation techniques — like yoga and tai chi — incorporate movement, and you can find classes and tutorials for them online or at your local gyms and fitness centers.

Identify Stressors and Set Boundaries

There are many sources of stress that are out of our control, like the COVID-19 pandemic, loss of income, or natural disasters. There are, however, other stressors we can control. One of the most useful tools for stress management is the process of identifying your stressors and establishing boundaries.

First, make a list of things that cause you to stress or worry. Next, ask yourself which of these things you have control over — like preparing dinner or paying bills — and which ones you don’t.

As you assess what is on your list, cross out the items that you don’t have control over. For the remaining items — those you do have control over — ask yourself some questions:

• Is it necessary that I complete all of these tasks?
• Do I need to complete all of these tasks today, or even this week?
• Is it reasonable to ask family or friends for help with these tasks?

Additionally, learning how to say no to requests or tasks can also help you manage your stress. Setting boundaries can be difficult at first. “I grew up being a people pleaser,” a MyPsoriasisTeam member wrote. “Making the transition to caring about my needs has been difficult! But it’s a journey I know I must take.”

Get Quality Sleep

Getting quality sleep is important for managing stress. Unfortunately, that can be difficult if you have psoriasis. A study examining 58 people with plaque psoriasis found that 60 percent experienced poor sleep quality. People with psoriasis scored worse than the healthy control group on measures of daytime dysfunction, habitual sleep efficiency, and subjective sleep quality.

Difficulty sleeping is a common topic of discussion for MyPsoriasisTeam members. “In the past week, I've had about eight hours of sleep, as it's difficult to sleep with the itch, which keeps me up all night,” one member noted.

Joint pain and itching from psoriasis may make sleeping more difficult. “I didn't fall asleep until 3 a.m. because of my joints and skin being so sore and so itchy,” a member wrote.

Getting enough good, quality sleep will aid with stress management. Some tips for good sleep hygiene include:

• Avoid electronic devices like phones and computers before bed.
• Avoid caffeine, alcohol, and large meals before bed.
• Establish a relaxing bedtime routine.
• Keep a consistent sleep and wake schedule.

Read more about tips on sleep and psoriasis here.

Seek Professional Help

Sometimes, the stress of life can become overwhelming, and it’s OK to seek professional help if you feel like you need it. If stress starts to interfere with your daily routines and responsibilities, and your self-care and stress-management techniques aren’t enough to help you, it might be time to reach out to a counselor, therapist, or doctor. “Seeing a psychologist has helped me,” a MyPsoriasisTeam member shared. “As a nurse, I tried to manage it myself and found it was OK to need some help with my mental well-being.”

Counselors and therapists often help people when their burden of psychological stress has become too heavy, and they can provide professional advice and practical tools to help you manage your stress. Specific therapeutic practices, like psychotherapy and cognitive hypnotherapy, have also been found to help improve stress and symptoms of skin conditions like psoriasis.

Talk With Others Who Understand

Another tool for dealing with stress is connecting with others, and especially those that may understand what you’re going through. Joining a psoriasis support group, whether in-person or virtual, can help address your stress levels and improve your quality of life.

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 108,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Are you living with stress and psoriasis? Share your experience in the comments below, or start a conversation by posting on your Activities page.