What Triggers Psoriasis Flare-Ups?

Symptoms of psoriasis may include:

• Patches of skin:
  • Are red, dry, thick, or dark
  • With silvery-white scales that itch or burn
  • Dry, cracked skin 
  • Itching or bleeding
• Rashes on the:
  • Scalp
  • In skin folds (armpits, groin, or under the breasts)
  • Genitals
• Nail changes 
  • Pitting
  • Thickness
  • Ridges
  • Crumbling
  • Changes in color 
• Emotional effects
  • Embarrassment
  • Depression
  • Anxiety
• Psoriatic arthritis
  • Occurs in some patients
  • Stiff, swollen, painful joints

There is no cure for psoriasis, but treatments can relieve the symptoms. Treatment for psoriasis includes: 

• Topical treatments, such as creams and ointments
  • Prescription topical treatments
    • Steroids
    • Anthralin
    • Calcipotriene (Dovonex) 
    • Calcipotriene and betamethasone (Taclonex)
    • Tazarotene (Tazorac)
    • Calcitriol (Vectical)
  • Over-the-counter (OTC) topical treatments
    • Salicylic Acid
    • Coal Tar
    • Moisturizers
      • Fragrance-free
      • Apply after showering and hand washing
      • Use moisturizing soaps
      • Shower in lukewarm water and limit showers to 10 minutes or less
    • Bath solutions such as oil, oatmeal, Epsom salts or Dead Sea salts
    • Scale lifters (keratolytics) usually contain an active ingredient of salicylic acid, lactic acid, urea, or phenol 
    • Coverings (occlusion) applied over topical treatments such as plastic wrap, cellophane, waterproof dressing, cotton socks or a nylon suit
    • Anti-itch treatments such as calamine, hydrocortisone, camphor, diphenhydramine hydrochloride (HCl), benzocaine, and menthol (may increase irritation and dryness)
    • Aloe vera, jojoba, zinc pyrithione, capsaicin and others may also help moisturize, soothe, remove scale, or relieve itching 
    • Castederm for inverse psoriasis to help dry moist plaques in the folds of the body
• Phototherapy (light therapy)
  • Ultraviolet light B (UVB): broad band and narrow band
  • Psoralen + UVA (PUVA) 
• Systemic treatments
  • Biologics and biosimilars
    • Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi and Simponi Aria)
    • Interleukin 12 and 23 (IL-12, IL-23) inhibitors such as ustekinumab (Stelara)
    • Interleukin 17 (IL-17) inhibitors such as secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
    • T-cell inhibitors such as Orencia (abatacept)
    • Interleukin 23 (IL-23) inhibitors such as tildrakizumab-asmn (Ilumya), risankizumab-rzaa (Skyrizi), and Tremfya (guselkumab)
    • Biosimilars to adalimumab (Humira): adalimumab-atto (Amjevita), adalimumab-afzb (Abrilada), adalimumab-adbm (Cyltezo), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio), and adalimumab-adaz (Hyrimoz) 
    • Biosimilars to etanercept (Enbrel): etanercept-szzs (Erelzi) and etanercept-ykro (Eticovo) 
    • Biosimilars to infliximab (Remicade): infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), infliximab-qbtx (Ixifi), and infliximab-abda (Renflexis) 
  • Disease-modifying antirheumatic drugs (DMARDs) including tofacitinib (Xeljanz and Xeljanz XR)
  • Traditional oral systemics
    • Acitretin (Soriatane)
    • Cyclosporine
    • Methotrexate
    • Off-label systemics, including hydroxyurea (Hydrea), isotretinoin, mycophenolate mofetil, sulfasalazine, and 6-Thioguanine 
• Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen (Advil, Motrin)

There are some ways to help prevent flare-ups by managing triggers, such as: 

• Treat psoriasis
• Manage stress
  • Yoga
  • Meditation
  • Support groups
  • Deep breathing
• Prevent and treat skin injuries
  • Treat skin injuries quickly
  • Calm itching
    • Remove scale with a medicine like salicylic acid
    • Limit shower time and avoid hot baths and showers
    • Use moisturizer
    • Use itch-relieving products with menthol or camphor 
    • Apply a cool compress
    • Avoid scratching
    • Use insect repellent and staying indoors at dusk and dawn when bugs are most active to help prevent insect bites
• Avoid or limit alcohol consumption
• Don’t smoke
• Use a humidifier if the air indoors feels dry
• Protect the skin from extreme weather outside by wearing a hat, gloves, waterproof boots, and a winter jacket
• Keep a distance from fireplaces, radiators, or other heat sources to keep heat off the skin
• Remove wet clothes and footwear when coming in from the cold
• Use sunscreen that offers broad-spectrum protection, SPF 30 or higher, and water resistance to prevent sunburn
• Treat infections
• If a medication is causing flares, talk to your doctor about changing the medication or dose
  • Never stop taking a prescribed medication without first talking to your doctor
• Avoid getting tattoos or body piercings
• Take care not to cut yourself when shaving