Psoriasis is a complex and multi-factorial disease. Knowing the mechanisms and causes of psoriasis allows one to control flares better and accept the disease in everyday life.
In fact, psoriasis is a chronic inflammatory disease for which there is still no definitive and complete treatment.
Naturally, the same question ends up popping everywhere. What causes psoriasis? And more important, what can be done to control it?
It is essential to highlight that the available treatments work very well but do not prevent a new outbreak, hence learning to “live with” the disease.
At the origin of a psoriasis outbreak, there are usually one or several factors.
They can be stress, alcohol, strep infections, surgery, weather conditions, injuries, smoking, some medications, corticosteroids sudden removal, hormonal changes, and immune disorders.
These are all variables, from person to person and even from one crisis to another.
There are certain cases where these factors are clearly identified and recurring by a particular person. Therefore, the better way to self-help is to know what may cause these infections to try limiting the flares.
In other cases, no factor is really identified. It is disturbing and disappointing because one is always looking for a “culprit” to feel more secure and to have the impression of controlling the situation.
Also, know everything about psoriasis here, if you understand it well, there is a bigger change in controlling it.
- What Are the Different Factors That Trigger or Favor a Psoriasis Crisis?
- Strep infections
- Hormonal changes (pregnancy)
- Hormonal Changes (Menopause, Andropause)
- Hormonal Changes (Puberty)
- Weather Conditions
- Immune Disorders (HIV)
- Surgery (Koebner’s Phenomenon)
- Injuries (Koebner’s Phenomenon)
- Corticosteroids Sudden Removal
What Are the Different Factors That Trigger or Favor a Psoriasis Crisis?
The link between psoriasis and diet is at the center of many factor debates. What foods should you eat and what foods should you avoid? Sometimes it isn’t easy to understand.
While awaiting clear answers from studies and scientific publications, a healthy, varied, and balanced diet is recommended to avoid gaining weight.
Overweight and obesity are more often associated with psoriasis factors, and numerous cardiovascular and metabolic diseases.
In addition to nutrition, general hygiene and care is important in the case of psoriasis. Exposure to certain toxins such as alcohol and tobacco in psoriasis is not desirable as it can trigger outbreaks of the disease.
In case of heavy dependence on these substances, you should ask professionals for help to reduce/stop consuming so that you can achieve noticeable improvements in your psoriasis.
However, excess food, tobacco, and/or alcohol is sometimes the result of a deep psoriasis-related malaise.
Psoriasis’s psychological impact is genuine; it is marked by a loss of self-esteem, inner withdrawal, anxiety, stress, and depression…
Psoriasis is a visible disease and often creates a distance between oneself and others. It isn’t easy under these conditions to get help and support.
And yet, it is only by talking about what you feel that you can really move forward and get out of this vicious circle.
Now that we know some of the main obvious factors that can trigger a psoriasis crisis, let’s dig more deeply into what each of them means and what others relate to them.
Stress is also known to act as a strong trigger for various skin conditions, such as CSU, acne, and psoriasis. Studies found that about 40% of people who carry psoriasis perceived stress to exacerbate the disease’s symptoms.
A different study stated that several patients rated stress to be a trigger more dangerous than some infections, wounds, remedies, nutrition diets, and climate.
One of the major concerns is that stress is not only phycological. Stress triggers physical changes all over our bodies.
Thanks to psychoneuroimmunology, a science that studies the connection linking the brain, the nervous systems, and the immune system, researchers are starting to comprehend better why this phenomenon arises.
If we are stressed, our brain produces in the adrenal glands the stress hormones, adrenaline, and cortisol. In that time being, these stimuli make our body react to a particular menace.
In ancient times this was valuable when some situations required us to escape from imminent dangers.
However, this no longer happens, and our body relates the escape circumstance to a great exhibition for your company (which many people consider as terrifying as a dangerous situation).
A detailed analysis hints that in skin diseases like psoriasis, cortisol may be the main problem. Cortisol serves to mitigate the immune response. However, it seems that this reaction can be slightly “crooked in people with skin problems.”
