Why is My Psoriasis Getting Worse Even with Treatment?

People who are being treated for psoriasis sometimes face worsening symptoms. This is a common challenge for people with autoimmune diseases. Knowledge of psoriasis and your body’s unique responses can help you grasp what is going on. Then you can make informed treatment choices that might lead to better health outcomes.

Psoriasis and the nature of autoimmune diseases

Psoriasis is an autoimmune disease. These diseases are chronic and inflammatory in nature with flare-ups and periods of remission. Symptoms worsen during flare-ups and settle down in remission.

Periodic increases in symptoms are part of the cyclic nature of psoriasis. Even with treatment, flare-ups occur. The body’s immune system overreacts, giving rise to itchy, red, scaly patches on the skin. These patches or plaques may go away over time and then come back again.

Autoimmune diseases are complex, making them hard to diagnose and treat. Seeing a rheumatologist—a doctor with expert knowledge of these diseases—is so important. They can help ensure the right diagnosis and the best course of treatment.

When symptoms worsen because of treatment

Drugs are often used to treat psoriasis, but they may also play a role in worsening symptoms. Certain drugs have been shown to bring on psoriasis or increase current symptoms. These include antimalarial agents, beta-blockers, lithium, and some nonsteroidal anti-inflammatories.

Your doctor can suggest other drugs to take in place of these. Although certain biologics and systemic drugs are common treatments for psoriasis, people’s responses to them differ. Some doctors are studying signs of the disease in people to project likely responses.

A 2018 study reports responses to systemic drugs vary from 35 to 80 percent. People who do not do well with systemic drugs may take anti-tumor necrosis factor (TNF) drugs. The rate of patients who respond poorly to TNF drugs ranges from 30 to 50 percent.

Sometimes the problem lies with how a drug is used. People with psoriasis often use corticosteroid creams or pills to lessen inflammation. Consistent usage is vital. A sudden end to steroid treatment can make symptoms worse or cause other forms of psoriasis.

What other treatments impact psoriasis symptoms?

Other treatments for psoriasis besides drugs exist, but again, people’s responses differ. Oatmeal baths, phototherapy, topicals like petrolatum jelly that are applied to the skin, and vitamin D are common. But due to personal sensitivities, these treatments may not work for everyone.1

People with psoriasis sometimes make lifestyle changes to take care of their psoriasis. These include eating a special diet, exercising, managing stress, relaxing, and taking supplements. The benefits of these actions vary from person to person. Those who find it hard to adjust their routines do not make as much progress.

Infections can make psoriasis worse

Infections trigger the immune system, which is already too active in people with autoimmune diseases. Bronchitis; earaches; tonsillitis; strep throat; and other bacterial, fungal, and respiratory infections can flare up psoriasis.2,3,5

Strep throat has been shown to cause guttate psoriasis. Children who develop guttate psoriasis often do so after a strep throat infection. This form of psoriasis presents as small, round spots instead of patches.2,3

The impact of injuries

A person with psoriasis may see an increase in symptoms if they suffer a skin injury. Some experience what is called the Koebner phenomenon. Plaques appear at the sight of wound, and this area was not affected before the injury.1,3

Injuries that trigger psoriasis can range from mild to severe. They can include bruises, bug bites, cuts, needle punctures, scratches, and sunburn. Poison ivy can also harm the skin and lead to psoriasis. 1,3,5

Many factors can affect psoriasisMany factors can affect psoriasis, making it hard to find the right treatment. What is more, triggers and responses to treatment can differ from one person to the next. Your doctor can help you figure out what is making your psoriasis worse. They can also guide you to the health care that works well for you.

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