5 Questions on Psoriasis and Lifestyle: Expert Q&A

Anthony P. Fernandez, MD, PhD, is the director of medical and inpatient dermatology at Cleveland Clinic. He specializes in treating skin-related autoimmune and inflammatory diseases like psoriasis.

Here, Fernandez answers questions about effective lifestyle tweaks.

"It's important for people to recognize that they should take control, do everything they can to help make their psoriasis better," he says. "There are four things we typically recommend for people with psoriasis: diet, exercise, relieving stress, and getting adequate restful sleep." Yes, the same things that are good for your entire body may help with your psoriasis.

Keep these two things in mind: First, what works for you may be different from what works for someone else with psoriasis. It's a highly individual disease, so you'll want to notice what helps you feel better.

And second, it may take more than lifestyle to take care of your psoriasis.

"It's important for people to recognize that they should take control, do everything they can to help make their psoriasis better," Fernandez says. "But even if they do everything meticulously, they still may need medications."

Fernandez: For patients who are overweight or obese, losing weight can help improve their psoriasis. This shows the importance of diet.

When we’re educating patients with psoriasis about what they can do from a dietary standpoint to improve their disease, the diet most people recommend is the Mediterranean diet. It has the most data to support the idea that if you follow it, it’s likely that your chronic inflammatory disease, in this case psoriasis, will improve.

Many of the foods are anti-inflammatory in nature, and they also provide great nutrients and antioxidants. They’re good not only for general health, but also to help keep the immune system calm, which helps to control psoriasis.

It’s fruits and vegetables, it’s nuts, it’s fatty fish but not a lot of red meat, it’s olive oil. They’re all part of the Mediterranean diet.

There aren’t necessarily specific foods within the diet that are particularly important for psoriasis. It’s all about a balanced diet, and those types of healthy foods that make up the Mediterranean diet.

WebMD: Are there foods to avoid?

Fernandez: Gluten always comes up when patients ask about this. There’s very strong data that suggests if a patient is proven to have celiac disease along with psoriasis, avoiding gluten may help their symptoms. But aside from proven cases of celiac, there’s no evidence that being gluten-free will help psoriasis.

I don’t think there are specific foods all patients with psoriasis should avoid. It’s more about the types of foods. In the same way that foods in the Mediterranean diet have anti-inflammatory properties, some foods have pro-inflammatory properties.

These are foods with a heavy fat content or a lot of sugar, processed meats, and snacks – things like that. Patients should avoid them as best they can, within reason. It’s not that they can never enjoy an ice cream sundae or a hamburger with all the toppings. But that should be the minority of time.

To use diet to your advantage to help your psoriasis, most people should focus on eating anti-inflammatory foods.

Fernandez: Exercise is really important for patients with psoriasis, for many reasons. It can help keep your immune system healthy. It can calm an overactive immune system. It also promotes better overall components of your body: It builds muscle and decreases fat.

Also, body fat has pro-inflammatory properties. Weight-bearing exercise in particular can help build muscle and reduce body fat. It also helps to keep joints and tendons strong. This can help minimize your future risk of psoriatic arthritis, which is a concern for people with psoriasis.

Typically, patients don't bring up sweating as a problem. If a patient were to experience [worsening] of symptoms due to sweating, I would recommend clothing that could absorb the sweat to minimize symptoms yet still allow you to do the types of exercises you enjoy.

Avoid movements or positions that aggravate your pain or itching when you’re flaring. 

Too much pressure can induce skin lesions in areas where there weren’t any, which is known as the Koebner phenomenon. When you’re flaring, the immune system may be so active that there’s a higher risk of doing that.

If a patient with psoriasis is developing skin pain or itching with certain types of exercise clothing, just avoid wearing those. There aren’t general statements that we make to all psoriasis patients when it comes to what clothing to wear, or even what particular exercises to do.

Fernandez: This is extremely important. It’s one of the main things patients can do to try to take control of their psoriasis and calm it down.

When I educate patients, I say, "When you have stress, what types of strategies help you to relieve it?" For some people, it’s exercise. For others, it may be going for a walk, reading, listening to music.

There’s no one-size-fits-all approach. I encourage my patients to be conscious of what seems to work best for them and to adopt those practices whenever they’re feeling overly stressed.

Editor's note: If your stress is hard to manage, or if you feel depressed or anxious, consider talking with a mental health therapist. 

WebMD: Are mind-body practices like meditation proven to help?

Fernandez: To my knowledge, there’s no research to support one mind-body approach as better than another.

As far as what can help, the first thing that comes to mind is yoga. I bring that up with patients as a form of exercise. It’s particularly good for psoriasis. The movements are slow enough to promote relaxation, so it can be a great way to relieve stress. 

It also encourages flexibility, which is really important for the joints. With psoriatic disease, we want to do everything we can to keep the joints healthy, to keep the immune system components around the joints calm, in order to minimize the risk of psoriatic arthritis.

Beyond yoga, there are things like Transcendental Meditation (TM). If they want to pursue it, I encourage them to. But we don't want to pigeonhole any patient into one sort of methodology to try to improve their psoriasis. 

Fernandez: It’s the one thing patients can control that they forget about the most.

Restful sleep has been shown to be extremely important for a healthy functioning immune system and for keeping an overactive immune system calm.

Patients often say they feel fine after five hours of sleep. But research shows that the vast majority of people, including those who think they’re fine on less sleep, should get seven to eight hours a night to optimize their overall health and keep their immune system functioning ideally. I stress that to my patients.

With patients who are overweight or obese, I’ll ask about snoring. They might need to get evaluated for obstructive sleep apnea. When people have it, even if they’ve been in bed with their eyes closed for eight hours, they don’t get really restful sleep. They may wake up 50-60 times. They never enter the deep sleep stages that are truly restful.

This is a huge message for patients with psoriasis: You know about diet, you know about exercise, you know we should relieve stress. But sleep is still not on a lot of our patients’ radar.

Fernandez: I tell patients that using a moisturizer on their skin keeps the areas where the skin looks normal healthy. It also helps to minimize itching and skin pain in areas where they have active psoriatic plaques.

And I encourage sunscreen – you don’t want sunburn. Just like too much friction or pressure, it can cause new areas of psoriasis in some patients. 

You do want to get a little sun, but in moderation. That can help calm inflammation. Light treatment or phototherapy is something we’ve used to treat psoriasis for many, many decades.

I don’t tell patients to avoid fragrances or certain vehicles for moisturizer. Whatever you feel works to make your skin feel best, go for it.

Editor's note: Other sun protection tips include avoiding being outside during the sun's peak hours, wearing broad-brimmed hats and sunglasses that have UV protection, and wearing cool fabrics, especially in pale colors.