Researches have detected that in positions of great stress, people with this skin disease have lower cortisol and higher adrenaline in the blood than those’ free of psoriasis.
When cortisol is not present in the system, an immune response expires, resulting in the inflammatory compounds’ discharge of cytokines.
They can incite skin cells to regenerate more rapidly. Cells accumulate, and when you finally realize it, you have a strange patch on your skin, leading to a serious aggravation in your psoriasis condition.
Soothe your body, your spirit and, as a consequence, your skin will follow.
Knowing all of the causes above, here’s what you can do to prevent it.
Practice better sleep:
It seems to exist a connection between some skin diseases and sleep privation. Keep your head clear from stress at night, otherwise, you have a double blow to deal with.
Try to deal with your sleeplessness problem. Review your pending tasks, reduce other responsibilities, or start practicing a few “no’s,” so you can watch your favorite program at night.
Try to rest and sleep a good 8 hours per night. You can also consider good “sleep practices”: shutting down your phone a few hours before sleep time. A few days in this and you will start to get more relaxed and will fall asleep easily.
Everybody needs support:
Talk to close friends, virtual buddies, or try expert help from a therapist. Talking about your concerns will lead you to become calmer, which can reflect on your skin health.
Research issued in the (BJD) British Journal of Dermatology has found that habit changes and therapies that promote cognitive-behavioral actions are significantly beneficial in treating skin conditions.
Talk to your dermatologist, find support groups and other trained health professionals that can help you cope with stress.
If you don’t have a follow-up with a specialist yet, the first step may be to find a dermatologist!
Abandon stressful habits:
Many times the method we use to deal with stress ironically causes more stress.
Smoking and drinking can worsen skin conditions. Search for healthier alternatives to extravasate, like spending more time with your family or taking a walk in your neighborhood.
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Bacterial infection can also trigger a psoriasis episode, more specifically by the bacteria belonging to the genus Streptococcus.
These bacterial infections are very common in throat infections and usually lead to a guttate psoriasis infection.
Small, drop-shaped wounds covered by a thin “scale” begin to form in the skin. They usually appear on the trunk, legs, arms, and scalp.
It affects mainly children and young people, sometimes following a pharyngitis episode. The lesions appear suddenly, and the infection may occupy extensive body areas.
It can disappear definitively after the first episode, or it can develop into psoriasis Vulgaris.
Guttate psoriasis can also happen as a consequence of other inflammatory and infectious processes, such as respiratory infections, inflammation of the tonsils, stress and the use of some medications, in addition to being caused by genetic alterations.
The mildest cases of guttate psoriasis do not require specific treatment, as the signs and symptoms of the disease usually disappear on their own between 3 and 4 months.
However, your dermatologist can indicate the use of creams, ointments, or lotions that should be applied directly to the affected skin.
It’s always good to enjoy a good drink to relax, especially after moments of stress at work or a crazy day running after the kids.
There’s nothing wrong with that. But the next time you pour a glass of wine, you should opt for a smaller one.
According to the latest research, this “relaxing drink” may actually have the opposite effect on your skin.
People who consume alcohol are more at risk for psoriasis.
For example, a recent study found that women who drink more than 2-3 drinks per week are exposed to a significantly higher risk of developing psoriasis compared to women who do not drink.
The risks seem to be even higher in men, where a second study found that regular alcohol consumption is associated with an increased risk of psoriasis as well as increased severity of flares.
Drinking alcohol dries the skin…
Alcohol is a diuretic (the real reason you go to the bathroom more often after a night out) meaning it can dehydrate the body and dry out the skin.
There is also evidence that it alters the blood supply to the skin. We know, for example, that alcohol causes blood vessels to dilate, allowing more blood to circulate to the surface of the skin, which can aggravate symptoms such as rosacea, in addition to triggering the papules and itching seen in chronic spontaneous urticaria (ECU).
Another major concern is that alcohol can deeply affect the immune system and cause inflammation throughout the body.
And as if that wasn’t enough, alcohol consumption can lead to an increased risk of growth factor that accelerates the production of skin cells – you’ll notice that your skin scales much more after a night out.
