Over 40% of patients with psoriasis experience fatigue, which varies in intensity and duration from person to person.¹ It is not to be confused with normal tiredness, since fatigue associated with psoriasis may not improve after rest. Symptoms of fatigue include:

• an overwhelming sense of tiredness, which may persist even after a good night’s sleep
• lack of energy
• feeling physically and/or mentally exhausted^2, 

Why do I feel fatigued and what causes it?

The exact mechanisms that cause fatigue in psoriasis are not clear. It is thought that fatigue may be a byproduct of inflammation, which is also the mechanism by which the symptoms in the skin and joints appear. The process of inflammation in the body is very complicated and triggers a release of an assortment of powerful chemicals, which exceed those usually present in the body.

For many patients, fatigue is the most bothersome symptom of the illness, and should not be downplayed. Fatigue can interfere with physical, mental and social function and ultimately lead to withdrawal from usual social activities, causing sick leaves and disability. It is important to be aware of the fatigue symptoms and learn how to manage them to help lead a happier and healthier day-to-day life.⁴

How can fatigue from psoriasis affect my relationship?

The fatigue experienced with psoriasis can often indirectly impact relationships with partners and families. The disruption in sleep, reduced energy levels, and lower productivity may require a partner to take on more responsibilities (household duties, additional sources of income). Such changes and imbalance in day-to-day activity can lead to a potential strain on the relationship.⁵

Impaired sexual function is also present in over 40% of men and women with psoriasis.⁶ This could be due lowered self-esteem with the lesion location, but also due to anxiety, depression, and fatigue. It is important to take note of how psoriasis impacts your sexual life and bring it up at your visits with a dermatologist. Awareness of the interplay of fatigue symptoms and impaired sexual function is important to take necessary management steps to improve overall life satisfaction.⁷

What can I do to manage and overcome fatigue that comes with psoriasis?

Fatigue can be managed through general lifestyle interventions:

• Regular exercise⁸  
  • This may be difficult given muscle and joint pain (not to mention fatigue), but everything counts - do as much as you can without incurring pain and extra stress
  • Light to moderate cardio - biking, rowing, swimming, walking
• Maintain a regular sleep-wake schedule and practice good sleep hygiene⁹  
  • Go to bed and wake up around the same time (~10PM - 7AM)
  • Reduce screen time 1-2 hours before bed
  • Limit intake of caffeine
  • Avoid sleeping pills, nicotine and alcohol - these may be effective at putting you to sleep, but lead to disrupted overall sleep
  • Sleep in a cool and dark room
• Eat a diet rich in fruit and vegetables (ideally 5-10+ servings), low in saturated (animal) fat and minimal sugar; avoid processed foods as much as possible¹⁰ 
  • Green leafy vegetables
  • Fish, avocado, nuts
  • Eat regular meals and try to lose weight if you are overweight

Remember to speak to your dermatologist about symptoms of fatigue. Some medications for psoriasis are better at improving these symptoms than others. Take the medications prescribed for psoriasis diligently, as they can help alleviate symptoms of fatigue and ultimately improve overall quality of life.

Being the partner of someone with psoriasis

Support from partners is very important for managing fatigue. It is important for partners to take the time and understand that this is a common symptom, beyond normal tiredness, that “ebbs and flows.” Here are some tips on how to help support a partner with psoriasis:

• Your partner with psoriasis may be ashamed or try to downplay their symptoms - do your best to maintain an open dialogue, “check in” from time to time to monitor how they feel, and do your best
• Accept that it is not your partner’s fault, they are not being “lazy” - psoriasis treatment is a complex and ongoing process - they may have “good days” and “bad days”

Other important notes^{11, 12}

• Take care of your mental health - psoriasis symptoms have a seasonal component, and tend to be worse in winter months when skin is more likely to be dry and itchy
• The mental and physical exhaustion, and poor self-image can be further compounded by the impact of reduced physical activity and seasonal depression
• Recognize symptoms of depression, agitation and anxiety associated with your fatigue and do your best to discuss these openly with your partner, close friends, family physician and dermatologist
• Consider incorporating mindfulness meditation and relaxation techniques to reduce overall stress and improve sleep quality
• If fatigue-associated/seasonal depressive symptoms are severe enough, they could contribute to further inactivity and dysregulation of your daily life - your family physician may recommend additional treatment for mood/mental health

References:

1. Skoie IM, Dalen I, Ternowitz T, Jonsson G, Kvivik I, Norheim K et al. Fatigue in psoriasis: a controlled study. Br J Dermatol 2017;177:505-12.
2. Rosen CF. Fatigue and psoriasis. Br J Dermatol 2017;177:346-7.
3. Carneiro C, Chaves M, Verardino G, Drummond A, Ramos-e-Silva M , Carneiro S. Fatigue in psoriasis with arthritis. Skinmed 2011;9:34-7.
4. Skoie IM, Ternowitz T, Jonsson G, Norheim K , Omdal R. Fatigue in psoriasis: a phenomenon to be explored. Br J Dermatol 2015;172:1196-203.
5. Young M. The psychological and social burdens of psoriasis. Dermatol Nurs 2005;17:15-9.
6. Duarte GV, Calmon H, Radel G , de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis (Auckl) 2018;8:93-9.
7. Duarte GV, Calmon H, Radel G , de Fátima Paim de Oliveira M. Psoriasis and sexual dysfunction: links, risks, and management challenges. Psoriasis (Auckl) 2018;8:93-9.
8. Sharif K, Watad A, Bragazzi NL, Lichtbroun M, Amital H , Shoenfeld Y. Physical activity and autoimmune diseases: Get moving and manage the disease. Autoimmun Rev 2018;17:53-72.
9. Henry AL, Chisholm A, Carter LA, Bundy C, Griffiths CEM , Kyle SD. The relationship between sleep disturbance, symptoms and daytime functioning in psoriasis: a prospective study integrating actigraphy and experience sampling methodology. Sleep Med 2020;72:144-9.
10. Ko SH, Chi CC, Yeh ML, Wang SH, Tsai YS , Hsu MY. Lifestyle changes for treating psoriasis. Cochrane Database Syst Rev 2019;7:Cd011972.
11. Wu JJ, Feldman SR, Koo J , Marangell LB. Epidemiology of mental health comorbidity in psoriasis. J Dermatolog Treat 2018;29:487-95.
12. Ferguson FJ, Lada G, Hunter HJA, Bundy C, Henry AL, Griffiths CEM et al. Diurnal and seasonal variation in psoriasis symptoms. J Eur Acad Dermatol Venereol 2020.