What Triggers Psoriasis Flare-Ups? Common Causes and How to Manage Them
Updated: Aug 21
Written by Dr. Charles Drew, Lead Pharmaceutical Content Specialist & Clinical Drug Information Reviewer
Reviewed for medical accuracy under the Ivermectinkart Editorial Policy
Introduction
Psoriasis is a chronic inflammatory condition in which symptoms can improve for a time and then become more active again. These periods of worsening are called psoriasis flare-ups, and they may involve more plaques, itching, scaling, soreness, or inflammation. Common triggers include emotional stress, infections, skin injuries, certain medicines, cold or dry weather, smoking, and heavy alcohol use, although triggers differ considerably from one person to another. A trigger does not necessarily cause psoriasis itself; instead, it can activate or worsen disease in someone who is susceptible. Some flares have an obvious explanation, while others occur without a clearly identifiable trigger. Understanding your own patterns can help you reduce avoidable exposures and recognize when worsening psoriasis needs medical attention.
What Are the Most Common Triggers for Psoriasis Flare-Ups?
The most widely recognized psoriasis triggers include stress, infections, injury to the skin, certain medications, weather changes, smoking, and heavier alcohol consumption. Major dermatology guidance emphasizes that the same trigger does not affect everyone, so identifying personal patterns is often more useful than trying to avoid every possible trigger.
Psoriasis is driven by immune-system activity and genetic susceptibility, but environmental or physical events can influence when symptoms appear or worsen. The American Academy of Dermatology's guide to psoriasis flare triggers lists everyday factors ranging from stress and skin injury to infection, weather, medications, smoking, and alcohol.
TABLE 1
Possible trigger | What may happen | Useful clue |
Emotional stress | Existing psoriasis may worsen | Flares repeatedly follow stressful periods |
Skin injury | New plaques may form at injured areas | Psoriasis appears where skin was cut, scratched, burned, or bitten |
Infection | Psoriasis may flare after illness | Symptoms worsen after infections such as strep throat |
Certain medications | Psoriasis can appear or worsen | Flare follows starting or changing a medicine |
Cold, dry weather | Skin may become drier and psoriasis more active | Symptoms consistently worsen during colder months |
Smoking | May contribute to worsening psoriasis | Flares or poor control occur alongside tobacco exposure |
Heavy alcohol use | May worsen disease or affect treatment | Symptoms become harder to control with frequent or excessive drinking |
A flare can also result from several factors occurring together. For example, winter may bring dry air, less sunlight, more respiratory infections, and increased stress at the same time.
Psoriasis triggers are personal. A factor that reliably causes one person's symptoms to worsen may have little effect on another, so tracking patterns over time is usually more useful than following a universal “avoid” list.
Can Stress Trigger Psoriasis?
Yes. Emotional or psychological stress is one of the most commonly reported triggers for psoriasis flare-ups. Stress does not mean psoriasis is “all in your head”; psoriasis is an immune-mediated inflammatory disease, but emotional stress can influence biological processes that affect inflammation and symptom severity.
There can also be a two-way relationship. Stress may contribute to worsening psoriasis, while visible plaques, itching, disrupted sleep, or concern about appearance can themselves create additional stress.
How can you tell whether stress is one of your triggers?
Look for repeated patterns rather than assuming every stressful event will cause a flare. You might notice symptoms becoming more active after periods involving:
major work or family pressure
poor sleep
prolonged emotional strain
bereavement or major life changes
repeated anxiety about psoriasis itself
Stress-management approaches such as regular physical activity, adequate sleep, relaxation techniques, counseling, or mindfulness may help some people cope better. They should complement appropriate psoriasis treatment rather than replace it.
If stress or psoriasis is significantly affecting your mood, relationships, sleep, or daily functioning, discussing this with a health professional is worthwhile.
How Do Infections, Skin Injuries, and Weather Affect Psoriasis?
Infections, physical injury to the skin, and environmental conditions can all trigger psoriasis in susceptible people. These connections are particularly useful to recognize because the flare may not occur at exactly the same time as the triggering event.
Infections and psoriasis
Infections can activate the immune system and sometimes lead to psoriasis worsening. Strep throat is a well-recognized trigger, particularly for guttate psoriasis, which often appears as numerous small, drop-like lesions.
The American Academy of Dermatology notes that psoriasis may flare several weeks after infections such as strep throat, bronchitis, or an ear infection.
If psoriasis suddenly changes after an illness—especially when accompanied by fever, sore throat, or other infection symptoms—tell your clinician rather than assuming the skin changes will resolve on their own.