Beer can be your worst companion
The alcoholic beverage you choose may also make a difference – one study determined that beer is associated with a higher risk of psoriasis, leading researchers to suspect that the gluten present in the drink may be the major culprit.9
Website “NIH, National Institute of Arthritis and Musculoskeletal and Skin Diseases” – Questions and Answers about Rosacea. Last update: 05.11.15. http://www.niams.nih.gov/Health_Info/Rosacea/ Alcohol intake and risk of incident psoriasis in US women: a prospective study. Qureshi AA, Dominguez PL, Choi HK, Han J, Curhan G. Arch Dermatol. 2010 Dec;146(12):1364-9. http://www.ncbi.nlm.nih.gov/pubmed/?term=20713772 Alcohol intake: a risk factor for psoriasis in young and middle aged men? Poikolainen K, Reunala T, Karvonen J, Lauharanta J, Kärkkäinen P. BMJ. 1990 Mar 24;300(6727):780-3. http://www.ncbi.nlm.nih.gov/pubmed/?term=1969757http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1662565/pdf/bmj00171-0026.pdf Huffington Post citing Dr. Debra Jaliman in “Here's How Alcohol Wrecks Your Skin... And How To Choose The Least Damaging Drink” Last update: 05.11.15. http://www.huffingtonpost.com/2013/10/24/alcohol-skin_n_4146391.html Chronic urticaria and treatment options. Godse KV. Indian J Dermatol. 2009;54(4):310-2. http://www.ncbi.nlm.nih.gov/pubmed/20101328http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807703/ Cutaneous disease and alcohol misuse. Higgins EM, du Vivier AW. Br Med Bull. 1994 Jan;50(1):85-98. http://www.ncbi.nlm.nih.gov/pubmed/?term=7908595 Alcohol, inflammation, and gut-liver-brain interactions in tissue damage and disease development. Wang HJ, Zakhari S, Jung MK. World J Gastroenterol. 2010 Mar 21;16(11):1304-13. http://www.ncbi.nlm.nih.gov/pubmed/?term=20238396http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842521/ Ethanol and acetone stimulate the proliferation of HaCaT keratinocytes: the possible role of alcohol in exacerbating psoriasis. Farkas A, Kemény L, Széll M, Dobozy A, Bata-Csörgo Z. Arch Dermatol Res. 2003 Jun;295(2):56-62. http://www.ncbi.nlm.nih.gov/pubmed/?term=12720008 Alcohol intake and risk of incident psoriasis in US women: a prospective study. Qureshi AA, Dominguez PL, Choi HK, Han J, Curhan G. Arch Dermatol. 2010 Dec;146(12):1364-9. http://www.ncbi.nlm.nih.gov/pubmed/?term=20713772http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3017376/
Everybody already knows that smoking is not good for wellness. If you live every day beside psoriasis, by now you must have realized how sensitive and delicate your skin can be. Get rid of the cigarette! Psoriasis without smoking is having more quality of life.
Before detailing why you should quit smoking, have this in mind: If you stop smoking, it will not be enough to cure psoriasis, however keeping in doing it so will have a major role in damaging your skin
Dangers of smoking to the skin and body
The smoke dries the skin:
Just by inhaling cigarette smoke, you will have damaged skin. When the tobacco is burned, it releases in the air a mixture of 7 thousand chemical products, which in contact with the skin leads to dryness.
Smoking can cause wrinkles:
Smoking accelerates aging inside and out, even smokers seem older than non-smokers.
One of the reasons is the chemical substances that are present in tobacco, damage fibers (elastin and collagen) that help to sustain the composition and elasticity of the skin.
Also, smoking cigarettes in a row cause expression marks in the mouth and crow’s feet around the eyes.
One study showed that the facial signs in the group of smokers stood so evident that the experts who were doing the research were capable of identifying 50% of the smokers just by looking at their expression characteristics.
Skin becomes stained and unhealthy:
Cigarette nicotine contracts the blood vessels, this reduces the flow of blood in the skin’s surface and thus the arrival of nutrients.
