What causes psoriasis flares and how to manage them

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Psoriasis is a chronic, lifelong condition. Some people with psoriasis may go into remission and have no symptoms. However, according to the American Academy of Dermatology Association (AAD), periods of remission typically last less than 1 year.

T cells may play a role in worsening psoriasis. According to a 2021 research review, dysfunctional T cells respond to triggers by promoting psoriatic inflammation.

When someone comes into contact with a trigger, they may develop a psoriasis flare that begins as a small patch and eventually spreads. Psoriasis triggers can vary from person to person. However, common triggers include the following.

Stress and anxiety

Stress is a common cause of psoriasis flares, and a psoriasis flare can further worsen a person’s stress.

A 2018 review of studies investigating the link between psoriasis and stress indicates that 31–88% of people living with psoriasis report that stress is a trigger for their symptoms.

Skin injury

According to some older studies cited in a 2019 research review, 25–30% of people with psoriasis experience new psoriatic lesions after injury or trauma to their skin. This process is also known as the Koebner phenomenon.

Physical traumas that may cause a psoriasis flare include:

• cuts and scrapes
• tattoos
• piercings
• bug bites
• sunburn
• vaccinations or injections

Illness

According to the National Psoriasis Foundation (NPF), certain illnesses, including the following, can lead to a psoriasis flare:

• tonsillitis
• ear infections
• bronchitis
• respiratory infections

Infections resulting from Streptococcus bacteria, such as strep throat, are often responsible for flares of guttate psoriasis. Symptoms typically begin 1–3 weeks after a person contracts the infection.

Weather

Some people may find that their psoriasis worsens in the winter and improves in the summer.

The NPF suggests this occurs because warm weather provides natural sunlight and more humidity, whereas people are more likely to experience illness and drier indoor air during winter.

Medications

Certain medications can cause a psoriasis flare, including:

• beta-blockers
• chloroquine
• steroids
• lithium
• nonsteroidal anti-inflammatory drugs (NSAIDs)

A person should speak with their doctor if they notice their psoriasis worsening after they start a new medication.

Smoking and alcohol

A 2022 cross-sectional study examining smoking and psoriasis in China suggests that smoking positively correlates with psoriasis severity.

A 2019 review also suggests that alcohol can potentially trigger or worsen psoriasis flares.

Other possible triggers

Triggers may vary from person to person. However, the NPF suggests that allergies and certain foods may also lead to flares.

According to a 2020 review, the following foods may worsen psoriasis:

• red meat
• simple sugars
• saturated fatty acids

Although there is no cure for psoriasis, doctors can prescribe treatments to help a person manage it, such as the following:

• Topical medications: These are typically the first-line treatment for mild to moderate psoriasis. Topical options include corticosteroids, coal tar, retinoids, vitamin D analog, Zoryve, Vtama, and dithranol.
• Phototherapy: This treatment is also called ultraviolet light therapy. It uses ultraviolet light to target psoriasis lesions and typically works best to treat guttate psoriasis.
• Systemic medications: Systemic drugs such as methotrexate and cyclosporine may help treat extensive psoriasis.
• Biologics: Doctors may prescribe biologic agents if people’s symptoms do not respond to other treatments. Biologics target cells in the immune system that cause psoriatic inflammation.

Lifestyle strategies

According to the AAD, the following lifestyle strategies may also help a person manage worsening psoriasis symptoms:

• reducing alcohol consumption
• quitting smoking, if applicable
• making efforts to maintain a healthy weight
• eating a nutritious, balanced diet
• exercising regularly
• finding healthy ways to manage or reduce stress
• scheduling and attending regular dermatology appointments

Keeping skin moisturized and avoiding psoriasis triggers, when possible, may also help people manage their psoriasis flares.

The NPF advises anyone with psoriasis symptoms to speak with a dermatologist. It is particularly useful to find a dermatologist who has experience in treating psoriasis if:

• a person’s symptoms are worsening
• treatments are not relieving symptoms
• the person wishes to try an alternative treatment

Here are some common questions about psoriasis and how to manage flare-ups.

Does psoriasis get worse with age?

Psoriasis is a chronic condition that can occur at any age. However, the average age at which people have an initial flare is 15–20 years. People may experience a second peak at 55–60 years of age.

How long do psoriasis flares last?

Psoriasis flares can last weeks to months. In between flares, people may experience periods of remission, which typically last up to 1 year.

Why does psoriasis spread so fast?

Psoriasis may spread in response to certain triggers, which can vary for each person with the condition. Exposure to triggers such as stress, alcohol, and cold, dry weather may worsen psoriasis.

Psoriasis flares can also cause stress, contributing to a potentially ongoing loop of worsening symptoms.

There is no cure for psoriasis, and every person with this condition may experience flares. However, avoiding psoriasis triggers and working with a healthcare professional can help a person manage their symptoms.

If a person experiences a flare-up or has worsening symptoms, they can talk with a specialist, such as a dermatologist, who can create a personalized treatment plan.

Sticking to a treatment plan and maintaining a healthy lifestyle can help a person reduce the severity of their symptoms and potentially enter remission.