What causes a flare

[daytonaflyer]

I'm in a nasty flare right now and it couldn't have come at a worse time. I have to drive from Dallas to Las Vegas today to begin 7 weeks of training with a new company. Plus I currently don't have health insurance, so going to the doctor is something I'm trying to avoid. The P seems to be spreading to places it has never been before and growing in some spots that it was very small before.
I work as a pilot, so I cannot take most drugs that help P.

Here's the background of what I have been doing before I started to flare.

Two weeks ago I was in FL at the Warm Mineral Springs. I spent a week laying in the sun and wading in the waters. I did not have any flaring then. Do flares occur after getting lots of sun?

After that, I went to visit my parents in Oregon for two weeks and it was overcast, rainy, and I stayed inside most of the time and didn't get any sun.

I also started a vegetarian diet about a week and a half ago and have been avoiding meat, sweets, breads, etc. I'm also taking flax oil, turmeric, vitamin d, and ibuprophen daily.

How would you go about determining which of these factors may be causing this flare and getting it to stop? Any suggestions would be great.

[Resist]

I work as a pilot, so I cannot take most drugs that help P.This is not true as I know of no Psoriasis drugs that prevent you from flying an aircraft. This is because most of the drugs that do any good are topicals.

Do flares occur after getting lots of sun?Yes if you get a nasty burn.

[daytonaflyer]

I didn't get a nasty sunburn, so that's not an issue.

Topicals don't work very well for me. I've used Clobex/Dovonex last year and Taclonex this year. Both times the P returned within 2 weeks or so.
Protopic only helps on thin skin areas like the face or genitals. No other topicals ever worked very well for me.

Perhaps I have been misinformed on other P drugs and being able to fly. I was told that the side effects would inhibit me taking many of them.

[pgerpup]

Hey There Daytona!

I'm just guessing but it sounds like you have many factors that could have caused your flare. Stress is one, starting a new job and the fact that you don't currently have health insurance can cause a flare. Even if you don't feel the stress, your skin could be reacting.

A rebound effect from the drastic climate changes from Florida to Oregon. I was in Florida one time and had some very nice skin for about two weeks. Came home and then had a flare. I went to my derm and told him that while in Florida I had nice skin. He said that I was probably having a rebound flare. Until that point I'd never heard of a rebound flare. Who knew?

Diet change. While in the long run your diet change will probably be for the better, but it will take some time to adjust. In the meantime I suspect this diet chance could be part of the stress your body is feeling and we all know stress can cause a flare.

So, my guess is you've bombarded yourself with factors that lead to a flare in a relatively short period of time. Sorry you are feeling badly and hope the flare doesn't last too long.

I would like to reiterate that this is all guessing and hope that no one wants to pick me apart.

Fay

[DottieD]

Hi Daytona -
Sorry to hear about your flare-up. Couldn't have picked a worse time to hit you.

I have a few thoughts:

1) I use clobetasol, but my derm said to use it no more than 2 weeks at a time, then go off 1 week. I found I got better results using it only 1 week then off 1 week. I don't think the topical steroids are supposed to be used constantly. Maybe you could try an off-on regime with a topical.

2) You made such a drastic change in your diet -- why not just go off of meat and eggs for a while, then gradually cut out other foods? Perhaps that would make it easier for your body to adjust.

3) My husband and I travel a fair amount (4 or 5 trips a year). We often come down with a cold or upper respiratory infection not long after we return - we attribute it to the viruses in the new area that our bodies haven't built up a resistance to. (I don't know if that's right or not.) When this happens, my p usually gets worse for a while. Your flare up might be due to some mild viral infection that was a result of your travel. If so, hopefully it will gradually settle down.

Good luck to you. Wave to us when you're up in that beautiful blue sky!! DottieD

[MikeK]

Hi Daytonaflyer,

I'm sorry to hear that you're flaring. :(

Methotrexate (MTX) can fatigue, so it probably should be avoided by anyone who flies a plane. You might want to check with your doctor, your pharmacist, the FDA and maybe even the drug companies themselves to see if there are any warnings about piloting a plane by someone who is on a particular med. (You can start by checking with Enbrel's customer service hotline -- Eliven Services -- and go from there. Their number is: 1-888-4ENBREL (1-888-436-2735)).

