The course of psoriasis is different in each person. Some people find that their psoriasis is cyclical (following seasons of the year or other events), and others find the disease unremitting and constant over time. In some individuals, the skin may worsen at certain times. Although every person’s skin reacts differently, exacerbating factors, including changes in medications and stress, are common among many patients.
Harold’s comment: My psoriasis seems to get worse when I’m under stress, the weather is dry, and if I fail to keep moisturizer or medicines applied to it.
Stress
Both emotional and physical stress can cause psoriasis to flare or worsen. A psoriasis flare could occur weeks or months after a stressful event. Stressful events can range from major life changes, such as the death of a family member or a job change, to a new diet or the flu. Some people find it helpful to practice stress-reduction techniques, whether it’s yoga or meditation or spending time with family or a pet. Although illness and other stressful events are at times unavoidable, a careful eye on psoriatic skin can pick up exacerbations early and treat them aggressively .
Medications
Any medication (or changing medications) can affect the skin. In particular, classes of medications known to cause psoriasis flares include the following : Medications for high blood pressure:
- Thiazide diuretics (e.g., hydrochlorothiazide)
- Beta-blockers (e.g., metoprolol, propranolol, atenolol, and labetolol)
- Calcium channel blockers (e.g., amlodipine, verapamil, and diltiazem)
- ACE inhibitors (e.g., captopril and enalapril)
Other medications:
- Oral steroids when suddenly stopped (prednisone and dexamethasone)
- Nonsteroidal anti-inflammatories (Ibuprofen and naproxen)
- Immune system stimulators (GM-CSF)
- Antimalarials (chloroquine)
- Lithium
These medications do not cause flares in all people. However, if psoriasis worsens after starting one of these medicines, consider discussing with a doctor whether an alternative medication could be used in its place.
For any medication, if psoriasis worsens after beginning or increasing a dose, consider following the same steps. However, for new medications, such as antibiotics prescribed to treat an infection, it is important to consider whether the underlying problem might be the trigger for a psoriasis flare.
Fall and Winter
Because sunlight helps calm psoriasis, the decrease in sunlight hours during the fall and winter can worsen psoriasis. For people who respond well to sunlight, treatment with light therapy such as PUVA or UVB over the winter can supplement sunlight to the level available during the summer months.
Skin Trauma
Psoriasis has a propensity to affect previously injured skin, an event named the Koebner phenomenon or Koebnerization . The result is that injured skin anywhere on the body, whether dam-aged from surgical scars, tattoos, or even cosmetic procedures such as laser treatment or dermabrasion, may develop psoriasis even in unexpected areas. Although sun is beneficial to psoriasis, sunburn can worsen psoriasis through this phenomenon, whether the burn stems from natural sunlight, tanning beds, or phototherapy .
Over time, many people notice cycles in the severity of their psoriasis and are able to predict which events, medications, or foods worsen their disease. Something that causes a severe flare in one person may not affect another. Because the triggers for worsening psoriasis are widely variable in different people, the best predictor for an individual’s skin disease may be personal experience.
When trying to determine which factors seem to make skin better or worse, a diary can help to associate symptoms and events. A diary can include any important factors, typically psoriasis activity, treatment and medications, and daily routines such as diet, exercise, and daily activities. This recordkeeping can help to identify flare triggers and can track how changes in daily routine (such as a change in diet, for example) affect the skin.