Does stress cause psoriasis?

Lifestyle

Synopsis

Stress does not cause psoriasis. However, stress can contribute to flare-ups. Our experts pointed out that individuals under a lot of stress often experience more severe symptoms of psoriasis. Many people say that their first flare occurred after a particularly stressful incident or time in their life.

Our experts also explained that psoriasis is caused by multiple factors, including environmental and genetic. While stress does not in and of itself cause psoriasis, it can worsen the symptoms or sometimes provoke a flare-up.

Finally, managing stress, particularly psychological or emotional stress, may have a beneficial effect on a person’s psoriasis. In her comments, Sandra Walsh provides a few suggestions for programs or therapies that can be helpful in coping with stress. Several of the experts mentioned that individuals with psoriasis suffer from anxiety and depression at levels higher than the general population. Stress can complicate these conditions, and finding the necessary help and support to deal with stress, anxiety, and depression may result in an improvement in a person’s symptoms of psoriasis. 

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Expert Answers

Dr. Marc Bourcier:

Stress does not cause psoriasis. But it does have an effect on psoriasis. High stress tends to worsen the symptoms of psoriasis.

We usually distinguish between two types of stresses: physical stress (that can be caused by an infection, a hospitalization, a surgery, a fracture, etc.) and psychological stress (caused by work situations, family situations, mourning, etc.)

When patients talk about the first manifestations of psoriasis, they often link it with a stressful event, and more often than not, that initial stressor is of a psychological nature.

There is a genetic component to psoriasis, which means that the disease is already there – at least potentially – in the individual. At some point, something triggers an inflammatory state and the symptoms of psoriasis manifest. Stress is very often this trigger. But, we do not yet know how this process works.

After the initial onset of psoriasis, the person will be affected for her whole life.

When someone already suffers from psoriasis, stress tends to worsen their symptoms, and it can also trigger flares. Stress has an effect on the immune system, and since psoriasis has to do with the immune system, it is easy to see that there would be a relationship between the two.

Anxiety and depression are two very common comorbidities associated with psoriasis. In fact, close to 25% of patients who have moderate to severe psoriasis experience anxiety or depression. There is a definite link between stress, anxiety, depression and psoriasis.

So stress does not cause psoriasis, but it can trigger the first manifestation of psoriasis and can worsen the symptoms for those who already have it. 

 

 

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Sandra Walsh:

Many patients consider stress to be a main cause of their flare-ups. We know that chronic stress can make psoriasis worse for some people  which can in turn increase stress. Some people also report first getting psoriasis following a major stressful event.

Studies have shown that people who report that stress is a trigger for their psoriasis have lower levels of the hormone cortisol and higher levels of the hormones epinephrine during an episode of stress.  These are the fight-or-flight stress hormones that help our body react, focus and regulate body functions so we can respond to a stressful event. Unfortunately, this is the opposite of a so-called normal response to stress. This altered response is also seen in other inflammatory conditions such as atopic dermatitis, rheumatoid arthritis and inflammatory bowel disease.  Further research is needed to know why this occurs and how it relates to inflammation and psoriasis.

Stress reduction or management may result in reducing symptoms or flare-ups. Although we cannot eliminate stress from our lives, we can change the way we react to stress. Professional help with stress management is available through professional counselling or group therapy, among other practices.  Mindfulness-Based Stress Reduction Therapy is one form of group therapy that is offered in many hospitals and private clinics.  It is an 8 week program that teaches the practice of mindfulness, or being aware of your body and focused on what is happening in the moment.  A referral from your doctor may be required and the program may or may not charge a fee.  One study using mindfulness recordings during phototherapy to treat psoriasis showed that those people who listened to the mindfulness recordings had a 50% improvement in their psoriasis in 49 days, compared to 85 days for the people who did not listen to the recordings.

If you are having difficulty coping with stress, talk to your doctor about group or private counseling available in your area. In my practice, I spend a lot of time with patients, teaching and talking about their psoriasis. We talk about how they are doing emotionally, and I frequently offer to help people manage their stress or other emotional needs. I often recommend individual counseling to help a patient deal with the issues they are struggling with, such as stress, anxiety, depression, or not coping well. Sometimes, they need support dealing with other things that are happening in their lives.

Some physicians or other health care providers don’t always feel they have time or adequate resources to address these issues. But, from my experience, I know that it is helpful for patients to know that there are resources out there to help them cope and manage their stress. This is why I often bring it up when I’m talking to patients.

For more information about stress reduction programs in your area, try an internet search of “mindfulness-based stress reduction” and your hometown.  For those who do not have access to a computer try calling your local hospital, it may be operated through the mental health department. …..

For more information about seeing a counselor or therapist, go to http://www.cmha.ca/

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Andrew Gosse:

No. Saying that psoriasis is caused by stress is insane. If psoriasis was caused by stress, then everybody in the world would have psoriasis. Stress is part of everyone’s life – except the very few – in one form or another. And, if relaxing decreased the symptoms of psoriasis, you would see a lot more people with psoriasis in yoga or meditation classes.

I’ve often wondered what people mean precisely when they use the expression “reducing stress.” Does it mean to unplug from work? From commitments at home? Does it mean to stop worrying about problems? How does one achieve those things, exactly? Also, having psoriasis is something stressful in itself. Does it mean that psoriasis causes itself? This makes no sense. What’s worse, implying that stress causes psoriasis can put the burden of the disease on the patient suffering from psoriasis, in turn causing more stress!

And stress is not just one condition. Different types of stress have different effects. Work stress, marital stress, parental stress, financial stress, each of these kinds of stress has a different acuteness. In a way, stress is like cancer. Cancer is not just one disease.

However, from a rational point of view, of course, stress does negatively affect the whole body. It has been shown that stress puts a strain on the cardiovascular system, and affects mental well-being, amongst other things. Can it amplify manifestations of psoriasis? Can it trigger flares? From my own experience, I can’t confirm this, but I can see how it makes a certain sense. Given that stress does have a negative impact on the immune system, it is possible that it could worsen or amplify some symptoms of psoriasis. But stress does not itself cause psoriasis. 

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