What can trigger psoriasis?

Triggers of Psoriasis

Psoriasis can be triggered or exacerbated by multiple factors including stress, systemic infections, medications, skin trauma, and obesity, with medications and infections being among the most well-documented triggers. 1

Medication Triggers

Certain medications have strong evidence for triggering or worsening psoriasis:

• Lithium - Can cause severe, even life-threatening deterioration of psoriasis in patients with pre-existing disease 2
• Antimalarials (chloroquine, hydroxychloroquine) - Can severely worsen pre-existing psoriasis 2
• Beta-blockers - Can exacerbate pre-existing psoriasis or trigger new onset in susceptible individuals, with stronger association in long-term use 2
• NSAIDs (non-steroidal anti-inflammatory drugs) - Can worsen existing psoriasis 2, 3
• TNF inhibitors - Can paradoxically trigger psoriasis in some patients despite being used to treat the condition 2
• Other medications with reported associations:
  • Tetracyclines 3
  • Angiotensin-converting enzyme inhibitors 4
  • Gold salts 5
  • Interferon 5
  • Gemfibrozil 5
  • Iodine 5
  • Digoxin 5
  • Clonidine 5

Infectious Triggers

• Streptococcal infections - Strong evidence exists for the induction of guttate psoriasis following tonsillar Streptococcus pyogenes infection 4
• Skin and gut colonization by Staphylococcus aureus, Malassezia, and Candida albicans have been linked to disease exacerbation 4
• Viral infections - The role of papillomaviruses, HIV, and endogenous retroviruses remains under investigation 4

Environmental and Lifestyle Factors

• Skin trauma (Koebner's phenomenon) - Physical injury to the skin can trigger psoriasis at the site of trauma 1
• Stress - Psychological stress is a well-documented trigger for psoriasis flares 1, 6, 7
• Weather - Cold weather can exacerbate psoriasis symptoms 6
• Alcohol - Excessive alcohol intake can precipitate or worsen psoriasis 2, 6
• Obesity - Higher BMI is associated with increased risk of developing psoriasis and may worsen existing disease 1
• Smoking - Has been identified as a potential trigger factor 7

Genetic Factors

• Psoriasis has a strong genetic component with at least 8 chromosomal loci (PSORS I-VIII) linked to the disease 1
• HLA-Cw6 allele (PSORS1) is the major susceptibility gene for psoriasis 1

Clinical Implications

• Identifying and avoiding triggers is an important aspect of psoriasis management 1
• For medication-induced psoriasis, consider alternative therapies when possible 2
• In cases of severe flares triggered by medications, discontinuation of the offending agent may be necessary, though this should be balanced against the need for the medication 2, 3
• Streptococcal infections should be treated promptly, especially in patients with a history of guttate psoriasis 4
• Weight management may help reduce psoriasis severity in overweight patients 1

Understanding these triggers can help patients and clinicians develop strategies to minimize flares and improve quality of life for those living with psoriasis.