These blood vessels end up being forced to enlarge to obtain sufficient nutrients; as time goes by, the tendency is to become forever dilated.
This is probably the number one reason why smokers always have their faces red even when they have no exposure to the hot sun.
Smoking can deprive your body of essential vitamins:
Cigarette smoke contains carbon monoxide which removes oxygen, and if that was not enough nicotine decreases blood flow.
This consequence strips vital nutrients from being absorbed by the skin. One of them is nothing less than vitamin C. This vitamin is one key component in skin regeneration.
Smoking raises the chance of cancer in your skin:
Not only sun and UV rays can cause skin cancer.
Studies have revealed that smokers have a 3 times greater chance of having some variation of cancer in the skin.
Our immune system suffers a lot from the effects of smoking; you should think about that seriously if you have psoriasis or any skin condition.
There is even more incentive to stop smoking if you have psoriasis. A study conducted in 2007 showed that smoking a pack of cigarettes per day for 10 years is lesser, increases by 20% the risk of having psoriasis; for 11 to 20 years, the risk increases to 60% higher. Those who manage to surpass the 20-year mark have seen the risk increase more than double.
Benefits of quitting smoking
Quitting smoking isn’t simple, but it is rewarding! Some encouraging studies revealed that when quitting smoking, psoriasis can respond better to the different therapies.
In reality, you’ll get an enhancement in your whole body in less than 90 days! That’s just 3 months! With the increase of blood flow, you will get a big improvement in your blood vessels, and nutrient levels are restored easily with each passing day.
National Cancer Institute. Harms of Cigarette Smoking and Health Benefits of Quitting. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet. Last update August 2020.
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Mayo Clinic. Is it true that smoking causes wrinkles? https://www.mayoclinic.org/healthy-lifestyle/quit-smoking/expert-answers/smoking/faq-20058153 Last update August de 2020.
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McDaniel, J. C., & Browning, K. K. Smoking, chronic wound healing, and implications for evidence-based practice. Journal of wound, ostomy, and continence nursing: official publication of The Wound, Ostomy and Continence Nurses Society 2014; 41(5), 415–E2.
Healthline. The Negative Effects of Smoking with Psoriasis. https://www.healthline.com/health/psoriasis-after-quitting-smoking#research. Last update August 2020.
Young, HC et al. Changes in Skin Color after Smoking Cessation. Korean Journal of Family Medicine, 2012 Mar; 33(2): 105–109.
Hormonal changes (pregnancy)
If you live with a psoriasis skin condition and want to get pregnant, it is natural to have some doubts: do women in your condition have a higher risk of complications in pregnancy?
Will psoriasis disappear during pregnancy? What follows following childbirth, do post-pregnancy flares really happen?
There is much to understand. So, to assist in the clarification of things, we detail what science says about it. Let’s go!
Psoriasis does not seem to affect your probabilities of pregnancy
Research tells that having this disease doesn’t harm your possibilities of being pregnant.
Still, some aspects needed to be considered before pregnancy, such as continuity or change of treatment during pregnancy.
Ideally, you should talk to your doctor before you become pregnant so that they can plan the best thing to do for you.
Have you ever heard of nipple irritation?
Although some specialists suggest topical light steroids to relieve crises following pregnancy, a warning is given against using in the breasts while breastfeeding. When in doubt, you already know: talk to your doctor!
Your psoriasis may improve during pregnancy
Do not neglect the term “can”! Psoriasis is a box of surprises. Many people hear that psoriasis gets normal throughout pregnancy, don’t stay in expectation.
Studies show this might not occur for everyone: around 50% of women actually think their skin has improved, and 25% say that the disease remains unchanged during pregnancy.
Your psoriasis may become more serious subsequent to pregnancy
Unfortunately, research explains that psoriasis can indeed worsen after pregnancy. In the very research, we cited above, 60% of women stated worsening of the psoriasis symptoms after childbirth.
Despite this being only one study, these conditions may interact uniquely for each patient. Your doctor will know your skin enough and therefore can decide what can be done for you.