You're flare could be related to your recent diet changes or to your recent trips to Florida and/or Oregon, but you could also be asypmptomic for some strep or some other infection. More then a few people have posted here that either their psoriasis or their child's psoriasis was triggered by some sort of infection. (Strep is the usual culprit, but just about any infection can trigger a psoriasis outbreak.) To further complicate things, many of these same people have also reported that the psoriasis outbreak was often the only sign that they had psoriasis because they were asymptomatic (i.e., no sore throat or fever in the case of strep throat) for the infection. Since your psoriasis cleared and then came back with a vengeance, it's possible that you're asymptomatic for strep. Please go to the doctor and get tested for strep. Insist on a culture, because the so-called "quick test" is often unreliable. Some people have to get a blood test, called an ASO blood test, to confirm that they have strep. Here's a link to some previous discussions about psoriasis and infections:

http://www.psoriasis.org/forum/showthread.php?t=7538&highlight=importance+strep+test;

http://www.psoriasis.org/forum/showthread.php?t=3074&highlight=presentation+strep;

http://www.psoriasis.org/forum/showthread.php?t=4988&highlight=uti; and

http://www.psoriasis.org/forum/showthread.php?t=18602&highlight=aso. (The ASO blood test is discussed in this thread.)


Also, have you started any new medications lately? The reason why I ask is that there are also several medications that are known triggers for psoriasis. Several people have posted (http://www.psoriasis.org/forum/showthread.php?t=22781&highlight=channel+beta) that blood pressure medications have caused their psoriasis to spread. PSunny posted that her psoriasis was triggered by Lipitor: http://www.psoriasis.org/forum/showthread.php?p=221451&highlight=Lipitor#post221451. Margueratt posted that her psoriasis was triggered by an anti-malaria drug http://www.psoriasis.org/forum/showthread.php?t=18739&highlight=Instant+psoriasis.

Finally, here's the link to the NPF's discussion of psoriasis triggers: http://www.psoriasis.org/about/living/triggers/.

I hope this helps!

Feel better!

Keep us posted.

Mike

[sergecosta]

While NSAIDs are not listed as triggers on the page that Mike kindly linked for us, ibuprofen triggers my PA. I've read that NSAIDs are known triggers of psoriasis or exacerbate inflammation of the skin. Why do you take ibuprofen everyday? Are you arthritic -- or have PA?

[Ihurt]

Research shows that there is a correlation between stress and P and PA. It seems (and they cannot prove this yet, but it is the working theory) that our 'Hypothalamus" cannot regulate body temperature quickly or adjust in a timely manner. In other words our climate clock is off. I hope the research that they are doing comes up with more because I believe they may be onto something. (The study was done at Fair Oaks Hospital-Summit NJ). Since then other places have conducted the studies as well.

THIS IS IMPORTANT because the hypothalamus is responsible for regulation of our body temperatures.

They did a study of 100 victims of abuse, and 100 vietnam vets and found that PTSD had shrunken their hypothalmus, so there is a strong correlation between stress and the hypothalamus, and when you look at it in these terms that applies to us with disease as well. MANY (almost 93%) of these people in the study suffered from Raynaud's Phenominon (sp) and had problems with depression in winter and the cold area's of the country.
Here's a quote from the Medicine net article regarding this issue:

]"The hypothalamus is the part of the brain that rules our body's main functions (mood, activity, sleep, temperature, appetite and sex drive). It is stimulated by the natural light that passes through the retinas in our eyes, and when less light is available these functions slow down[/B]."

I have had this happen to me more than once. In Sept of 01 I was in Houston, TX in 114 degree weather. I flew home that very same day to NJ to 55degree's when I unboarded in Newark! Talk about a flare. It took me three days. Now going from PA to houston, the same thing happens to me. It takes me three days to get through and "assimulate" again.

I have to go to Sugarlnad (Houston) late Nov because my mil is having knee surgery and wants some hand holding and some nurising skills. It will take me three days each way. I absolutely hate it. I need to sleep for three days...the fatigue for me is strongly associated with this change of weather.

But in answer to your question: FOR ME, THREE THINGS CAUSE FLARES...first AND FOREMOST-WEATHER-ANY CHANGE AND SUDDEN CHANGES KILL ME.

Second STRESS-especially emotional stress-that's killer.

