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Updated December 30, 2014.
One of the more distressing features of psoriasis is the occasional sudden and severe worsening of symptoms, often without any obvious cause. A closer look however may yield several clues as to possible inciting factors. Treatment of flares can be challenging, and in worst cases, may require a brief hospitalization. Most psoriasis flares however can be handled with systemic medications in the setting of the doctor's office.
Causes of Flares
Several triggering factors have been identified as contributing to worsening psoriasis:- External Factors: Nearly any injury to the skin can result in the development or worsening of psoriasis including sunburn, other rashes like allergic reaction to drugs, surgery, cuts or scratches, and viral rashes. The worsening of psoriasis after injury is known as the Koebner phenomenon.
- Infections: Most notoriously, streptococcal infections such as strep throat can trigger the disease, especially an outbreak of guttate psoriasis. HIV infection is another condition known to aggravate psoriasis.
- Psychological Stress: Job loss, divorice, death or other major emotional upsets have been known to flare psoriasis weeks or months after the stressful event.
- Medications: Many medications are known to trigger psoriasis and should be avoided in patients with the disease.
Treating Psoriasis Flares
At one time, hospitalization for psoriasis flares was common. Due to changes in insurance reimbursement (Medicare only allows so many days of hospitalization for a skin condition) and more powerful and faster acting drugs, most flares are treated in the outpatient setting.
Drugs commonly used for severe flares include cyclosporine, Remicade (infliximab), and for pustular flares, Soriatane (acetretin). When psoriasis flares, don't delay -- seek treatment urgently with a qualified dermatologist.
Source:
Bolognia et. al., ed. Dermatology. Mosby New York 2003.
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