You may have a higher risk of complications in pregnancy
Researches reveal that women with a skin condition like psoriasis have a greater risk of complications of the placenta and have a great probability of having a low light-weighted baby.
If you are concerned about these risks, speak about them with the doctor.
There is a chance of your baby having psoriasis or not…
With psoriasis, there is a chance of 1 to 4 to the baby inherit the disease. If both parents of the child suffer from psoriasis, that probability rises to 65%.
Remember that despite the newborn receives the genes associated with psoriasis, it is not a strong indicator that will develop the disease.
In fact, about 1 in 10 people have associated genes with this disease and only about 2% actually have the disease.
Seeger JD, Lanza LL, West WA, Fernandex C, Rivero E. Pregnancy and pregnancy outcome among women with inflammatory diseases. Dermatol. 2007; 214(1) :32-9.
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Yang YW, Chen CS, Chen YH, Lin HC. Psoriasis and pregnancy outcomes: a nationwide population-based study. J Am Acad Dermatol. 2011; 64(1):71-7.
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Swanbeck G, Inerot A, Martinsson T, Enerbäck C, Enlund F, Samuelsson L, Yhr M, Wahlström J. Genetic counselling in psoriasis: empirical data on psoriasis among first-degree relatives of 3095 psoriatic probands. Br J Dermatol. 1997; 137(6):939-42.
National Psoriasis Foundation/USA. Genes and Psoriasis. https://www.psoriasis.org/research/genes-and-psoriatic-disease Last update October 2019.
Hormonal Changes (Menopause, Andropause)
Hormonal imbalances during menopause or andropause can trigger a psoriasis condition.
Studies worldwide clearly show that individuals from the age of 40 begin to lose their hormone balance, keeping them below what is necessary to remain healthy.
Both women and men require a correct hormonal balance, among those of extreme importance are: DHEA, testosterone, thyroid hormones, estrogen, cortisol, and some others
Every hormone performs a role that is interconnected to others and essential to maintaining health. The decrease of these levels is what starts the aging process.
We can observe a reduction in desire, less energy, increased overall fat in the body, bone delicacy, flaccidity of the skin, other tissues, osteoporosis, memory loss, cardiovascular changes, sleep disorders, and several different symptoms.
Hormones play a very important role in maintaining the body’s natural balance and consequently maintaining your skin health as well.
Exercise and a balanced diet can help you maintain those hormone levels and decrease the effects of menopause or andropause on your skin.
Hormonal Changes (Puberty)
There is a genetic predisposition to acquire psoriasis, probably multifactorial and polygenic, although an autosomal dominant transmission model is dependent on a single gene, located on chromosome 6, it is also postulated.
This condition results in an aggravation of the disease at puberty, when hormonal imbalance begins to occur.
The prognosis is difficult to establish since it is a patient that is going through a period of body changes. It is important to assure the patient that the change in question is strictly cutaneous, not related to internal organs, that has a benign character, and is not contagious.
Some psychological counseling could be an added value during this stage.
Despite being the favorite season for many, winter is a period that requires specific skincare, temperatures drop, the weather becomes dry, winds become strong, and humidity is on the edge.
The largest organ of the human body is most sensitive to these changes during this season and can suffer doubly from climate change.
The general tendency is to take hotter and longer baths due to cold, which is also very harmful and has a big role in psoriasis appearance.
Far beyond covering the human body, the skin is often our “calling card”, since it is the first characteristic noticed when we meet someone. And dry skin can be easily identified, it gets rough, thick, red, and flaky.
It is very noticeable in individuals with atopic dermatitis. Whitish plaques full of more apparent and rough spots appear, the famous pityriasis alba.
In addition, the dry skin tends to be scratched a lot, which makes the patient develop infections more easily.
Besides the combination of winter and excess of hot water, other factors such as pollution, exposure to ultraviolet radiation, inadequate care routine, excessive use of soaps, chemicals, age, genetics, diet, smoking, drugs, contribute to psoriasis and atopic dermatitis trigger.