Third and hopefully last is OVERDOING IT.


It appears that the trip to Oregon may have been the trigger for you with dreary rainy days (those are always the worst for me, skin flares and pain).


I hope you start to feel better really soon. I hate the "enhanced' jetlag (which really doesn't even come close to describing it) and pain I get when having to do this so I know how you are feeling. I travel frequently to Houston and Florida and it has always taken a toll on me.

Elaine

[Sunnysideup]

I didn't know about P and PA and ibuprofen. Maybe I should switch to Aspirin and Tylenol. My P has been worse lately and I take alot of Ibuprofen.

[daytonaflyer]

I am taking the Ibuprophen as part Barney's Formula. I have been trying alternative methods to avoid taking the harsh meds that I might someday need. I don't think it's the culprit since I've done this regimen in the past with some success and no flare.

I agree that it could be a combination of all the things together. Perhaps I should slowly change my diet back to normal and then gradually work towards the vegetarian diet again at a slower pace. Hopefully that will help. I should now be able to get some sun too since I'll be in Las Vegas for a while. Maybe that will help too.

Thanks for the replies. As soon as I get health insurance again, I'm gonna go get checked by a doctor; just in case.

[sergecosta]

I didn't know about P and PA and ibuprofen. Maybe I should switch to Aspirin and Tylenol. My P has been worse lately and I take alot of Ibuprofen.

Hi Sunny,

Unfortunately, eliminating ibuprofen did not do very much for my psoriasis. However, I noticed a big difference with my nail psoriasis which was mild to being with. I used to get oil spots on my nail bed. My nails never crumbled or lifted or became distorted. They always looked normal except for the few oil spots. I have not seen one on my nails since.

Tylenol is an analgesic. I take that for the occasional headache without a problem. But it won't do very much for inflammation. In fact, nothing at all.

However, that being said, my rheumatologist is certain I was experiencing symptoms of psoriatic arthritis. My body simply declares that way if I take NSAIDs. All that I can do is hope that nothing else triggers my PA again. I call the years when I was 18 to 32: the painful years. Here is the more insidious catch: when I stopped taking NSAIDs, my pain gradually went away after two months. I tested this on two occasions. Two whole months for the pain to go away after taking the last pill!! (The second time I went through this, I took an Advil for headache because I was too lazy to look for Tylenol. Within a day, I started getting pain in my sternum, Achilles tendons, shoulders, toes, and ligaments throughout my legs. And it gradually went away after two months of taking nothing). For the past 1.5 years, I have been pain-free 100%. I jog, I walk fast and walk often (at least one hour a day), I tend to climb every two steps if I take the stairs, etc. These were all activities I could not do when I suffered from PA. If I chose to do them, I would pay a big price--which usually meant that I would take more and more NSAIDs without really knowing that they were contributing to the problem. I just thought because they masked the pain pretty well, but still left me rigid and creaky, that they were doing the best they could for me. I was definitely convinced that I was going to need the big guns in a few years time. My pain was definitely impacting mobility.

As far as psoriasis goes, I am pretty confident that eating well helps control my symptoms of itch and inflammation. However, it does not do very much to resolve my lesions. Nevertheless, I have seen loads of improvement after reducing skin contact with soaps and shampoos AND reducing physical stress like rubbing and picking and scratching. No question. I am a believer in subtracting things to do with your skin as opposed to adding (i.e., doing too much with it)

[squeepig]

I can certainly relate to the climate changes. Last week, I flew to Las Vegas and my days there were heaven! My psoriasis around my eyes almost disappeared. But then I came home to Washington state, and, WOW, flare city! It's so bad that the skin is parting and bleeding around my eyes. I'm ready to ditch everything here and move back to Las Vegas.

[bsavanigilbert]

Personally, all the things you are doing sound very healthy and safe, so maybe the drastic diet change along with lack of sun, have triggered the gp....but give that diet a chance as all I've been reading says getting all the toxins out takes some time. Daytona and pilot= ERAU? yes? Have a son that started there, got very involved in rotc and ended up with terrible strep and first major flare of gp. Went to Daytona thinking sun would be an answer to scalp p only to have a flare affect body, oh well....sure college lifestlye had some impact also. Be well

[wpeng4]

Stress seems to be a big factor in causing my flare-ups. I am now going through one of hte worse flares in six months. I started diet in April, and my P has gradually coming down with occasional flares. It seemed to be getting better until last week. I am about to go on a biz trip for 10 days. The trip preparation has been very intense, which I think caused my flare this time. it is pretty bad. I got pinky, round flares all oover my body, and topicals are as effective as they have been in the past. I hope it calms down once I am done with this project. It's very depressing to look at my skin.

