Peer Reviewed

DermClinic

What is responsible for this flare of psoriasis?

DAVID L. KAPLAN, MD—Series Editor University of Missouri Kansas City, University of Kansas

DAVID L. KAPLAN, MD—Series Editor: Dr Kaplan is clinical assistant professor of dermatology at the University of Missouri Kansas City School of Medicine and at the University of Kansas School of Medicine. He practices adult and pediatric dermatology in Overland Park, Kan.

Volume 52 - Issue 10 - October 2012

psoriasis

A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer

What do you suspect?

A. An allergic reaction to one of the anesthetics.

B. An exaggerated allergic reaction to the preoperative povidone-iodine preparation.

C. A flare of psoriasis that is unrelated to the biopsy.

D. A flare caused by the psychological stress of the procedure.

(Answer on next page)

 

Answer: Psoriasis flare caused by stress

 psoriasis

Psychological stress, D, is the primary trigger for psoriasis. This patient’s anxiety about the proce- dure and its potential outcome in- duced a major flare of her psoriasis. A short course of a selective sero- tonin reuptake inhibitor and aggres- sive topical corticosteroid therapy calmed the patient and the outbreak within a few weeks.