What the pandemic has taught us about stress and psoriasis
The COVID-19 pandemic has resulted in job losses and other stressors. People with psoriasis may find that symptoms such as itching, scaling, and discoloration worsen during times of stress.
Psoriasis is a chronic inflammatory condition that affects the skin. The most common type of psoriasis causes scaly skin patches, known as plaques. Some people with psoriasis also develop psoriatic arthritis, which causes joint pain and stiffness.
Some people with psoriasis found that their symptoms worsened during the COVID-19 pandemic. Pandemic-related stress may be responsible for this.
Read on to learn how stress may affect psoriasis.
Certain triggers can cause a psoriasis flare, which happens when psoriasis symptoms get worse. Stress is a common psoriasis trigger.
“Stress can definitely make psoriasis symptoms worsen, initiating flares and causing symptoms of itching, scaling, and redness to become more prominent and bothersome,” Anna Chacon, M.D., a board-certified dermatologist with My Psoriasis Team, told Medical News Today.
Studies suggest that the relationship between psoriasis and mental health runs both ways.
People with psoriasis have an increased risk of depression, report the authors of a 2020 reviewTrusted Source. In turn, more stress and depression may lead to more psoriasis flares.
Many people have experienced stress during the COVID-19 pandemic. Some research has linked psychological stress during the pandemic to worsened psoriasis symptoms.
In an international survey of people with psoriasis, 42.7%Trusted Source said their psoriasis symptoms have worsened during the pandemic. (The survey is currently in the preprint stage prior to publication.)
More women than men reported that their psoriasis symptoms worsened. However, study authors noted that this may be because the survey included more women than men overall. Researchers also noted that because predominantly white European people took the survey, the results may not necessarily apply to everyone.
Of the survey respondents, those who said their psoriasis worsened had greater likelihood of reporting symptoms of anxiety or depression.
Several pandemic-related stressors may contribute to stress, anxiety, and depression. Along with fear of developing COVID-19, these include changes to people’s:
- social lives
- job security
“There are many pandemic-related stressors including job insecurity, financial struggles, changes in work hours or schedule, lack of access to healthcare, and development of comorbid conditions,” said Dr. Chacon. “Others include fear to continue a biologic immune-based therapy due to fears of [developing] COVID-19.”
Social isolation and job loss
To curb the spread of COVID-19, many governments passed temporary laws to close or reduce the hours of nonessential businesses, schools, and other sites.
Many have also passed laws to limit social gatherings in public and private spaces or put lockdowns in place.
These measures have interrupted the usual rhythms of life, contributed to social isolation, and disrupted many people’s employment and income.
A 2020 online survey of adults with psoriasis in China found an association between loss of income during the pandemic and worse psoriasis symptoms. Outdoor activity restrictions also had an association with worse symptoms.
Many clinics and other medical centers have restricted in-person appointments during the pandemic. This has made it harder for some people to get treatment for psoriasis, anxiety, depression, or other health conditions.
Loss of health insurance also makes it harder for people to get healthcare. Researchers from the Commonwealth Fund estimate that millions of Americans have lost employer-sponsored insurance during the pandemic.
These barriers to healthcare may lead to delays or interruptions in treatment, as well as increased stress.
Concerns about psoriasis treatment
Some people worry about how psoriasis treatment might affect their risk of developing COVID-19.
Healthcare professionals often treat moderate to severe cases of psoriasis with systemic therapies, including biologic drugs and other injected or oral medications.
Many systemic treatments affect the immune system, which has raised concerns about how they might affect a person’s ability to ward off COVID-19.
Although research remains limited, results from a small 2021 surveyTrusted Source of Americans with psoriasis suggest that systemic treatments for psoriasis do not increase the risk or severity of COVID-19. However, some people with psoriasis may still have concerns and experts must perform more research on the topic.
A 2021 global study looking at people with psoriasis who potentially had COVID-19 found that those on biologics had a lower risk of hospitalization than those on nonbiologic drugs.
In the international survey mentioned earlier, 18.5%Trusted Source of people with psoriasis had not taken systemic treatments as prescribed during the pandemic. Many expressed concern about how the treatments might affect their risk of developing COVID-19.
Those who had not followed their prescribed treatment plan were more likely to say their psoriasis had worsened.
In the 2021 surveyTrusted Source of American adults with psoriasis, people who took biologics expressed more concern than others that their treatment might raise their risk of developing COVID-19.
Concerns about treatment may cause stress. If someone stops taking a psoriasis treatment, it can cause a flare of psoriasis symptoms.
Post-vaccination psoriasis flares
A December 2020 studyTrusted Source documented psoriasis flare-ups in four patients at a single clinic after vaccinations for influenza.
However, this is a very small sample. Researchers noted that vaccinations are an uncommon trigger for psoriasis flare-ups.
Of the 30,420 participants in the Moderna phase 3 clinical trial for the SARS-CoV-2 vaccine, 244 people (0.8%) experienced a delayed skin rash after the first dose, according to a 2020 controlled trial. After the second dose, 68 people (0.2%) experienced a delayed skin rash (8 or more days after the injection).
The National Psoriasis Foundation (NPF) Covid Task Force encourages people with psoriasis to take any of the three SARS-CoV-2 vaccines available in the United States.
The Centers for Disease Control and Prevention (CDC)Trusted Source recommend the following strategies to help manage stress during the pandemic:
- Take breaks from reading, watching, or listening to the news, including stories about the pandemic.
- Make time for hobbies and relaxing activities, such as deep breathing exercises or meditation.
- Connect with other people and community- or faith-based organizations.
- Try to get enough sleep, eat a nutritious diet, and avoid misusing alcohol or using tobacco or other substances.
Getting regular exercise can also help relieve stress, which may have benefits for psoriasis. Many governments have loosened restrictions on outdoor activities, allowing people to get active outside.
“I recommend trying alternative methods to control stress, including picking a sport that will be good for your skin,” said Dr. Chacon.
She encouraged that people should wear sunscreen, a wide-brimmed hat, and a long-sleeved shirt to avoid sunburn during outdoor sports. Sunburns can make psoriasis symptoms worse.
Getting treatment for psoriasis can help reduce symptoms and improve quality of life.
The NPF COVID-19 Task Force recommends that in most cases, people who do not have the coronavirus that causes COVID-19 should continue taking biologic or oral treatments that their doctor has prescribed.
The task force encourages people to avoid long-term systemic steroid use for psoriatic disease if possible. When long-term systemic steroids are necessary, the task force recommends taking the lowest dose possible.
A person should not stop taking any prescribed medications without speaking with their doctor first. A healthcare professional can help them understand the potential benefits and risks of changing their treatment plan.
People should let their doctor know if they have felt frequently stressed, worried, angry, sad, or disinterested in things they usually care about. These may be signs of anxiety or depression.
Their doctor may prescribe antidepressants or refer them to a mental health specialist for support.
Pandemic-related stress may cause psoriasis symptoms to get worse. Fear of COVID-19, social isolation, loss of income, and difficulty accessing healthcare are just some of the stressors that people may encounter.
Some people also worry about the effects that psoriasis treatments might have on their risk of developing COVID-19. However, current evidence suggests that psoriasis treatments do not increase the risk or severity of COVID-19.
Following prescribed treatment plan for psoriasis, taking steps to manage stress, and reaching out to a mental health specialist when necessary may help limit psoriasis symptoms and stress.