Skin injury and the Koebner phenomenon
Psoriasis can sometimes develop at sites where otherwise unaffected skin has been injured. This is known as the Koebner phenomenon.
Possible triggers include:
cuts and scratches
insect bites
severe sunburn
friction or repeated rubbing
tattoos or piercings
shaving cuts
The National Psoriasis Foundation's overview of psoriasis causes and triggers explains that scratches, sunburns, bites, and other forms of skin trauma can lead to psoriasis appearing at the injured site.
That does not mean every minor scratch will cause a plaque. The response varies among individuals and may also depend on how active the psoriasis is at the time.
Cold, dry weather
Many people find that psoriasis becomes harder to control during colder months. Lower humidity, heated indoor air, reduced sunlight, and increased skin dryness can all contribute.
Moisturizing regularly, using warm rather than very hot water, and protecting skin from extreme cold may reduce dryness and irritation. Sunlight may improve psoriasis for some people, but sunburn can trigger a flare, so deliberate overexposure is not a safe strategy.
Can Medicines Trigger or Worsen Psoriasis?
Yes. Certain medicines can trigger new psoriasis or worsen existing disease in some people. However, you should not stop a prescription medicine on your own because abrupt withdrawal can be dangerous and, in some situations, may itself worsen psoriasis.
Medicines that have been associated with psoriasis exacerbation include certain:
lithium preparations
antimalarial medicines
medicines used for high blood pressure or heart conditions
systemic corticosteroids, particularly when withdrawn rapidly
other medications depending on the individual and clinical situation
The AAD psoriasis guideline specifically recognizes medication-related exacerbation and highlights withdrawal of systemic corticosteroids as a potential trigger.
What should you do if a medicine seems to trigger a flare?
Contact the clinician who prescribed it and explain when the psoriasis worsened relative to when the medicine was started, stopped, or changed.
Do not abruptly stop corticosteroids or other prescription drugs without medical guidance. Your clinician may decide that the medicine is unlikely to be responsible, adjust the treatment, switch to an alternative, or manage the psoriasis while continuing a medicine that is medically necessary.
TABLE 2
Situation | What to do | What to avoid |
Flare after starting a medicine | Contact the prescriber and review the timing | Do not stop prescription medication abruptly |
Psoriasis appears at an injury site | Protect and gently care for the skin | Avoid scratching or repeated friction |
Flare follows an infection | Discuss persistent or significant symptoms with a clinician | Do not self-treat presumed infections unnecessarily |
Symptoms worsen in winter | Moisturize regularly and protect skin from cold, dry air | Avoid very hot showers and sunburn |
Stress repeatedly precedes flares | Use practical stress-management strategies alongside treatment | Do not assume stress management alone replaces medical care |
Smoking or heavy drinking accompanies poor control | Discuss support for reducing exposure | Do not assume lifestyle change alone will control moderate or severe psoriasis |
Do Smoking, Alcohol, Diet, or Body Weight Affect Psoriasis Flares?
Smoking and heavier alcohol consumption are recognized factors that can worsen psoriasis, while the relationship between individual foods and flares is much less predictable. Lifestyle factors may influence disease activity, treatment response, and overall health, but psoriasis should not be reduced to a lifestyle problem.
Smoking
Smoking is associated with psoriasis and can contribute to poorer disease control. Tobacco smoke may also compound cardiovascular risks already associated with psoriasis.
If you smoke, stopping can benefit your overall health even if the effect on individual psoriasis flares is not immediate. A primary-care clinician or dermatologist can help with evidence-based smoking-cessation support.
Alcohol
Frequent or excessive alcohol consumption can worsen psoriasis in some people and may interfere with effective treatment. Alcohol can also create safety concerns with certain psoriasis medicines.
If you are receiving systemic treatment, tell your clinician how much alcohol you typically drink rather than assuming occasional or regular drinking is automatically compatible with your medicine.
Food and psoriasis triggers
People often report that particular foods seem to affect their psoriasis, but there is no single food or universal “psoriasis diet” proven to prevent flare-ups for everyone.
Broad dietary patterns that support cardiovascular and metabolic health may be worthwhile because psoriasis is associated with health risks beyond the skin. However, restrictive elimination diets should not be started solely on the basis of online claims, especially when they create nutritional deficiencies or make eating unnecessarily difficult.
Body weight
Living with obesity is associated with psoriasis and may influence disease severity and treatment response. The NHS includes obesity among factors that can worsen psoriasis or contribute to flares.
Weight management, when medically appropriate, should be approached as part of overall health rather than as a claim that psoriasis is simply caused by body weight.
