If you have psoriasis, you probably know that it’s an inflammatory condition. And if you exercise regularly—say, by sweating it out in a HIIT class or lifting heavy weights—you might be scratching your head, perhaps literally and figuratively, wondering if the acute inflammation from these workouts is sending your system into overdrive.
We asked dermatologists to see if your workouts of choice can either help or hurt psoriasis, and how to adjust your routine to avoid exacerbating flares.
Can you safely exercise with psoriasis?
The good news: You don’t have to choose between your skin and your six-pack. Exercising isn’t just safe for most people with psoriasis; it’s encouraged.
According to Sandra Oska, MD, a board-certified dermatologist in Los Angeles, consistent exercise helps to reduce systemic inflammation. “Exercise can help lower pro-inflammatory cytokine activity,” she says, including TNF-alpha and IL-6, “both of which are relevant to the inflammatory cascade in psoriasis.” In addition, exercise helps improve metabolic factors—including insulin sensitivity and visceral fat—associated with psoriasis. “Higher BMI and higher body fat are associated with greater psoriasis risk and often more severe disease,” Dr. Oska continues. While exercise is beneficial across the board, it can be especially beneficial for those who are overweight or have metabolic syndrome.
And it’s not just about skin. Psoriasis is linked to higher rates of depression and anxiety, which makes exercise’s mood-boosting effects a solid bonus.
Are some workouts better or worse than others?
It seems counterintuitive, but high-intensity exercise—the red-faced, sweat-through-your-shirt kind—just might be the most likely to help calm your skin over time. “High-intensity bursts of exercise can be a stressor in the short-term, but consistent exercise generally decreases chronic inflammation in the long-term,” says Dr. Oska. Observational research supports this idea, including a 2018 review of 13 studies showing that intense physical activity was associated with a lower prevalence of psoriasis. Shira Wieder, MD, board-certified dermatologist at Montefiore Einstein Advanced Care, adds one caveat. For people with psoriatic arthritis—symptoms of which include joint pain, stiffness, and fatigue—she recommends low-impact exercises like swimming, walking, and yoga instead.
In addition, you might need to take extra precautions depending on the types of exercise you do and where your plaques show up. Brendan Camp, MD, FAAD, a double board-certified dermatologist and dermatopathologist at MDCS Dermatology in New York City and Long Island, says people with inverse psoriasis (in which plaques occur in areas when skin rubs against skin, such as the underarms and groin folds) need to be more cautious. Exercises that require repetitive motion in these areas—which could include anything from running and rowing to kettlebell swings and battle ropes—can aggravate psoriasis, he says. He also advises limiting friction on commonly affected areas like the elbows and knees—say, via forearm planks, deep lunges, and cable crunches. Friction can trigger new lesions through the Koebner phenomenon, a response in which skin trauma sparks plaques in previously unaffected areas.
“Some patients have scalp psoriasis and are bothered by sweating of the scalp,” adds Dr. Oska. “Others have involvement of the palms and soles, which can make gripping weights uncomfortable.” Medication is another variable to account for. For instance, Dr. Oska says that patients on methotrexate may experience fatigue, while those on acitretin may deal with increased dryness and skin irritation as a side effect. If you’re dragging through workouts or struggling to finish sets, your prescription—not your discipline—could be the culprit.
More tips for exercising with psoriasis
On top of doing what feels right by your body on a given day, there are a few other ways to make your workout routine more comfortable. All of the derms we interviewed suggest wearing light, loose, moisture-wicking fabrics that limit friction. Anti-chafing balms can also help reduce irritation in high-friction areas. And a post-workout shower is always a good idea. “Sweat is not dirty, but letting it sit on already inflamed skin for long periods can contribute to irritation,” says Dr. Oska.