Psoriasis and Fatigue: What’s the Connection?

Inflammatory conditions can leave you feeling tired. Here’s why, plus some tips to help you feel more rested.

Psoriasis (PsO) is an autoimmune, inflammatory condition that causes rapid turnover of skin cells, resulting in thick, scaly plaques that may be itchy, inflamed, or painful.

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Can psoriasis make you tired?

PsO is commonly known as a skin disease, but it can actually affect your entire body — even causing fatigue.

Feeling tired periodically is normal, but if you feel exhausted all of the time despite getting adequate sleep, this could be due to your PsO.

What’s the link between psoriasis and fatigue?

The medical community is not entirely sure how PsO causes fatigue, but they think it has something to do with the immune system’s reaction and attacks on healthy tissue.

People with PsO typically experience some level of inflammation throughout their body, even with mild disease. The cytokines — a type of protein that helps fight inflammation — released during the body’s immune response can cause fatigue, too, but this result is not yet well understood.

Another theory behind PsO fatigue is that the misfiring immune system requires a lot more energy than an efficient immune system, and this can make you feel tired.

Chronic pain has also been associated with fatigue. For example, chronic pain can interfere with your quality of sleep by making it harder to fall asleep and stay asleep.

This means that your pain can make you feel more tired. This is often referred to as painsomnia.

In some cases, PsO can be associated with other medical diagnoses that can cause fatigue, such as sleep apnea, depression, anxiety, and psoriatic arthritis.

Is psoriasis fatigue normal?

The prevalence of fatigue among people living with PsO has varied across studies. One study found that 17% of participants with PsO experienced extreme fatigue. A 2017 study showed that almost 50% of people living with PsO experienced this symptom.

In a 2022 study on psoriatic arthritis (PsA), researchers found that 1 in 3 people with psoriatic conditions report severe fatigue, and this fatigue started before the onset of PsA in people with psoriasis.

If you experience fatigue related to PsO, you’re not alone.

What causes it and how can I manage it?

Although the cause of PsO-related fatigue isn’t entirely clear, and there are no direct treatments for this, if you have PsO and you’re waking up feeling tired, here are some tips to help you cope:

Time your medications conveniently

You might not be able to change what medications you take or their schedules entirely, but if you notice you’re especially fatigued 24–48 hours after you take them, consider taking them on a Friday so you have the weekend to rest, or on another day that works better for your lifestyle.

For example, if you take methotrexate (MTX) and experience methotrexate fatigue — aka methotrexate hangover — be sure to schedule in a day of rest after.

Eat a nutritious, balanced diet

Eating too many packaged or processed foods isn’t beneficial for anyone, but it’s especially important to be mindful if you have PsO. Be sure to feed your body whole foods that are nutrient-dense for optimal energy levels.

Although there isn’t a specific diet for PsO, there are recommendations for foods to avoid and foods that might help manage inflammation. Here are some anti-inflammatory recipes that you might find helpful, too. 

Avoiding eating less than 2 hours before you go to bed can also help prevent any stomach upset or heartburn that may interfere with your sleep quality.

Listen to your body

If your body is telling you to rest, you may need more rest.

PsO is a systemic condition. You may require more sleep than the average person. If you aren’t able to sleep more at night, try naps during the day.

Manage stress

High stress levels can worsen symptoms of PsO as well as directly cause poor sleep quality.

Some tips for managing stress include practicing mindfulness and other relaxation techniques regularly.

Practice good sleep hygiene

Sleep hygiene is an important part of our routines. When possible, plan for at least 8 hours of sleep, turn off all electronic devices about an hour before bed, and try some black-out curtains if you need them.

The temperature of your bedroom can also make a difference in your sleep. Find your sweet spot on your thermostat and stick with it.

It’s also worthwhile to invest in a mattress that fits your needs. After all, we spend around a third of our lives in bed!

Avoid stimulants

Try to avoid alcohol, nicotine, and caffeine before bed. Limiting your caffeine intake during the day to under 400 mg — about 4–5 cups of coffee — might also help you sleep better.

Caffeine levels in energy drinks, specialty coffees, and other supplements can be tricky to track, so be sure to read the labels and calculate accurately.

And remember that everyone’s body is different. You may be more sensitive to caffeine than someone else.

Get regular exercise

Getting regular exercise improves sleep quality by reducing stress, establishing a solid sleep-wake cycle, helping to relieve disordered sleep symptoms, improving the quality of sleep, and even just making it easier to fall asleep.

Increasing your activity throughout the day might make for better sleep at night.

Go outdoors

A 2022 study found that vitamin D may also improve your sleep quality.

Consider getting some sun (with sunscreen, of course!) or taking vitamin D supplements if you’re experiencing a deficiency.

Talk with a healthcare professional

The best way to manage PsO-related fatigue is to manage your PsO. It’s also important that you mention your fatigue to your doctor. They may need to change your current PsO treatment plan or address other issues that are contributing to your tiredness.

The bottom line

It may not be possible to eliminate the fatigue associated with your PsO, but you may be able to improve your overall symptoms.

Start with lifestyle changes, and be sure to talk with a healthcare professional.