What Triggers Psoriasis Flare-Ups?

Reviewed on 7/27/2021

The cause of psoriasis is believed to be an overactive immune system, but is not known. Triggers for psoriasis flare-ups include stress, skin injury (scratches, bug bites, sunburns, and vaccinations), illness or infection, allergies, certain foods, alcohol, environmental factors, and weather.
The cause of psoriasis is believed to be an overactive immune system, but is not known. Triggers for psoriasis flare-ups include stress, skin injury (scratches, bug bites, sunburns, and vaccinations), illness or infection, allergies, certain foods, alcohol, environmental factors, and weather.

Psoriasis is a chronic autoimmune skin condition that causes skin to be red, thick, scaly, and flaky. Psoriasis commonly affects the scalp, elbows, and knees.

Psoriasis is caused by an overactive immune system, but the reason the immune system becomes triggered in some people is unknown. 

Psoriasis symptoms may worsen (flare) for a few weeks or months and then subside (go into remission). 

Triggers for psoriasis flare-ups include:

Risk factors that may increase the chances of developing psoriasis include:

  • Family history of psoriasis
  • Certain medicines
  • Certain infections, such as strep
  • Smoking
  • Obesity

What Are Symptoms of Psoriasis Flare-Ups?

Symptoms of psoriasis may include:

  • Patches of skin:
    • Are red, dry, thick, or dark
    • With silvery-white scales that itch or burn
    • Dry, cracked skin 
    • Itching or bleeding
  • Rashes on the:
    • Scalp
    • In skin folds (armpits, groin, or under the breasts)
    • Genitals
  • Nail changes 
    • Pitting
    • Thickness
    • Ridges
    • Crumbling
    • Changes in color 
  • Emotional effects
  • Psoriatic arthritis
    • Occurs in some patients
    • Stiff, swollen, painful joints

What Is the Treatment for Psoriasis Flare-Ups?

There is no cure for psoriasis, but treatments can relieve the symptoms. Treatment for psoriasis includes: 

  • Topical treatments, such as creams and ointments
    • Prescription topical treatments
    • Over-the-counter (OTC) topical treatments
      • Salicylic Acid
      • Coal Tar
      • Moisturizers
        • Fragrance-free
        • Apply after showering and hand washing
        • Use moisturizing soaps
        • Shower in lukewarm water and limit showers to 10 minutes or less
      • Bath solutions such as oil, oatmeal, Epsom salts or Dead Sea salts
      • Scale lifters (keratolytics) usually contain an active ingredient of salicylic acid, lactic acid, urea, or phenol 
      • Coverings (occlusion) applied over topical treatments such as plastic wrap, cellophane, waterproof dressing, cotton socks or a nylon suit
      • Anti-itch treatments such as calamine, hydrocortisone, camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol (may increase irritation and dryness)
      • Aloe vera, jojoba, zinc pyrithione, capsaicin and others may also help moisturize, soothe, remove scale, or relieve itching 
      • Castederm for inverse psoriasis to help dry moist plaques in the folds of the body
  • Phototherapy (light therapy)
    • Ultraviolet light B (UVB): broad band and narrow band
    • Psoralen + UVA (PUVA
  • Systemic treatments
    • Biologics and biosimilars
      • Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi and Simponi Aria)
      • Interleukin 12 and 23 (IL-12, IL-23) inhibitors such as ustekinumab (Stelara)
      • Interleukin 17 (IL-17) inhibitors such as secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
      • T-cell inhibitors such as Orencia (abatacept)
      • Interleukin 23 (IL-23) inhibitors such as tildrakizumab-asmn (Ilumya), risankizumab-rzaa (Skyrizi), and Tremfya (guselkumab)
      • Biosimilars to adalimumab (Humira): adalimumab-atto (Amjevita), adalimumab-afzb (Abrilada), adalimumab-adbm (Cyltezo), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio), and adalimumab-adaz (Hyrimoz) 
      • Biosimilars to etanercept (Enbrel): etanercept-szzs (Erelzi) and etanercept-ykro (Eticovo) 
      • Biosimilars to infliximab (Remicade): infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), infliximab-qbtx (Ixifi), and infliximab-abda (Renflexis) 
    • Disease-modifying antirheumatic drugs (DMARDs) including tofacitinib (Xeljanz and Xeljanz XR)
    • Traditional oral systemics
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen (Advil, Motrin)

SLIDESHOW

Types of Psoriasis: Medical Pictures and Treatments See Slideshow

How Do You Prevent Flare-Ups?

There are some ways to help prevent flare-ups by managing triggers, such as: 

  • Treat psoriasis
  • Manage stress
    • Yoga
    • Meditation
    • Support groups
    • Deep breathing
  • Prevent and treat skin injuries
    • Treat skin injuries quickly
    • Calm itching
      • Remove scale with a medicine like salicylic acid
      • Limit shower time and avoid hot baths and showers
      • Use moisturizer
      • Use itch-relieving products with menthol or camphor 
      • Apply a cool compress
      • Avoid scratching
      • Use insect repellent and staying indoors at dusk and dawn when bugs are most active to help prevent insect bites
  • Avoid or limit alcohol consumption
  • Don’t smoke
  • Use a humidifier if the air indoors feels dry
  • Protect the skin from extreme weather outside by wearing a hat, gloves, waterproof boots, and a winter jacket
  • Keep a distance from fireplaces, radiators, or other heat sources to keep heat off the skin
  • Remove wet clothes and footwear when coming in from the cold
  • Use sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance to prevent sunburn
  • Treat infections
  • If a medication is causing flares, talk to your doctor about changing the medication or dose
    • Never stop taking a prescribed medication without first talking to your doctor
  • Avoid getting tattoos or body piercings
  • Take care not to cut yourself when shaving

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Reviewed on 7/27/2021
References
https://www.uptodate.com/contents/psoriasis-the-basics?search=psoriasis&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

https://www.psoriasis.org/

https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.15059

https://www.aad.org/public/diseases/psoriasis/insider/diet/psoriasis-what-should-eat

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7432353/

https://www.onegreenplanet.org/natural-health/managing-psoriasis-with-a-plant-based-diet/