A Flare Management Master Plan: What Safety Protocols Can Teach Us

In my twenties, I wrote safety protocols. The benefit? Planning for a disaster before it occurs can make a significant difference to your health.

The most useful process I have scripted is the one for my psoriasis care following infection with the dreaded Strep throat. This is my nemesis by the way: full whole body flare of both guttate and plaque psoriasis. My first flare nearly broke me, and having this process in place helps reduce the stress I have every time I get a sore throat.

Being prepared

The point of a safety protocol is that it forces you to identify the ‘what if’ and then clearly present the potential solution you will apply. It is much faster if something goes wrong to implement the right solution because it has already been clearly laid out for you. The added advantage is that the answer was thought out entirely when your mind was straight, not in fight or flight mode and not while under extreme emotional or physical stress. So its probably a better solution than the one you come up with on the fly (like buying creams someone recommended in a forum or bulk buying neem oil…*guilty*)

I'm laying out my process to help get your creative juices flowing. You should talk to your doctor to find the best procedure for you. Mine involves steps my dermatologist is very strongly against. I have taken some risks because I have deemed they are worth it relative to the risks to my mental health. I do not recommend any of these steps to you, but think about what yours would be because it helps prevent that feeling of isolation and desperation when things start to go wrong, and you begin to feel that loss of control.

My flare management plan (not yours)

1. The realization: I notice I have a sore throat. I cancel all plans that are cancellable for the next few days, take high dose vitamin C and rest as much as humanly possible. Fighting the infection before it takes hold is essential.
2. If the infection takes hold and I suspect that it is Strep (usually Streptococcus pyrogens/ tonsilitis) I will get an emergency on the day appointment at my doctors and get erythromycin prescribed (I am allergic to penicillin). Whatever you do, don't take any antibiotics you have in your cupboard. I also get a prescription for topical steroids for my body and scalp but don't put it into the chemist yet (purely to save money if I don't end up needing them). I also ask for a referral to a dermatologist: where I live in the U.K if you get an appointment in 6-8 weeks you are doing well, the current waiting time is around 3 months. In the Republic of Ireland, the waiting time is 2 years in some places. So it's better to get on the waiting list- an appointment is easier to cancel than it is to get.
3. If  I know its Strep: If the plaque psoriasis starts flaring (I always have plaques so its an easy indicator) I put the prescription in and begin with topical steroids as prescribed. When the guttate spots start showing up I need to move to the next tier of intervention. For me, this is  U.V treatment. My guttate plaques do not respond to topical steroids. This is why it is useful to have a plan. I know what I will do next. When guttate psoriasis sets in I know I am in for a minimum of 6 months of flare unless I tackle this head on and this is where I grate on my dermatologist. I bought a nb.U.V.B machine with hospital grade tubes. It was that or my sanity. It does mean that my home treatments are not regulated. I do not recommend this. The only reason I do this is that if I wait for a referral I will have had a mental health breakdown, and that is not an option for me. Fortunately, in the U.S and more recently in the U.K there is a system that enables the use of home regulated machines on prescription.
4. If it turns out that it is not a Strep induced flare, and the guttate plaques do not make an appearance, then I will use topical steroids while I wait to see my dermatologist. If my skin is still flaring and I am struggling to cope I will be prescribed systemics. I react badly to Prednisone and so this is not an interim option for me. Knowing what definitely does not work will really help you develop an effective plan in conjunction with your doctor.

Making a plan for yourself

What are you going to do now? Drawing out a plan for yourself is an excellent use of an appointment with your doctor, you can use your G.P as more than a drug dispensary so don't feel guilty about going without a specific need for drugs. Most doctors will be glad you are taking control of your health. If they are hostile then take this as an opportunity to say; Thanks, but no thanks’ and then go chat to the receptionist to find out how to get a different doctor. I hear a great quote the other day though I can't remember where from. ‘Half of the doctors where at the top of their class, the other half were at the bottom.’ Some doctors are better than others, and some just have a personality that meshes better with yours, and that is O.K.

Let me know how you get on in the comments :-)