Therefore, it is not only in summer that the skin needs care. The protection of a good sunscreen it is essential all year long, ultraviolet rays are continuous, even on cloudy days, and are able to penetrate the deepest layers of the skin, oxidizing the region and breaking the collagen molecules.
With time, it loses its elasticity and becomes flaccid, generating the famous wrinkles. This process can be potentiated by the cold, which damages and dries our face.
This is the main reason not to neglect skin care in any season. Do not forget the rejuvenating creams and the continuous stimulus of collagen”.
There are several dermatological treatment options in these cases. You should intensify hydration at this time of the year. For this to take effect, there are creams, lotions, mild soaps, and bath gels with high hydration power.
While taking these measures, you are preventing psoriasis episodes and consequent damage to your skin.
You can also try more powerful actives such as shea butter, glycerin, vitamin E, urea, and antioxidants. The dermo-cosmetics help to restore the hydrolipidic coat, conferring more smoothness and vigor.
The products should be applied daily, preferably, after the bath still with the humid skin in order to have better absorption of the properties.
Lips and hair also need special attention this season. The skin of the lip is thin, which causes cracks and flaking. It is important not to tear off these ‘little skins’ and hydrate the place with products based on lanolin, cocoa butter, hyaluronic acid, vitamin E, ceramides, and collagen.
A good tip is to apply baby roasting prevention ointment in the lips before sleeping.
It is indicated to give preference to cold water while washing your hair, even in winter. Hot water takes the shine off the hair, it opens the cuticle giving the appearance of frizz and dryness.
This can provoke vasodilatation, causing urticaria and itches, mainly, in individuals that already have greater predisposition for the appearance of these problems as atopic dermatitis, psoriasis and skin sensibility in general.
There is a possibility of social isolation which “discourages” some people to dedicate time to self-care. Some feel as if they lose their energy and potential.
Symptoms of anxiety or depression seem to gain space. It is recommended to increase the practice of physical activities, avoid excessive consumption of caffeine, seek a healthier diet and pay attention to the care of oneself.
It is normal to feel sad for a few days. But if you start to realize that sadness always occurs, religiously, in the same periods, seek medical help.
Immunity is related to self-esteem. We know that we cannot control external factors, but self-care is a matter of physical and mental health.
Immune Disorders (HIV)
The first publication on the link between psoriasis and the human immunodeficiency virus (HIV) dates back to 1985.
Since then, clinical practice has shown us that skin diseases are among the most common manifestations of HIV infection.
With a prevalence similar to the general population, HIV-related psoriasis can have an extensive and aggressive presentation that is inversely related to the number of CD4+ T cells and directly with the CD8+ T cells, given their relative expansion in advanced disease.
Given the systemic therapies of psoriasis if based on immunosuppression, the treatment of this association becomes a challenge.
Skin involvement is also considered a stigma of the disease, as well as a challenge in its diagnosis and treatment. Some opportunistic systemic infections, or even neoplasms, manifest themselves first in the skin, making it extremely important to identify the dermatoses associated with HIV.
Potentially, all HIV-infected people will have some degree of skin involvement throughout their lives. However, after the introduction of combined antiretroviral therapy (ART), some modifications in the prevalence, incidence, and presentation of dermatoses related to this virus were observed.
There was a decrease in the frequency of opportunistic diseases (including Kaposi’s sarcoma) and the appearance of immunological recovery reactions.
The skin is an important organ of defense. As it is our first protective barrier against external agents, it presents a very complex immune system.
The HIV infection causes, most of the time, an unbalance of the immune system and therefore innumerable complications related to psoriasis pre-disposal individuals.
Surgery (Koebner’s Phenomenon)
When a psoriasis patient has the need to undergo surgery there is a great risk to develop psoriasis symptoms around the cut area.
This phenomenon is best known as Koebner’s Phenomenon, or sometimes also called an isomorphic response.
In 1982, the German doctor Henrich Koebner observed the appearance of psoriasis lesions in patients with inflammation due to itching, animal bites, or even tattoos.
