What are the best methods for preventing psoriasis outbreaks?

Best Methods for Preventing Psoriasis Outbreaks

The most effective approach to preventing psoriasis outbreaks involves practicing good hand hygiene, maintaining physical distancing from non-household members during pandemic conditions, wearing appropriate face coverings, and receiving recommended vaccines including the seasonal influenza vaccine. 1

General Prevention Strategies

Lifestyle Modifications

• Maintain ideal body weight, avoid tobacco products, limit alcohol consumption, and practice stress reduction techniques to improve disease management 2
• Recognize and avoid known triggering factors including streptococcal throat infections, skin injury, certain medications, low humidity environments, and emotional stress 3
• Follow the "Three-P Concept" for psoriasis management:
  1. Prevention of injury to skin
  2. Persistence in avoiding overtreatment
  3. Pauses or rest periods during treatment with focus on sedation, emolliation, and humidification 3

Medication Management

• Continue prescribed biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases, as discontinuation may lead to flares 1
• Avoid chronic systemic corticosteroids when possible for psoriatic arthritis management, as long-term use has been associated with worse outcomes 1
• Be aware that in rare instances, treatment with corticosteroids (or withdrawal of treatment) may exacerbate psoriasis or provoke the pustular form of the disease 4

Specific Prevention Strategies During Pandemic Conditions

Personal Protection Measures

• Practice good hand hygiene consistently 1
• Maintain physical distancing from non-household members 1
• Wear face coverings of the nose and mouth when indoors (except in your own home) and when outdoors but unable to maintain physical distancing 1
  • Note: Face coverings should not be used in children under 2 years old due to risk of suffocation 1

Vaccination Recommendations

• Receive the seasonal inactivated (killed) influenza vaccine to lower risk of seasonal influenza infection 1
• Patients with psoriatic disease who don't have contraindications should receive an mRNA-based COVID-19 vaccine as soon as it becomes available 1
• Discuss timing of vaccinations with healthcare providers, especially for patients taking systemic medications, to optimize vaccine response 1

Special Considerations for Different Settings

• Workplace: Follow measures to prevent infection in the workplace; if the environment doesn't allow for maintenance of prevention measures, discuss with clinician whether specific accommodations are medically necessary 1
• School (for youth with psoriasis): Maintain physical distancing, wear masks if over age 2, and wash hands frequently; if these measures cannot be ensured, develop an appropriate learning plan with healthcare providers 1
• Phototherapy: If receiving office-based phototherapy, follow safety protocols including:
  • Being screened for symptoms before entering the treatment unit
  • Attending appointments alone (minors may be accompanied by a guardian)
  • Applying hand sanitizer upon entering and leaving the unit
  • Wearing appropriate protective equipment 1

Treatment Selection for Preventing Flares

For Mild to Moderate Disease (Less than 20% Body Surface Area)

• Topical therapies are most appropriate for initial treatment, including:
  • Topical corticosteroids
  • Calcipotriene (vitamin D analogue)
  • Tazarotene (retinoid)
  • Anthralin 5

For Severe, Recalcitrant, or Extensive Psoriasis

• Phototherapy alone or in combination with coal tar or psoralen
• Systemic therapies such as acitretin, methotrexate, cyclosporine, hydroxyurea, and thioguanine
• Biologic agents targeting specific inflammatory pathways, particularly IL-12, IL-23, and IL-17 5, 6

Monitoring and Management

• Educate patients about their disease and encourage them to take responsibility for self-care to lessen morbidity 3
• Use the Psoriasis Area and Severity Index to assess severity and monitor treatment effectiveness over time 2
• For patients who become infected with SARS-CoV-2, monitor symptoms and discuss management of psoriasis treatments with healthcare providers 1
• Be aware that infection with SARS-CoV-2 may result in a flare of psoriasis based on case reports 1

Cautions and Pitfalls

• Avoid overtreatment which can lead to side effects and potential worsening of the condition 3
• Be aware that long-term phototherapy can lead to erythema, pruritus, wrinkling, solar elastosis, and increased risk of skin cancer 5
• Recognize that systemic therapies, while effective, require careful monitoring due to potential toxicity 5
• Consider that treatment selection must balance disease severity and patient expectations against the risk-benefit ratio of each potential therapy 5