Ask the Expert: Help! I’m Having a Psoriasis Flare-Up

If you have psoriasis, you’ll know that flare-ups can feel unpredictable, uncomfortable, and create confusion about the best way to manage them.

Consultant Dermatologist Dr Veronique Bataille is here to help by answering your questions about psoriasis flare-ups, including why they happen, what can trigger them, and how you can help to get them under control.

Q: I’ve had psoriasis for years but not had a flare-up for a long time. Why now?

A: Psoriasis is a long-term (chronic) inflammatory skin condition that tends to flare up at certain points, often unexpectedly. A flare-up simply means your symptoms, that can include itchy, flaky, inflamed skin, suddenly get worse. This can happen even if your psoriasis has been dormant for months or even years.

There can be various common triggers, including infections, skin injuries, certain medications, stress, and even weather changes. Understanding your personal triggers can be key to reducing the frequency and severity of flare-ups — and that’s something we at the clinic can work closely with you to identify.

Q: What are the early signs of a psoriasis flare-up I should look out for?

A: Often, the first sign is a sensation before you even see a red patch — a tight, dry, itchy feeling. Some people also notice a burning or stinging sensation. You might start to see other new red, pink, or dark patches appearing, or existing patches of psoriasis becoming more inflamed or scaly.

Seeking expert help if your psoriasis is becoming quite active is important, as it is now known that psoriasis that covers large areas of your body causes systemic inflammation. This can have implications for your overall health, especially regarding blood pressure and your heart; it is also hard living with a widespread rash, that can impact your wellbeing. By managing your symptoms as early as possible, you’ll be more likely to be able to soothe your skin, and reduce the ways it negatively affects your life.

Q: I had a sore throat before a flare-up. Could that be the cause?

A: Yes, it’s a surprisingly common trigger. Guttate psoriasis, which causes small, cluster-like spots of psoriasis to appear on your skin often follows a streptococcal throat infection. That’s because infections can stimulate your immune system in a way that increases inflammation in the skin.

In these cases, we might prescribe a course of antibiotics to treat the underlying infection, which can help ease the flare-up. It’s also worth noting that even if you don’t develop guttate psoriasis specifically, infections of any kind can still trigger other forms of psoriasis.

Q: Can I manage a flare-up with certain lifestyle changes at home?

A: There’s a lot you can do yourself. First, stick to any treatment plan that’s been created for you by your doctor or dermatologist.

You can also:

• Keep your skin well moisturised. This can help prevent cracking and reduce itchiness
• Avoid known triggers (if you’ve identified them with the help of a doctor, especially medications such as Beta Blockers).
• Try to avoid unnecessary stress. This can put undue pressure on your immune system, and can be a significant trigger for many people with psoriasis
• Try to maintain a healthy lifestyle. Eat well, avoid smoking and excessive drinking of alcohol. Do some form of regular exercise. If you drink alcohol, do so in moderation as this can help to support your immune system and overall health

Even though you may feel self-conscious during a flare-up, it’s really important to remember that psoriasis isn’t contagious. Exposing your skin to the open air when possible is important as the UV light from the sun can be beneficial and safe exposure, depending on your skin type, is often recommended. 

Q: What treatments are available if creams and moisturisers aren’t enough?

A: If your psoriasis is more severe or doesn’t respond well to topical treatments (like corticosteroid creams mixed with Vitamin D), we might explore other options. These include:

• Phototherapy: this is a controlled treatment that can be highly effective in helping with psoriasis flare-ups. It uses specific types of UVB or UVA light on your skin over a very short amount of time to reduce inflammation
• Systemic medications: these work throughout your whole body and may be taken orally or by injection. These are often used for more widespread or persistent psoriasis.

Your treatment plan will focus on specific symptoms, past outbreaks, your medical history, and your lifestyle.  

Q: Can psoriasis affect other parts of the body besides the skin?

A: Yes. In fact, around 1 in 5 people with psoriasis go on to develop psoriatic arthritis, an inflammatory condition that affects the joints. It can cause pain, stiffness, and swelling — and if left untreated, it can lead to joint damage. It is often missed unless your doctor asks you specific questions about your mobility and joints. There are more specific joints which are affected by psoriasis and your doctor can help you to recognise the condition. 

If you’re experiencing joint pain alongside your skin symptoms, it’s important to tell your dermatologist or doctor. Early intervention means that we can adapt your treatment plan accordingly, which can make a big difference to your overall health and wellbeing in the long-term.

Q: Is there anything I should watch out for long-term?

A: People with psoriasis, particularly men, are at a slightly higher risk of other conditions such as high blood pressure, high cholesterol, and heart disease. That’s why we often recommend speaking with a GP to assess your overall health, especially if your psoriasis is widespread and resistant to treatment. 

Dr Veronique Bataille

Q: Is there a cure for psoriasis?

A: Psoriasis is a long-term condition which is genetic but the number of genes involved is very large so it is not transmitted via a single gene. However, roughly more than half of people with the condition have no family history of psoriasis, as the transmission down generations is very complex. While many do go through long periods with limited or no symptoms and have a very good quality of life, there’s a lot we can do to help manage flare-ups and reduce the impact it has on your life.

It’s crucial to find the right combination of treatment and lifestyle approaches for you, and that’s where our team of experienced Consultant Dermatologists can help.  

Make an appointment at our London clinic?

If you’re struggling with a psoriasis flare-up, we’re here to offer our expertise and help. Our Consultant Dermatologists have extensive experience managing all types of psoriasis, from mild flare-ups to complex symptoms that haven’t responded to previous treatments. Please call 020 7244 4200 or make an appointment online.