Anything that causes a skin lesion can be a triggering factor for the Koebner phenomenon, such as burns, the use of razor blades, animal bites, depilatory wax, constant dermatitis in one place, laser treatments, and surgery.
Even the constant use of jewelry, watches, glasses, and comb can lead to the appearance of lesions.
It was thanks to Koebner’s Phenomenon that doctors were able to explain why elbows, knees, and scalp are the main sites affected by psoriasis.
These areas are most susceptible to friction in everyday life; the elbows because they are where we lean all the time; the knees because they are in constant friction with clothes, and the scalp because it is in direct contact with combs and brushes.
This phenomenon if one of the best-known problems in dermatology. It appears when a patient diagnosed with chronic skin diseases suffers a trauma in a healthy skin region.
Then the disease starts to manifest itself in that place. This happens with psoriasis and also with vitiligo (characterized by loss of skin pigmentation) or lichen planus (an inflammatory disease that affects the mucous membranes).
Generally, the symptoms of psoriasis appear soon after the lesion on the skin, but cases have already been identified in which they took up to years to appear on the spot.
There are no absolute contraindications for surgical procedures, whether plastic or not, solely for psoriasis.
But it is not known in advance what percentage of patients that this phenomenon may occur. You should be careful to check with your doctor or plastic surgeon (whichever is the case), that any medications you are using for psoriasis do not compromise the outcome of the surgery.
Injuries (Koebner’s Phenomenon)
Anyone with psoriasis should take extreme precautions when it comes to injuries. Firstly, avoid trauma and skin lesions at any cost and whenever necessary take care of your nails in order to keep them short to avoid scratches.
Just like surgery, traumas that include any injury to the skin including, cuts, insect bites, injuries, and various irritations, burns, tattooing, and even after shaving or waxing may be a fast trigger for an isomorphic response.
It is important to note that this phenomenon does not occur only in more serious injuries, but can arise from small and simple skin irritations, for example:
A shank of glasses can cause a lesion behind the ear, or lesions on the fingers can arise due to manicure.
Psoriasis lesions can appear (or worsen) from 10 to 15 days after the injury, but they can also appear several years later.
In cases where a psoriasis lesion is already present, a wound can make the picture much worse and therefore requires twice as much care.
However tempting it may be, do not cut psoriasis lesions! It is very important not to tear off scales, scratch plaques, and whenever possible try to avoid injury or any skin-irritating situation (including thick or very tight clothing).
Wash and comb your hair gently and perhaps letting your beard grow a little may be a good option for men with facial lesions.
These tips can help, but we know how complicated it is to keep an eye on yourself all the time to avoid getting hurt or irritating your skin, but keep in mind that the care of your skin is a 24/7 responsibility.
The Koebner phenomenon can occur in other dermatological diseases, but it is more common in people with psoriasis itself, you just need to have a little extra care for extra health of your skin.
Sometimes, some drugs can worsen or make more resistance to the treatment of Psoriasis.
Remissions, regressions, aggravation. Psoriasis is a chronic skin disease whose evolution is impossible to predict.
If attacks are sometimes attributed to stress, some drugs can also trigger, aggravate or make the patient resistant to treatment.
Experts warn of several groups of drugs, including beta-blockers and angiotensin-converting enzyme inhibitors prescribed for high blood pressure, as well as lithium, indicated in certain psychiatric disorders.
Interference in the immune system
If beta-blockers are more involved, they are not the only drugs. Inhibitors of conversion enzyme, sartans, lithium, synthetic antimalarials, interferons, terbinafine (antifungal), immunosuppressive agents, and antitumor are also part of the list drawn up by experts.
The mechanisms by which these drugs aggravate or trigger psoriasis are little known. “Many medications involved interfere with the immune system,” the experts briefly state.
As a reminder, psoriasis is a chronic, non-contagious inflammatory skin disease whose mechanism is not yet fully understood.
- “A certain type of immune cell, T cells, abnormally produces inflammatory messenger molecules, cytokines. This will induce the accelerated and abnormal renewal of the epidermis and therefore dandruff and redness”.
