Psoriasis Flares During Stress

A few months ago, I was experiencing an extreme about of stress and worry. We were in the middle of the COVID-19 global pandemic — literally. I live in New York City, where the disease has killed people by the thousands. Every day was darker than the last; the grief was palpable in my city. My partner lost his job. I was worried for my immunocompromised parents and myself, and everything felt — stillfeels — generally unstable.

I was full of dread

That sort of trauma affects the body in a weird way. Anxiety became the go-to emotion, taking on the feelings of sadness, worry, fear, and uncertainty. In my body, it all became anxiety. Tight-chested, can't-breath, hyperventilating anxiety. I felt like my mind was racing at night, and I couldn't sleep. I felt a pit of dread, of absolute terror, in my chest.

And I kept asking myself: Why am I feeling this so badly? I'm safe inside my home, I've got steady income, I'm healthy. I'm alive. 

But the truth is, when the world feels like (and is) collapsing, you begin to take on the weight of that trauma in subtle—-and then not so subtle-—ways.

I was in fight or flight mode

I'd dealt with heavy trauma a lot before (family trauma and childhood trauma) so my resilience is high — but I think my body is hard-wired to fight-or-flight reactions, and so when I sense danger, I go into high fight or flight mode.

Although my AS pain has been weirdly minimal as of the last two months, psoriasis — a sort of cousin to ankylosing spondylitis — decided to flare up. I started breaking out in psoriasis flares around both of my eyes. First on my top eyelid on the right, then underneath both eyes on the left and ride side. I used to have little psoriasis patches on my shins during a time of extremely high stress — and they vanished when the stress went away.

Ankylosing spondylitis and psoriasis

Here's the deal: People with AS are more likely to have psoriasis, which causes itchy red scales and patches. Psoriasis is immune-mediated, like AS, as well. Some people have psoriatic arthritis (PsA), which is, also like AS, inflammatory arthritis. PsA is part of the same family of diseases AS, and both are types of spondyloarthritis. So, yeah, they're all sort of connected.

And my anxiety made it worse

My flare looked like raised patches, and they were sort of dry and itchy. I noticed that when my anxiety was high, the patches came out stronger, redder, and bigger. Itchier. Dryer. They spread on their own accord and then would randomly go back down. While I couldn't see my rheumatologist during quarantine, I had a dermatologist confirm it was psoriasis over a telecall. While the patches were on my face, I wasn't self-conscious about them and they didn't spread. I remembered from the past patches on my shins how they were small and came and went. (I do know some people have debilitating, life-altering psoriasis, but mine wasn't like that at all).

Sure enough, it's still flaring, but only mildly. Some days it's gone entirely. Then it comes back and spreads. I've taken some serious, dedicated measures to work against anxiety (like CBD, meditation, mindful workouts, journaling, and getting into nature more often) and it's certainly helped the severity of the spread.

Stress = inflammation

But why does it happen? According to The National Psoriasis Foundation, "Stress is a common trigger for a psoriasis flare....Psoriasis is independently associated with stress-related disorders, such as post-traumatic stress disorder. Women, in particular, seem particularly vulnerable to stress due to psoriasis."1

They go on to say that inflammation is the way the body deals with stress. "Your immune system responds to injury and infection by sending out chemicals that cause inflammation and help heal a wound. In people with psoriasis, the immune system over-responds—it sends out too many of those chemicals," they write.1

So, there you go. Stress — the silent killer — was being the psoriasis flares the whole time. Ah, thank you immune system. You really are great (not). 

I wonder — do you deal with psoriasis flare-ups? Or, do you have PsA? If so, how do you treat it? I'd love to hear in the comments. 

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