Steven Siracuse was about 19 years old when his psoriasis got bad. Rash-like patches showed up on his elbows, forearms, knees, calves, and scalp. A college freshman at the time, he covered up in long-sleeve shirts to avoid questions and stares. He also used steroid creams that didn’t help.

Now, more than 10 years later, his skin is mostly clear. It didn’t happen overnight. It took several years of dermatology appointments and plenty of self-discipline.

“Even at my worst, my case would be considered moderate,” says Siracuse, a financial analyst for a credit union in Buffalo, NY. “Some people have it all over their bodies. They have it all over the face. … I always tried to keep that in perspective and tell myself that I was fortunate compared to other people.”

Over the years, Siracuse did what he could to manage the physical and mental effects of psoriasis. He worked closely with his dermatologist to find the right treatment and get his insurance company to cover it. He made the move from a high-stress job to a lower-stress one. He quit smoking cigarettes and cut back on alcohol. He patiently explained what the patches on his skin were when people asked questions or made comments that hurt.

When you have psoriasis, your immune system releases chronic inflammation inside your body. It can affect your skin and other organs and tissues.

The more weight you carry, the more inflammation your body creates, which makes psoriasis worse, says Francisco Tausk, MD. He’s a professor of dermatology, allergy, immunology, and rheumatology at the University of Rochester Medical Center in New York.

Tausk says studies show that biologic drugs used to treat psoriasis work better when people drop extra pounds.

Your goal should be to gradually get to a weight that’s healthy for you, says Dawn Marie R. Davis, MD, a professor of dermatology and pediatrics at Mayo Clinic in Rochester, MN.

Ask your doctor or dermatologist to help you get there.

A balanced, nutritious diet with sensible portion sizes can help you lose weight. Tausk says ideally, the best eating plan would be a plant-based diet of whole foods. If you’re not ready for that, try to eat more vegetables and legumes, and cut back on red meat and saturated fat.

Make a grocery list of healthy foods before you go to the store so you don’t buy tempting snacks that aren’t on the list, Davis says. And swap out your favorite treats for healthier substitutes. For example, buy baked veggie chips instead of potato chips, or sparkling flavored water instead of soda.

Exercise can also help you drop pounds. If you’re not active already, ask your doctor to help you get started — especially if you also have psoriatic arthritis, which makes joints painful and stiff. In that case, you can try low-impact exercises like swimming, yoga, or walking in supportive shoes, Davis says.

When you find a type of workout that you like, make it a habit, she says. If you like to swim, for example, set out your goggles, swimsuit, and towel the night before. Then call a friend who’s into swimming and ask them to meet you at the pool the next morning. That helps make you accountable.

“You may want to give up on yourself, but you’re not going to want to give up and no-show on your friend. So find an accountability buddy,” Davis says.

Research shows that limiting how much alcohol you drink can make your treatment more effective and help keep symptoms at bay longer.

Even drinking in moderation may affect your psoriasis, though, Davis says.

If you drink while you’re taking the medication methotrexate for psoriasis, your odds of liver damage will go up. What’s more, Tausk says, people with psoriasis already have “a much higher incidence” of fat in their liver along with inflammation and damage, a condition called nonalcoholic steatohepatitis.

“So if you add another insult, which would be the alcohol, you’re stressing the liver much more,” Tausk says.

Talk to your doctor or dermatologist about what’s safe for you. Ask if you need to think about giving up alcohol.

Kicking the habit is linked to fewer psoriasis flare-ups. Let your doctor know if you need help quitting. And if you live with someone who smokes, ask them if they’d be willing to quit or at least light up outside.

“Direct smoking and perhaps even secondhand or thirdhand smoke” can impact someone’s psoriasis, Davis says.

Some people with psoriasis see their condition get worse due to ongoing stress, Tausk says. “Chronic stress is very associated with depression, and it’s very pro-inflammatory,” he says.

Talk to your dermatologist if you notice that your psoriasis flares up when you’re stressed. Depending on things like your personal situation and how bad your flare is, they might add a medication to your usual regimen or change your treatment until your stress gets under control, Davis says.

Things that can help you take charge of stress include:

It’s important to speak to your doctor or dermatologist if you’re feeling anxious or depressed. They can refer you to a mental health specialist like a psychologist or psychiatrist, so you can get the help and relief you need — and deserve.

“We have surveys on our psoriasis patients that prove that they have a higher rate of depression and anxiety,” Davis says. “It is not uncommon for people to share that they feel different, they feel left out, they feel picked on.”

“[People] with psoriasis have more loneliness,” Tausk says. “They feel stigmatized. They tend to not participate in a lot of activities because they’re embarrassed.”

If that’s you, consider meeting other people with psoriasis, who may be able to relate to what you’re going through. Your dermatologist can point you to local support groups and other online resources.

“The National Psoriasis Foundation has groups in different cities,” Tausk says. “If [people] think that what they have is the worst thing in the world, they realize that there’s always people [who] are worse, and they’re able to share their experiences.”

Having psoriasis makes you more likely to get other health conditions.

“We used to see it as just [affecting] the skin. Well, not anymore,” Tausk says. “Nowadays we see psoriasis as a systemic disease that affects different parts of the body.”

He says more and more research links psoriasis with problems like inflammatory bowel disease and a type of eye inflammation called uveitis.

“We understand that we’re asking our patients to do a lot,” Davis says. “And while it appears to be uncomplicated, it’s difficult to put into practice.”

You don’t have to change everything about your lifestyle at once, she says. You can work on changing one thing at a time, and that can help you turn it a habit.

Your psoriasis may still act up at times, but “you should be so proud of yourself for being proactive, resilient, dedicated, and empowering your own health,” Davis says.