Still, it is not always easy to establish the link between these drugs and the multiplication of red spots, the worsening of scaling, or the cessation of the effectiveness of psoriasis treatments. Especially as these symptoms are usually exacerbated after a long period of time.
The abandonment of treatment should be decided according to the severity of the psoriasis, the inconvenience, and the benefit-risk ratio of the drug in question.
Corticosteroids Sudden Removal
Anyone living with psoriasis knows that getting the right treatment is not always easy. After months or even years of fighting the disease, many patients end up looking for “magic” solutions and ointments, which used without medical guidance can aggravate the condition of psoriasis.
Although the use of corticosteroids is widely prescribed in the initial diagnosis of psoriasis because it acts to control the inflammatory process of the skin, helping in the regeneration of the regions of the body affected by the disease, its extended and extreme application is followed by many undesired results.
Corticosteroids can have tremendous side effects in skin damage, irreversible damage like pigmentation change, increased susceptibility to bruising, stretching lines, dilated blood vessels on the skin’s surface, thinning, and redness of the later.
Corticosteroids can also be incorporated into the skin and therefore harm inner organs when applied to large areas of skin or used for long periods of time.
Because of these risks, corticoid medicines are contraindicated for prolonged use in the treatment of psoriasis because the body may develop resistance, failing to produce the desired effect and even aggravating psoriasis with continued use, rather than controlling it.
Fortunately, doctors and patients today already have a large therapeutic arsenal and can seek numerous alternatives until they reach the goal of psoriasis treatment: a skin without lesion or almost without lesion.
It is worth noting that there are several types of psoriasis, the most common being plaque psoriasis, which affects about 85-90% of patients.
In general, one-third of these patients are diagnosed with the moderately to severely severe and complex forms of treatment, which have an even greater impact on the quality of life of patients.
Monitoring of psoriasis treatment should be done through questionnaires such as the Psoriasis Severity Area Index (PASI) and the Dermatology Life Quality Index (DLQI), considering the effectiveness of the drug, which translates into decreased or extinction of symptoms (such as skin lesions and itching) and improvement in the patient’s quality of life.
Corticóide pode piorar a psoríase. Blog Amigos com Psoríase, 2016. http://www.amigoscompsoriase.com/#!Corticóide-pode-piorar-a-psoríase/cy97/57704c260cf2f8d6d10c7429. Last update August 2016.
O uso de corticoide no tratamento da psoríase. Blog Bem Estar, 2015. http://blogbemestar.com.br/o-uso-de-corticoide-tratamento-da-psoriase/. Last update August 2016.
Gorgievska-Sukarovska B, Lipozencić J. Topical management of psoriasis – corticosteroids and sparing corticosteroid therapy. Acta Dermatovenerol Croat. 2006; 14 (3):188-196.
Mild Psoriasis: Topical Steroids. National Psoriasis Foundation. https://www.psoriasis.org/about-psoriasis/treatments/topicals/steroids. Last update August 22nd 2016.
Committee for Medicinal Products for Human Use (CHMP). Guideline on Clinical Investigation of Medicinal Products Indicated for the Treatment of Psoriasis. European Medicines Agency (EMEA), London, 2004. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2009/09/WC500003329.pdf. Last update August 22nd 2016.
Salgo R, Thaçi D. Treatment of moderate-to-severe plaque psoriasis. G Ital Dermatol Venereol. 2009 Dec;144(6):701-11.
Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity Index (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol. 2014 Mar;28(3):333-7.
Psoriasis interferes and has a huge impact on everyday relationships. Therefore, and logically there is a strong psychological importance on those affected.
The disease can disappear spontaneously one day without a why or how. And for patients who are disabled by regular outbreaks, there are some alternatives in medial arsenal treatments that can guarantee prolonged remissions.
The constant search for effective remedies is an ongoing demand. However, no treatment for psoriasis guarantees a definitive cure.
Despite all the negative aspects of psoriasis, optimism must continue to thrive, so future studies reach for better solutions and help those in need, have a better quality in their everyday life.