LAS VEGAS — When patients newly diagnosed with psoriasis ask Elaine C. Siegfried, M.D., what they can expect, she offers up her usual response.
“I say, 'The only thing predictable about psoriasis is that it's unpredictable,'” Dr. Siegfried said at a dermatology conference sponsored by the Skin Disease Education Foundation.
This notion is highly applicable to flare, a term used to indicate worsening of psoriasis during or after treatment. Flare “reflects the unpredictable nature of psoriasis and potential for environmental triggers,” said Dr. Siegfried of St. Louis University.
The biologic agent efalizumab (Raptiva) may increase the risk of flare in a subset of patients, she said. Two types of flare have been described in patients taking the drug: localized flare that occurs during therapy, appears at new sites, and remains localized; and generalized flare, which occurs more often in nonresponders.
Flare may occur with efalizumab “slightly more than other drugs, but it certainly occurs with other [biologics] as well,” Dr. Siegfried emphasized, adding that flaring is not a phenomenon that's unique to efalizumab.
“There are lots of triggers that make psoriasis worse in a subset of patients,” she added. “Strep throat is one.” Other anecdotal triggers that she has observed in her patients include naproxen, hydrochlorothiazide, acute sinusitis, and Eucerin.
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