How Can You Identify and Reduce Your Own Psoriasis Triggers?
Keeping a simple record of symptoms and exposures can help reveal personal psoriasis triggers over time. The goal is not to monitor every detail of daily life but to look for repeated patterns that occur before meaningful flares.
Keep a flare diary
When your psoriasis worsens, note:
when the flare started
where plaques appeared
recent illnesses or infections
unusual stress
skin injuries or sunburn
medication changes
smoking or alcohol exposure
major weather changes
whether treatment was missed or interrupted
A trigger is more convincing when the same relationship occurs repeatedly.
Protect the skin you already have
Gentle skin care cannot eliminate the immune mechanisms behind psoriasis, but it may reduce avoidable irritation.
Practical habits include moisturizing regularly, avoiding scratching when possible, treating minor skin injuries appropriately, limiting very hot showers, and protecting yourself from sunburn.
Keep psoriasis treatment consistent
Flare prevention also depends on treating the underlying disease. Trigger avoidance alone may not adequately control psoriasis, particularly when disease is extensive, persistent, or affecting sensitive areas.
The American Academy of Dermatology's psoriasis clinical guideline recognizes psoriasis as a chronic multisystem inflammatory disease and emphasizes evidence-based topical, phototherapy, systemic, and biologic treatment according to individual needs.
If flares are becoming more frequent despite following your treatment plan, that is a reason to review treatment with a dermatologist rather than simply adding more lifestyle restrictions.
When Should a Psoriasis Flare Be Medically Assessed?
Most psoriasis flares are not emergencies, but medical review is important when symptoms are severe, rapidly worsening, repeatedly uncontrolled, or interfering substantially with daily life.
Contact a clinician if your psoriasis suddenly changes, covers much more skin than usual, becomes difficult to control despite prescribed treatment, or develops after starting or stopping a medication. Joint pain, swelling, or prolonged morning stiffness also deserves assessment because psoriasis can occur with psoriatic arthritis.
Seek urgent medical attention if large areas of skin become intensely inflamed or look burned, especially when accompanied by fever, chills, dehydration, severe weakness, or a rapid pulse. These can occur with erythrodermic psoriasis, a rare but potentially life-threatening form that requires immediate medical care.
Widespread pus-filled lesions together with fever or feeling severely unwell also require prompt medical assessment.
Conclusion
Psoriasis flare-ups can be triggered by stress, infections, skin injuries, certain medicines, weather changes, smoking, and heavier alcohol use, but the pattern is different for every person. Tracking when symptoms worsen can help you identify repeated triggers and reduce exposures that are realistically avoidable.
Trigger management works best alongside appropriate psoriasis treatment rather than as a replacement for it. Do not stop prescription medicines because you suspect they are causing a flare without speaking to the prescriber. If psoriasis suddenly becomes severe, covers large areas of skin, or is accompanied by fever, chills, widespread pustules, or significant illness, seek prompt medical care.
Frequently Asked Questions
1. What is the most common trigger for psoriasis flare-ups?
Stress is one of the most frequently reported psoriasis triggers, but there is no single trigger that affects everyone. Skin injury, infections, medications, cold weather, smoking, and heavy alcohol use are also common. Your own repeated flare pattern is usually the most useful guide.
2. Can stress really make psoriasis worse?
Yes. Stress can contribute to psoriasis flare-ups in some people, although it does not mean psoriasis is psychologically caused. Psoriasis itself can also create stress, forming a difficult cycle. Stress-management strategies may help alongside appropriate medical treatment.
3. Can a cold or infection trigger psoriasis?
Yes. Infections can activate or worsen psoriasis, and strep throat is particularly associated with guttate psoriasis. A flare may develop after the infection rather than during it. Tell your clinician about sudden psoriasis changes following an illness.
4. Why does psoriasis appear where I scratched my skin?
Psoriasis can sometimes develop where the skin has been injured, a response called the Koebner phenomenon. Scratches, cuts, burns, bites, and other trauma may trigger new plaques. Protecting injured skin and reducing repeated scratching can help limit avoidable irritation.
5. Can certain foods cause psoriasis flare-ups?
Some people notice personal food-related patterns, but no single food is proven to trigger psoriasis in everyone. Avoid overly restrictive diets based only on online claims. If you suspect a dietary pattern, discuss it with a health professional before making major nutritional changes.
6. Should I stop a medicine if it makes my psoriasis worse?
No. Some medicines can worsen psoriasis, but stopping them abruptly may be unsafe and can sometimes cause severe rebound disease. Contact the clinician who prescribed the medicine so the timing, risks, and possible alternatives can be reviewed safely.
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