Chapter 4 - Background and Triggers of Psoriasis Flares

Chapter 4 - Background and Triggers of Psoriasis Flares There does seem to be a genetic component of psoriasis, for most people who suffer from the disease have a thirty three percent chance that some close relative of theirs also suffers from a form of psoriasis.  When both parents have a form of psoriasis, there is a fifty percent chance that a child of theirs will develop psoriasis at some time.  Research has also found that some genes can be linked to psoriasis.  The puzzling part of that is that a number of people who carry those specific genes never develop any skin problems their entire life.  Psoriasis is difficult and puzzling to pin down. People who suffer from psoriasis will do whatever they can to prevent or minimize flare-ups of the syndrome.  The success of these methods varies with the individual and also with the type of psoriasis that they exhibit.  At the cellular level, they are trying to activate the chemical messengers cytokines that help control inflammation.  In order to do this, avoid common triggers as much as possible. Some of the triggers are behaviors that a person can choose to avoid.  Smoking, too much exposure to the sun (especially severe sunburn), and excessive drinking of alcohol can affect how often the symptoms of psoriasis appear and how long a flare up will last.  Smoking may play a part in initially developing the disease, and often increases the severity of outbreaks compared to other patients that do not smoke.  Though some sunlight is generally beneficial for most cases of psoriasis, this is not true for all patients, and excessive exposure should be avoided by all.  Alcohol is an especially significant risk factor in psoriasis for young to middle aged males. Other triggers are related to the health of the individual.  Infections, especially strep throat, can cause patches of scaly skin to appear just shortly after the infection appears and is treated.  HIV also causes more frequent appearances of the typical psoriatic patches since the patients’ immune systems are already affected by the HIV virus.   Once HIV is well advanced the psoriasis tends to become less active. Other triggers are incidental and are harder to control.  Some of these include skin injury, such as scratches, scrapes, or bug bites.   Psoriasis sufferers should avoid excessive scratching that may damage the skin and provoke a stronger immune reaction that can trigger an outbreak.   Often a skin injury will provoke new areas of psoriasis within seven to ten days after the skin injury was received, and this is known as the Koebner reaction.   Occasionally after a skin injury existing patches of psoriasis may clear.  Even though these are entirely different reactions to skin injuries, both are observed in many patients.   If a skin injury or psoriasis patch is showing signs of infection, such as red streaks or pus, or if a fever occurs, definitely schedule a visit to the supervising physician. Stress and cold weather also can have a strong impact on the immune system and may trigger patches to appear on the skin.  Being significantly overweight increases the risk of inverse psoriasis, as there are more creases and folds than in normal weight people.  Also, other types of psoriasis often can develop in the folded skin of overweight people.      Sometimes flare-ups of psoriasis may be triggered by medication that a patient is taking for some other condition.  One such drug is lithium, which is given to people that suffer from bipolar disorder and some forms of depression.  Several medications that decrease high blood pressure, those that are beta blockers, may have an effect.  Psoriasis may flare up when antimalarial drugs or drugs containing iodides are prescribed.  Many people are surprised that common over the counter drugs, such as ibuprofen (as in Advil) or naproxen (Aleve) can increase the chance that patches will result, even though these drugs are used in most people to reduce inflammation.  This is another reason that people with psoriatic arthritis should be identified, for it is not usually treated in the same manner as other forms of arthritis.         The symptoms of psoriasis tend to get worse during periods when hormones play a large role in the life of the patient.   The disease is typically worse during puberty (if it develops that early) and also during menopause.   However, pregnancy may not affect the psoriatic condition of the patient at all, and may improve the condition of the skin somewhat.   After the completion of the pregnancy symptoms may worsen in the postpartum period, or again may not have any real change.