What triggers psoriasis?

This section is about things which can ‘trigger’ psoriasis to start or become worse (see also causes). There are many reasons why inflammation or ‘flare-ups’ can be triggered and this can be different for different people and with different types of psoriasis. Everyone we talked to named at least one trigger which they thought had played a role in setting off their psoriasis, either for the first time or with ‘flare-ups’. Lots of different triggers were mentioned and some said it was hard to “pin down” as they varied over time. This can be confusing and lead to conflicting information from doctors as well as other people with psoriasis. The main triggers talked about were:
  • illness
  • stress and upset
  • injuries to the skin
  • clothes/fabrics and jewellery
  • weather/temperatures
  • household cleaning, bathing and cosmetic products with strong chemicals/fragrances
  • food, drink (including alcohol) and smoking

A few people noticed that being unwell or generally ‘run down’ was a trigger. Throat infections were commonly mentioned and, for some, the start of their psoriasis could be traced back to having a cough/cold, tonsillitis or strep-throat. Louis had only one period of psoriasis when he was 18 after getting the flu, which his doctors described as ‘post-viral’.
Stress and upset

A key trigger mentioned by most people was stress and upset, although not for everyone. Stress can stem from different sources, such as:
  • studies and exams
  • arguments and break-ups
  • jobs, being unemployed and money worries
  • other illnesses
Hannah said it can be difficult to know if stress and depression is a cause or effect of her psoriasis worsening. Many people thought it was both and said there’s a “vicious cycle”: stress triggers their psoriasis which causes more stress. Adam explained how he would “be upset by having psoriasis that would then stress me out and upset me, which then kind of made it a bit worse and a bit harder to manage”. As Carys pointed out, trying to avoid stress is “easier said than done”.
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Stress can “build up” over time or last only “a moment”, with big impacts for some on their psoriasis. For Damini, there’s often a “delayed reaction” between a stressful time and her flares-up. Some people tried to prevent or limit flare-ups at stressful times. Zara sometimes takes a course of antibiotics which stops her worrying as much about getting an infection on her feet – she says “it just makes everything a bit easier and calms down”. Many looked for ways to manage stress, such as: relaxing, meditation, being fully prepared for exams, exercise, hobbies, and talking to partners, friends and family.
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Some people had another illness affecting and affected by stress which could add to the ‘vicious cycle’. This includes epilepsy for Zara and Irritable Bowel Syndrome for Abbie, as both conditions can be made worse by stress and can also be stressful to have.

Injuries to the skin

Some people found an injury to their skin set off more psoriasis developing. Jack knew of this as ‘Koebner’s phenomenon’. Simon noticed that his psoriasis “spread” when he scratched his skin, which he thought was an attempt by his body to “protect” the skin. Simon also had nail psoriasis – knocks led to his nails becoming discoloured and pitted. Megan once fell off a swing and scraped her back which “all turned into psoriasis”. Other examples mentioned of injuries/damage to the skin which triggered more psoriasis to develop include acne scarring, shaving cuts, sunburn, ear piercings and tattoos.
Clothes/fabrics and jewellery

A few people spoke about fabrics and clothing irritating the skin. Abbie says most fabrics are okay but her pyjamas can be ‘too dry’ if they’ve been washed and folded up for a long time. Abbie thinks finding the right washing powder is also important. People talked about clothes rubbing and causing friction on their skin. Carys found jeans irritated her psoriasis and she couldn’t wear jewellery. Megan’s psoriasis would sometimes get ‘stuck’ to her tights and rip off when she removed them, but trousers overheated her. Simon found clothes and hats which cause sweating added to the problem.

Most people found their psoriasis was worse with cold weather. For some, it was the dryness of the air which aggravated their psoriasis. For Simon, though, humid heat irritated his skin. Abbie finds changing seasons can “set it off”. Many said the sun helped their skin clear up and some linked this effect with phototherapy. Lucy cautions though that you should use sunscreen when in the sun and avoid tanning beds.
Others were less sure about whether heat and sun helped their psoriasis. Russell hadn’t noticed much difference across the seasons but thinks it might be because he’s not had psoriasis for long enough to compare. Louie and Simon said heat and sweating in summer irritated their skins. Louie finds overheating when he’s sleeping at night irritates his psoriasis. Louis also tried to keep cool when he had a flare-up in winter by keeping windows open at home. 

Another aspect of holidays in warm climates which helped some was swimming in pools and the sea. Zara finds salt water helps and she feels less self-conscious about having her feet out when on holiday. Megan thinks chlorine and salt water “kills all the bacteria that’s in my psoriasis” and is “like cleaning it out”, but she doesn’t enjoy swimming because it stings. Adam and Steven talked about the Dead Sea and products containing ingredients sourced there as helpful too.

Products containing strong fragrances/chemicals

Products which contain strong fragrances or chemicals could trigger and irritate psoriasis. This includes products used in bathing, cosmetics and for household cleaning:
  • shampoos
  • shower gels, soaps and bubble baths (including for handwashing)
  • alcohol gels/hand sanitiser
  • deodorants
  • perfumes and aftershave
  • make-up (and make-up removers)
  • hair dye
  • hair styling products like gel
  • face washes and scrubs (including for acne-prone skin)
  • shaving foam
  • washing powder/detergent
For those whose psoriasis reacted badly to shower gels/soaps and shampoos, milder versions from shops and prescribed substitutes could be useful. There can be downsides to these though, as Steven found his prescribed shower gel replacement greasy. Many said that if they could use them, they would prefer “nice” smelling products and some occasionally would use these when their psoriasis was better. People often tried different brands of products to find one which suited them.
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Some people limited how they used products. Ella and Lucy found that make-up made their skin drier and flakier, so sometimes they didn’t apply any. One tip Damini has is to spray perfumes onto clothes rather than directly on skin.

Not everyone’s psoriasis reacted to any or all of the products. Louie avoids fragranced bath products but finds aftershave and deodorant are fine. Abbie has never had a reaction from wearing make-up but she makes sure to remove it in the evenings “to be safe”. 

Food, drink and smoking 

Some people thought that particular foods and an overall ‘unhealthy’ diet were triggers for their psoriasis (see also section on diet). Not everyone agreed with this though and some were sceptical about whether diet made a difference for them. A few people had tried diets cutting out certain foods/drinks types, sometimes on the advice from an alternative therapy practitioner. Some people didn’t stop eating any particular foods but tried to have a ‘healthy’ diet overall and avoid ‘junk’ foods.
Smoking cigarettes was mentioned by many as bad for psoriasis and their health in general. Those who smoked though said that this isn’t the only factor in having or developing psoriasis and that there were other underlying causes.


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