Your Psoriasis Skin and Beyond
Is Psoriasis Causing Your Fatigue?
Psoriasis is commonly regarded as a skin disease but it's actually a condition that affects your entire body and can often contribute to fatigue.
By Katherine LeeMedically Reviewed by Ross Radusky, MD
Persistent fatigue can interfere with your daily function.Fan Jianhua/Getty Images
It's normal to feel tired occasionally, especially if you've had a particularly busy day or didn't get enough sleep the night before, but chronic and persistent exhaustion may be a sign of an underlying medical condition. If you have psoriasis, your disease may be the culprit behind your flagging energy and mental or physical exhaustion.
According to the American Academy of Dermatology Association (AAD), many people with psoriasis experience persistent fatigue that may interfere with daily function. A study published in February 2017 in the British Journal of Dermatology assessed fatigue in 84 psoriasis patients and 84 healthy people without psoriasis and found that nearly 50 percent of those with psoriasis experienced substantial fatigue.
And a study published in February 2020 in the journal Advances in Dermatology and Allergology, which included 58 patients with psoriasis, 60 patients with psoriatic arthritis, and 61 people in a control group who didn't have these conditions, found that 17 percent of people with psoriasis were found to have severe fatigue. The researchers also noted that chronic fatigue is a serious but underrated problem in people with psoriasis.
Why Psoriasis May Lead to Fatigue
"Psoriasis is something people see on their skin so they may think it's just skin-deep, but it really isn't," says Rosalyn George, MD, a board-certified dermatologist and fellow of the American Academy of Dermatology and owner of Wilmington Dermatology Center in North Carolina. "It's actually a truly systemic disease." This means psoriasis can affect the entire body, not just the skin. One of the ways it does so is by causing persistent fatigue, notes Dr. George.
Doctors aren't sure exactly how psoriasis causes fatigue, but they suspect it might have to do with the fact that psoriasis causes an immune system reaction, and when your immune system is on hyper alert all the time, your body gets tired because it's constantly working, explains George.
"Psoriasis is a disease of inflammation," says Neelam Vashi, MD, an assistant professor of dermatology at Boston University School of Medicine and a dermatologist at Boston Medical Center. "Inflammation can go to the skin, to the joints, and to other places in the body." According to Dr. Vashi, when the body has disease, it makes proteins called cytokines that cause inflammation. It's not fully understood how these proteins can cause fatigue, but they set off the immune system and trigger inflammation, which takes up the body's energy.
There's also the fact that psoriasis can cause discomfort, which may impact sleep. "Itching can sometimes interfere with sleep patterns," says Stephen P. Stone, MD, a professor of dermatology at Southern Illinois University School of Medicine in Springfield, Illinois.
Psoriasis-Related Conditions May Contribute to Fatigue
According to the AAD, psoriasis can increase your risk of developing other health conditions that may interfere with sleep and contribute to fatigue.
Psoriatic arthritis According to the National Psoriasis Foundation (NPF), about 30 percent of people with psoriasis are affected by psoriatic arthritis. "A significant number of patients with psoriatic arthritis have joint pain, and that can also interfere with sleep patterns," says Dr. Stone.
Sleep apnea According to a study published in April 2020 in the journal Scientific Reports, people with psoriasis have a significantly increased risk for obstructive sleep apnea, and people with obstructive sleep apnea have a significantly increased risk for psoriasis — an example of a bidirectional association. The researchers note that people with psoriasis should be evaluated for sleep problems.
Depression Many people with psoriasis can feel down and depressed, and may find themselves dealing with intense feelings of anxiety, worry, sadness, and fear, which can interfere with their daily lives, according to the NPF. "Feeling down and depressed can contribute to fatigue," adds Vashi.
An article published in the January-February 2019 issue of Actas Dermo-Sifiliográficas notes that anxiety affects as many as 43 percent of people with psoriasis, and that approximately 20 to 30 percent of people with psoriasis experience depression, with some research reporting numbers as high as 62 percent. The article also notes that severe psoriasis is associated with higher rates of depression.
The AAD notes that certain medications, such as some pain medications and methotrexate, which is commonly prescribed by doctors to treat psoriasis and psoriatic arthritis, can make you feel tired.
Any of these factors can contribute to the fatigue commonly experienced by many people with psoriasis. "It's kind of a combination — the disease process itself, other diseases that are associated with psoriasis, and then some medications as well," says George. She also notes that some people may turn to unhealthy habits to cope with some of these issues, particularly depression or anxiety. "It could contribute to them making poor choices that will exacerbate fatigue, such as turning to food or alcohol, which can contribute to poor sleep," says George. She notes that poor diet and alcohol can also worsen inflammation and psoriasis. "It's kind of like a circle where you have psoriasis, you don't feel good so you seek out things that might make you feel better, and those things actually make everything worse," says George. "It can become a bad cycle for people, and it can be really hard to break out of it."
How to Manage Your Fatigue
If you have psoriasis and are experiencing persistent fatigue, there are several strategies you can try to boost your energy and improve your sleep.
Talk to your doctor. The first thing you should do is see your dermatologist to make sure you're doing everything you can to keep your psoriasis well-controlled. "Tell your dermatologist if you're having sleep difficulties so that they can make recommendations and help you deal with it," says Stone. For instance, your doctor can help you find the right medication to help keep inflammation down and keep your skin clear, says Vashi. "We don't have a cure for psoriasis but we have a lot of medications out there that really do work well to control it," says Vashi.
Your dermatologist can also refer you to other specialists who can deal with related conditions such as obesity, heart disease, diabetes, depression, substance abuse, and more, says George.
Exercise regularly. According to the AAD, low-impact exercises such as swimming and walking may help prevent excess weight gain and ease pain from psoriatic arthritis. They note that extra pounds can contribute to fatigue and that reducing pain can also help you feel less tired.
"When people have health conditions, it can be hard to get into the habit of exercising, but even starting a little can make such a big difference," says George. "Get outside, take a brief walk, and find something that can keep you active because if you get a little exercise, it can make it easier to fall asleep at night, too."
Eat a healthy diet. The AAD notes that eating a healthy and well-balanced diet of whole grains, fresh fruits and vegetables, and lean proteins may help reduce fatigue and keep your energy levels stable.
"I'm not saying you can never have a cheat day or a piece of cake, but in general trying to choose whole foods that aren't processed [can help reduce fatigue in people with psoriasis]," says George. "When you eat all that processed, sugary food, your body is on high alert all the time and inflammation is increased."
Get treatment for depression and anxiety. Depression and anxiety are common in people with psoriasis and these issues have been linked to sleep problems. According to the National Sleep Foundation, as many as 75 percent of people with depression exhibit symptoms of insomnia and many have been shown to also experience excessive daytime sleepiness and hypersomnia (sleeping too much). In addition, poor sleep has been associated with worsening depression, which then further impacts sleep.
Similarly, anxiety is also associated with an increased risk of insomnia, and poor sleep can in turn worsen anxiety and make it harder to fall asleep, according to the National Sleep Foundation.
"If you're feeling down and depressed, seek help from professionals and even from loved ones," suggests Vashi.
Practice good sleep habits. Practicing general healthy habits for good sleep can be an important part of managing your fatigue, says George. These include:
Keeping your bedroom dark and quiet
Sticking to the same sleep and wake schedule every day
Avoiding alcohol
Limiting caffeine, especially close to bedtime
Reducing stress (Meditation apps can be helpful as can identifying things that may be causing your stress, says George.)
Keeping electronic gadgets that emit blue light (such as the TV, tablets, computers, and cell phones) out of the bedroom
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