K.B. – Psoriasis Relapse

1. Most Common Triggers for Psoriasis and Clinical Types

Psoriasis is a chronic inflammatory skin condition characterized by periods of remission and flare-ups.

Most Common Triggers for Psoriasis Flares:

• Stress: Emotional or physical stress is a very common trigger for psoriasis flare-ups.
• Infections:
  • Streptococcal infections: Particularly common in guttate psoriasis, but can trigger other forms too. Upper respiratory infections (e.g., strep throat) are classic culprits.
  • Other infections like HIV can also exacerbate psoriasis.
• Skin Injury (Koebner Phenomenon): Trauma to the skin, such as cuts, scrapes, burns, sunburn, or even vigorous scratching, can lead to new psoriatic lesions developing at the site of injury.
• Medications:
  • Beta-blockers (e.g., propranolol, metoprolol)
  • Lithium (used for bipolar disorder)
  • Antimalarials (e.g., hydroxychloroquine)
  • NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, though less common than others)
  • Systemic corticosteroids (withdrawal): A rapid taper or discontinuation of systemic corticosteroids can cause a severe flare of psoriasis (e.g., pustular or erythrodermic psoriasis).
• Alcohol Consumption: Excessive alcohol intake, especially in men, can worsen psoriasis.
• Smoking: Nicotine and other chemicals in tobacco can exacerbate psoriasis.
• Weather Changes: Cold, dry weather can often worsen psoriasis, while warm, sunny weather (with moderate UV exposure) can sometimes improve it.
• Obesity: While not a direct trigger in the same way as an infection, obesity is associated with more severe psoriasis and can make it harder to treat.

Different Clinical Types of Psoriasis:

1. Plaque Psoriasis (Psoriasis Vulgaris):

   • Description: This is the most common type, affecting about 80-90% of people with psoriasis. It’s characterized by well-demarcated, raised, red patches (plaques) covered with silvery-white scales. These plaques commonly appear on the elbows, knees, scalp, lower back, and nails. They can be itchy and painful and may crack and bleed.
   • K.B.’s type: K.B. was initially diagnosed with “limited plaque-type psoriasis” and her current outbreak is also described as “plaque psoriasis” involving large regions.

2. Guttate Psoriasis:

   • Description: Characterized by small, red, salmon-pink, tear-drop shaped lesions (less than 1 cm in diameter) that appear suddenly over a wide area of the body, often on the trunk and limbs.
   • Trigger: Often appears after an upper respiratory infection, especially strep throat.
   • Course: Can clear completely, but some individuals may later develop plaque psoriasis.

3. Inverse Psoriasis (Flexural Psoriasis):

   • Description: Appears in skin folds (flexures) such as the armpits, groin, under the breasts, and in the genital area. It presents as smooth, red, shiny patches without the typical scaling (due to moisture in these areas).
   • Symptoms: Can be very irritating due to friction and sweating.

4. Pustular Psoriasis:

   • Description: Characterized by clearly defined, raised bumps (pustules) filled with non-infectious pus. The skin around the pustules is often red and tender.
   • Types:
     • Generalized Pustular Psoriasis (von Zumbusch): A rare, severe form that can be life-threatening. It involves widespread pustules, fever, chills, and fatigue.
     • Palmoplantar Pustulosis: Pustules confined to the palms of the hands and soles of the feet.
     • Acropustulosis: Pustules on the fingertips and toes, which can be painful and disfiguring.

5. Erythrodermic Psoriasis:

   • Description: A rare but severe form that covers nearly the entire body surface (over 90%) with fiery red, peeling rash. It disrupts the body’s temperature regulation and fluid balance, leading to systemic illness (fever, chills, severe itching, pain, swelling).
   • Complications: Can be life-threatening and requires immediate medical attention.

6. Psoriatic Arthritis:

   • Description: A chronic inflammatory arthritis that affects some individuals with psoriasis. It can cause joint pain, stiffness, and swelling, often affecting the fingers, toes, spine, and large joints.
   • Symptoms: Nail changes are common, and “sausage digits” (dactylitis) are characteristic. It can develop before, during, or after skin lesions appear.

2. Treatment Approaches for Psoriasis and Most Appropriate for K.B.’s Relapse

Psoriasis treatment aims to reduce inflammation, slow down skin cell growth, and remove scales. The approach depends on the severity, extent, and type of psoriasis, as well as the patient’s overall health and preferences.