Written by Johannah Kone Valentine, MD, a board certified Dermatologist and Assistant Professor in Dermatology. She is passionate about helping patients care for their skin.
It’s time to talk about an uncommon but potentially serious complication of psoriasis: Infection.
If you have psoriasis, it’s a good idea to empower yourself by learning about infection, because your risk is higher. A study published in British Journal of Dermatology in 2017 showed that people with psoriasis are more than 4 times as likely to have bacterial colonization on the skin, potentially the preliminary step to infection. And the more severe the psoriasis is, the greater your risk of infection. Another study showed patients with severe psoriasis are 63% more likely to develop infection than those without the disease.
Systemic treatments for psoriasis can be very helpful in preventing flares and keeping lesions at bay. However, most systemic medications work by suppressing your body’s immune system, which may predispose your body to infection. In fact, infection is the most common side effect of these medicines. If you also have diabetes or are overweight, your risk is higher!
There are several types of infections that can invade the skin. Some infections are superficial (on the top layer of skin) while others extend deeper, causing cellulitis. Watch out for cellulitis – it can become life threatening if not treated!
Skin can be infected by bacteria, viruses or fungi. Bacterial infection is most frequent, commonly caused by Staphylococcus aureus and group A Streptococcus. Infection with resistant bacteria, such as MRSA, is rare but could be serious if it happens. A study presented at the 13th World Congress of Pediatric Dermatology demonstrated that MRSA is on the rise in inpatients with psoriasis.
Less frequently, viruses can cause skin infection. Both herpes simplex virus and varicella, the virus that causes chickenpox have been reported to infect psoriasis lesions in patients with flares. Human papilloma virus, the virus that causes warts and molluscum contagiosum are other viruses that commonly cause bumps on the skin. While psoriasis patients do not usually develop these bumps in their psoriasis lesions, immunosuppressive treatments for psoriasis may increase your risk of outbreak of these virus related lesions.
Similarly, infection with a serious fungus is rare but the risk is higher if you are immunosuppressed from certain systemic medications. Treating yeast, on the other hand, is sometimes an integral part of psoriasis treatment, especially when it comes to scalp psoriasis. Discuss with your provider if yeast is playing a role in your symptoms.
Now that we have covered skin infections and their risk, the good news is, you can take action to keep infection from getting in the way of clear skin. Here are 7 tips you can use to ward off skin infections:
1. Heal your skin. Here is yet another reason to treat your psoriasis plaques. Don’t give the infection a chance to enter the skin! Inflamed and cracked skin of active psoriasis lesions is especially prone to infection. Microtears in flared skin serve as openings for infection. This is why it is key to prevent psoriasis flares and treat new lesions that arise.
Even if you are on a systemic medicine, consider adding a topical treatment or phototherapy to heal lesions that are not fully resolved on systemic medicine. Use your topical creams and home light therapy as prescribed. Just a few minutes of UV therapy can help resolve flare-ups.
Keep skin well moisturized with a thick moisturizing cream. Soothe your skin by applying Vaseline or Aquaphor to cracks or openings in the skin. If you treat inflammation and cracking, you are sealing the entry points so infection cannot get into the skin.
2. Ditch the itch! You know by now that psoriasis can be itchy, but what’s the harm in scratching a bit to give yourself relief? Unfortunately, scratching causes microscopic tears in the skin. As we discussed above, these tiny disruptions in the skin’s barrier serve as entry points for infection. If the itch hits, try not to scratch. Instead, apply a moisturizer or ice the area for a few minutes. Remember to keep your nails short. Consider taking an antihistamine, if you’ve already discussed it with your doctor. This can be especially useful at night, when you may scratch in your sleep without knowing it. If you are already using UV light therapy, this is a good time to make sure you are on top of your treatments, as UV light is well known to decrease itching.
3. Wash your hands. While psoriasis is not contagious, skin infection can be. Washing your hands is the first line protection against infection. Make sure you are washing up, especially after coming into contact with other people, visiting a public place such as the gym, subway or supermarket. An alcohol containing hand sanitizer is better than nothing but good old soap and water is preferred.
4. Change your clothes daily and launder safely. Although it may be tempting to fish out clothes from your hamper in a crunch, dirty clothes, sheets and towels may increase the risk of infection. Wash your clothes after wear (especially a workout!) and change your sheets and towels regularly. Consider washing underwear and towels separately in hot water and adding a cup of vinegar to the wash.
5. How is the rest of your lifestyle? Here’s another reminder to take care of yourself! It’s more important than ever to eat well, get enough sleep and avoid smoking. Not only will smoking, a poor diet and lack of adequate sleep flare your psoriasis but they may compromise your body’s ability to fight infection as well. Studies suggest that inadequate sleep prevents your immune system from recharging itself, thus decreasing your defense against infection. Furthermore, smoking can slow your skin’s normal healing process. The time to quit is NOW!
6. Be on the lookout for signs of infection. Infected skin can look swollen, red or be painful. Other signs of infection include a yellow-honey colored crust or discharge and fever. It is IMPORTANT to seek care promptly if you think you may have an infection. Also, if your psoriasis lesions are not healing as they normally do, an infection may be to blame.
7. Stop recurrence. If you have had infections in the past, talk to your healthcare provider. After a discussion, he or she may opt to start you on an antibacterial soap or have you take dilute bleach baths to prevent future infection.
If you arm yourself with knowledge and effective tools to treat your psoriasis, you can halt infection in its tracks!
- Ng CY, Huang YH, Chu CF, Wu TC, Liu SH. Risks for Staphylococcus aureus Colonization in Psoriasis Patients: A Systematic Review and Meta-Analysis. Br J Dermatol. 2017 Feb 3. doi: 10.1111/bjd.15366. [Epub ahead of print] Review.
- Garcia-Doval I, Cohen AD, Cazzaniga S, Feldhamer I, Addis A, Carretero G, Ferrándiz C, Stern RS, Naldi L. Risk of serious infections, cutaneous bacterial infections, and granulomatous infections in patients with psoriasis treated with anti-tumor necrosis factor agents versus classic therapies: Prospective meta-analysis of Psonet registries. J Am Acad Dermatol. 2017 Feb;76(2):299-308.e16.
- Silverstein P. Smoking and wound healing. Am J Med. 1992 Jul 15;93(1A):22S-24S.
- Besedovsky L, Lange T, and Born J. Sleep and immune function Pflugers Arch. 2012 Jan; 463(1): 121–137