Factors That Trigger Flare-ups in Plaque Psoriasis


Lifestyle modification and counseling to help manage flare-ups resulting from triggers for plaque psoriasis.


Lakshi Aldredge, MSN, ANP-BC, DCNP: It’s important that primary care providers also work in partnership with dermatology providers to do that coaching, or lifestyle modification because again, this is a lifelong journey with psoriatic disease, whether it’s skin or psoriatic arthritis. I teach them and emphasize all of the things that their primary care providers are telling them. Quit smoking; we know that smoking can be a trigger for worsening psoriasis. Certainly, alcohol use; we know that patients with psoriasis are already at risk for nonalcoholic fatty liver disease. If you add alcohol on top of that, that adds more insult to their liver. I tell them to do all of the things that they’ve been taught their entire lives: eat a healthy diet, avoid alcohol and tobacco, try to get exercise, and try to get good restful sleep because all of those things play a part in the management of psoriasis and also in preventing the development of those comorbidities.

Matthew Brunner, MHS, PA-C, DFAAPA: Another important thing is sometimes I see these patients referred to us, and they’re on medications like β-blockers that may be exacerbating their underlying psoriasis. It’s important to recognize that the first time you see the patient, and have a discussion that this is a potential trigger for them and that we need to talk with their managing provider about transitioning them from a β-blocker possibly to another agent.

Patients can also have exacerbations from Koebnerization, and it’s important to acknowledge that and to understand from your patients what kind of physical work they may be doing. I have a lot of patients who work physically, and they may have to be on their elbows or knees for their jobs or have repetitive trauma to an area of friction. I acknowledge that with the patient so they at least understand what’s happening and the concept of Koebnerization, and how that can also be exacerbating their condition. This helps them feel at least empowered enough to understand that they are in control and understand why those things are happening.

Lakshi Aldredge, MSN, ANP-BC, DCNP: That’s an excellent point. Speaking of other triggers that can cause psoriasis, oftentimes patients say, “What am I doing that caused this?” Or, “I don’t have any family members who have psoriasis.” Well, we know that about 40% of patients can have a family history of psoriasis. There’s definitely a genetic component to psoriatic disease. However, there are many patients who don’t have a family history. And there are other triggers. You mentioned medications such as β-blockers, and trauma, such as scratching themselves, even at the site of surgery can be the first place you develop psoriasis, scratching really hard. Also, there are environmental factors, such as chemicals, moving to a really cold environment. We know the further you get away from the equator, the higher the incidence of psoriasis. Sometimes colder environments can trigger psoriasis. We also know that emotional stress, the death of a loved one, the loss of a job, the COVID-19 pandemic, those kinds of stressful events can certainly be the trigger for psoriasis. It’s important that primary care providers have that knowledge and understanding as well. Then also for patients to be aware that this is not something that they’re doing, but it can be caused, not only because they have a family history and it’s genetic, but it can also be because of environmental factors, medications, trauma, or injury, or even emotional stress. Those are good things to keep in mind as well.

Matthew Brunner, MHS, PA-C, DFAAPA: Thank you for watching HCPLive® Peers & Perspectives®. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming Peers & Perspectives® and other great content right in your inbox.

Transcript edited for clarity.

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