Being diagnosed with psoriasis can be difficult, as the management of this condition may sometimes be unpredictable. Unlike other chronic conditions where signs and symptoms can be seen daily, patients diagnosed with psoriasis have recognized that associated signs and symptoms can come and go. Understanding why the disease comes and goes in waves and identifying reasons or triggers for flare ups can help patients better manage their condition and prevent future flare up occurrences.
Why Does Psoriasis Come and Go?
Psoriasis is considered a chronic disease, meaning it is long-lasting. While there is currently no cure for psoriasis, medications and lifestyle changes can significantly help to subside the noticeable red patches that are common with the disease and other symptoms associated with the different subtypes.
Read MoreThe duration of remission is unpredictable and varies from patient to patient. However, most patients will experience another episode of psoriasis within twelve months of achieving remission. Episodes of psoriasis outbreaks are commonly linked to specific triggers. Because of this, your healthcare team will discuss potential triggers and create an individualized plan to help identify causes for psoriatic flare ups.
Triggers
Psoriasis outbreaks can be triggered by various environmental or social factors.
“It’s the right combination of things to happen to cause psoriasis,” Dr. Saakshi Khattri, a dermatologist/rheumatologist at Mount Sinai Health System, said in an interview with SurvivorNet.
The National Psoriasis Foundation has created a guide that helps patients track their disease to monitor and identify triggers that cause a new or exacerbate an existing outbreak. Because each person's condition is unique, it is important to understand what causes your psoriasis to come and go to minimize outbreaks and push towards the goal of remission.
Stress
One of the most common causes of a psoriasis flare is increased stress. According to the International Journal of Dermatology, a review of literature demonstrated that approximately 31-88% of patients living with psoriasis indicated stress as a major trigger of their psoriatic symptoms.
“You can you have a patient that perhaps has a family history of psoriasis then they might have, you know, a stressful event which can be a trigger,” Dr. Khattri explained.
Stress is often exacerbated by the emotional burden (e.g. anxiety, depression, shame) associated with living with the disease. Because of this, understanding how to manage stress is essential to managing flare ups. Stress management techniques, such as meditation, exercise, counseling, and relaxation, should be integrated into normal daily activities. Additionally, speaking to your healthcare team about changes in stressors within your life may help track potential reasons for flares more easily.
Medications
While certain medications are used to help treat psoriasis, other medications that may be used for coexisting conditions can cause psoriasis to flare up or worsen. Examples of treatments that have been shown to induce or exacerbate a psoriasis flare up include the following:
- Antifungal medications: Terbinafine
- Antimalarial medications: Chloroquine and hydroxychloroquine
- Mental health medications: Lithium and fluoxetine
- Beta-blockers used for heart conditions: Atenolol and pindolol
It is important your healthcare team has a complete, up-to-date list of all medications (both prescription and OTC) and vitamins you may use both routinely and as needed. If you experience a flare-up or worsening of symptoms, be sure to communicate any changes to your medication regimen. They will review your medications and may recommend an alteration in therapy if something is suspected to be causing flare-ups.
Weather
Changes in the weather can also contribute to psoriatic flare. Many patients experience symptoms during the cold winter months and have some resolution when the weather becomes warmer in the spring and summertime.
In the winter, the weather is typically colder and dryer (depending on your geographical location). Whenever the temperatures decrease, the humidity will typically decrease with it. As a result, there is less moisture in the air to protect the skin, causing it to become dry, cracked, and even itchy. Making sure skin is properly moisturized can help minimize weather related triggers.
Additionally, patients typically have less sun exposure in the winter months, due to less daylight and less activity outside. Furthermore, people with psoriasis may not get as much natural exposure to UV light. If psoriasis flares tend to occur in the winter months, your provider may recommend phototherapy to compensate for the lack of natural UV exposure.
Other Causes of Psoriasis Flares
Skin Injuries
Sometimes, whenever injury occurs to the skin, a psoriasis flare can arise. This is due to a condition called the Koebner Phenomenon. The Koebner phenomenon occurs when an injury to previously healthy skin causes skin lesions to arise that are consistent with a pre-existing condition (such as psoriasis). Examples of instances that may cause this phenomenon include the following:
- Scratches or cuts
- Bodily injections or piercings
- Tattoos or tattoo removal
- Bug bites or stings
- Shaving
Infection
Developing an illness from an infection can cause a flare-up or make a current one even worse. Whenever an infection occurs, the body elicits an inflammatory response to fight the bacteria, virus, or other microbial pathogen that the body considers a foreign substance. Because psoriasis is an inflammatory condition, inflammatory response to eliminate an infection from your body can also cause a flare up to occur.
According to the American Academy of Dermatology, psoriatic flares that occur due to an infection typically occur 2 to 6 weeks after the initial illness. Infection related flare ups are more commonly seen in children, although they can also occur in adults.
How to Manage Psoriasis Flares
Managing flare ups is essential to achieve remission and a better quality of life. Treatment will likely include basic skincare principles, such as keeping your skin moisturized and utilizing salicylic acid or other scale softeners to gently soften the affected area. If you are diagnosed with moderate to severe psoriasis, your provider may decide to initiate systemic therapy. Many patients with more severe forms of psoriasis may use injectable treatments.
In the event you experience a flare while on an injectable medication, your provider will evaluate your individualized situation. In many cases, the addition of a topical steroid therapy may help treat with breakthrough symptoms. Because psoriasis comes and goes, it is not uncommon for your provider to continue a treatment even if you achieved remission. Maintaining remission and being symptom free is the key to a better quality of life.
If you are concerned about the effectiveness of your treatment, it is important to voice the concern to your healthcare team. Together, they can evaluate if the treatment is working as intended, rule out any controllable flares, and determine the best treatment path moving forward. Being an advocate for yourself will help ensure you stay educated about your condition and 'in the know' when it comes to formulating an action plan toward achieving remission.
Moving Forward – Questions to Ask Your Doctor
- What can I do to manage my psoriasis flares?
- Have you noticed a pattern to explain why my psoriasis comes and goes?
- What tools can I use to track and monitor potential causes of my psoriasis flares?
- Could any of my medications cause my psoriasis to be worse?
- Could COVID-19 be causing or attributing to my recent psoriasis flare ups?
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