• Stress and Psoriasis: Managing Triggers and Flare Ups

    by Dr. Payal Bhandari
    on Aug 1st, 2018

Psoriasis is an autoimmune condition in which the immune system speeds up the lifecycle of your body’s skin cells. These cells accumulate rapidly on the surface of the skin. As a result, the skin can appear red and scaly, sometimes even cracked or bleeding. This process produces mild to severe inflammation. Psoriasis can also cause joints to swell or stiffen. In some cases, people with psoriasis notice cosmetic changes to the nails and/or hair. It is a recurring condition for which there is currently no clear cure (more on this later). It affects between 1-3% of Americans, and is partially hereditary.

Psoriasis is not pleasant. It can cause transient disfigurement, pain, and can degrade a person’s quality of life. Psoriasis is now understood to be highly associated with certain cancers and inflammatory bowel diseases.

Mental Health, Stress and Psoriasis

As with any autoimmune condition, psoriasis can be caused or intensified by stress.

As a person experiences repeated stress, their body produces cortisol, which is a “stress hormone”. This is a natural phenomena and important for our survival. For example, in limited, time-restricted doses cortisol is designed to supercharge the body, allowing a person to outrun danger, forage farther for food in times of scarcity, and protect one’s children from an attacker. It’s like running the body on overdrive.

However, in the post-industrial age, outrunning danger, surviving scarcity, and defending yourself and/or loved ones is not commonplace. It’s unlikely that you’ll ever have to outrun a bear, but it’s very likely that you’ll experience financial stress or a setback at work at some point in your life. Events like these can provoke exactly the same stress response as a clear and definible danger. With no practical, physical recourse, the stress reaction doesn’t abate. It lingers overhead like a dark cloud. With excess cortisol in circulation, the immune system goes into overdrive, provoking inflammation, allergic reactions, gout, and psoriasis.

These conditions can exacerbate their own underlying causes in a feedback loop. The relationship between psoriasis and stress provides a prescient example. A person with psoriasis might experience a sort of muted omnipresent pain, or drag. Imagine those scaly patches developing between the fingers of a typist. That omnipresent discomfort would exacerbate the underlying stress which might have caused the condition. Or if it should present on a more sensitive area of the body, the impact on one’s self-image, and self-esteem, could take a pervasive toll on a person’s mental health. The stress becomes ever-present.

Managing Stress and Triggers to Prevent Psoriasis Flare Ups

While some forms of psoriasis are difficult to treat directly, managing stress and avoiding the specific triggers for flare-ups are always possible. Here are some helpful techniques to moderate your stress levels:

Yoga

The regular practice of yoga gently exercises the body and helps a person to feel more grounded. It promotes a sense of wellness that can dramatically reduce stress and fosters better habits for managing stressful triggers down the line. The low-impact, consistent exercise also helps to work the body, boosting metabolism and reducing the hormonal impact of stress. Another important point is that yoga helps stabilize the immune system, increasing the production of anti-inflammatory cytokines (proteins that can inhibit the symptoms of psoriasis).

Exercise

Higher intensity exercise is even more effective for reducing psoriasis, though excessive exercise can actually have a detrimental impact on certain autoimmune conditions, including psoriasis. Thus, balance, as with every intervention, is key. Working the body through exercise increases blood- and lymph-flow. There is no pump to push the lymph (like the heart pushes blood around), so the body requires movement to push it around. Otherwise, lymph remains stagnant. Exercise also encourages the production of endorphins to decrease stress and encourage a state of mental clarity. Choosing exercise you enjoy matters—it will look different for every body.

Sleep

Getting regular, good quality sleep is essential for reducing and managing stress. Chronic loss of sleep is correlated with stress, depression, anxiety, and other mood disorders. In a practical sense, sleep is when the body recharges and rebalances its various systems. Autoimmune conditions reflect a clear imbalance, and sleep is one of the most fundamental tools you can leverage to begin to correct it.

Massage

Skin to skin contact decreases stress, and increases levels of oxytocin and endorphins. It’s been shown to help treat depression, improve mood, and promote those feelings of security and wellness that help to calm the underlying stress response that causes psoriasis. Regular therapeutic massage, in a very real sense, works out the tension and leaves the body more relaxed, open, and serene. Massage, in treating stress, can decrease the duration and severity of outbreaks, and can help you to cope with future potential stressors.

Meditation

Meditation produces a cognitive state of heightened awareness and clarity, sometimes called an “alpha state” from the particular waveform of the brain’s electrical activity. In this state, as different parts of the brain are engaged, a pervasive feeling of calm is cultivated. The brain’s stress response is quieted. In doing so, the brain halts production of the hormones which propagate stress reactions, and decrease levels of related protein markers through the rest of the body. It is these protein markers which cause psoriasis, and their removal from the system allows the skin and other tissues to return to normal.

CBT

Cognitive Behavioral Therapy treats stress by encouraging relaxation techniques, breathing exercises, problem-solving, assertiveness training, and other means to help reduce the impact of stressors—and sometimes remove them altogether. Breathing exercises, in particular, are a very effective way to reassure the body that all is well (and that the stress reaction can rest). As a result, conditions like psoriasis and inflammation can significantly reduce.

Diet

In integrative medicine, no discussion is complete without addressing diet. Psoriasis responds to the same sorts of food triggers as other types of inflammation. Foods to avoid include processed foods, high trans- and some saturated fats, and refined sugar and alcohol. Keep in mind that certain food triggers for one person (i.e. eggs and dairy) will be different from another (i.e. pork, peanuts, and soybeans).

Advanced Health and Dr. Payal Bhandari, M.D.

Advanced Health’s team of practitioners, under the leadership of Dr. Payal Bhandari M.D., practice Integrative Medicine. In this practice, the body is treated as a coherent whole, rather than a collective of discrete isolates and sub-systems. A skin condition, like psoriasis, can be caused by refined sugar and alcohol intake, allergenic foods, nutrient insufficiencies and other lifestyle imbalances. Smoking should be avoided as it’s likely to provoke or exacerbate an outbreak.

If you’re suffering from psoriasis, contact Advanced Health for a consultation, and an evaluation with any or several of our providers. By taking charge of your stress, you can bring your body back to balance, and find the relief you’ve been hoping for.

Author Dr. Payal Bhandari Dr. Payal Bhandari M.D. is a leading practitioner of integrative and functional medicine in San Francisco.

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