[clementinecannibal]

its sometimes hard to figure out what causes flair ups. for me, it's mostly stress. or big life changes (new job, break ups, moving etcetera) so maybe the fact that you're going to do this thing could have caused it.

[Resist]

I've used Clobex/Dovonex last year and Taclonex this year. Both times the P returned within 2 weeks or so.Psoriasis will retrurn with any treatment option right now. There is no cure. Sometimes you have to vary treatment options to get results. It is as if Psoriasis adapts. This is what makes Psoriasis such a hard disease to treat. What works one day can stop working the next. But stress seems to be a major cause of flares. For me I feel my skin itch when I don't get enough sleep. Others say it is certain foods or alcohol.

Perhaps I have been misinformed on other P drugs and being able to fly. I was told that the side effects would inhibit me taking many of them.I'm curious who told you this. I know of no Psoriasis drugs that alter a persons ability to drive a vehicle or fly. These drugs don't alter your mind in any why like alcohol.

[daytonaflyer]

I'm curious who told you this. I know of no Psoriasis drugs that alter a persons ability to drive a vehicle or fly. These drugs don't alter your mind in any why like alcohol.

The mind altering effect isn't the only concern. The FAA only allows a very small percentage of drugs to be taken while flying and they refuse to publish a list of approved medications. Luckily some private organizations have compiled a list of drugs the FAA usually approves. Some can be approved on a case by case basis, but many are never allowed. Even OTC cold medicines are disallowed.

[AnnieB]

But I can see why OTC cold medicines would be a problem, as antihistamines can make you drowsy and Nyquil has alcohol in it. Might be worth looking into in more detail. I guess the point being made is that biologics don't make you sleepy or dizzy. MTX makes people very tired sometimes so that would probably be out.

[DD]

Research shows that there is a correlation between stress and P and PA. It seems (and they cannot prove this yet, but it is the working theory) that our 'Hypothalamus" cannot regulate body temperature quickly or adjust in a timely manner. In other words our climate clock is off. I hope the research that they are doing comes up with more because I believe they may be onto something. (The study was done at Fair Oaks Hospital-Summit NJ). Since then other places have conducted the studies as well.

THIS IS IMPORTANT because the hypothalamus is responsible for regulation of our body temperatures.

They did a study of 100 victims of abuse, and 100 vietnam vets and found that PTSD had shrunken their hypothalmus, so there is a strong correlation between stress and the hypothalamus, and when you look at it in these terms that applies to us with disease as well. MANY (almost 93%) of these people in the study suffered from Raynaud's Phenominon (sp) and had problems with depression in winter and the cold area's of the country.
Here's a quote from the Medicine net article regarding this issue:

]"The hypothalamus is the part of the brain that rules our body's main functions (mood, activity, sleep, temperature, appetite and sex drive). It is stimulated by the natural light that passes through the retinas in our eyes, and when less light is available these functions slow down[/B]."

I have had this happen to me more than once. In Sept of 01 I was in Houston, TX in 114 degree weather. I flew home that very same day to NJ to 55degree's when I unboarded in Newark! Talk about a flare. It took me three days. Now going from PA to houston, the same thing happens to me. It takes me three days to get through and "assimulate" again.

I have to go to Sugarlnad (Houston) late Nov because my mil is having knee surgery and wants some hand holding and some nurising skills. It will take me three days each way. I absolutely hate it. I need to sleep for three days...the fatigue for me is strongly associated with this change of weather.

But in answer to your question: FOR ME, THREE THINGS CAUSE FLARES...first AND FOREMOST-WEATHER-ANY CHANGE AND SUDDEN CHANGES KILL ME.

Second STRESS-especially emotional stress-that's killer.

Third and hopefully last is OVERDOING IT.


It appears that the trip to Oregon may have been the trigger for you with dreary rainy days (those are always the worst for me, skin flares and pain).


I hope you start to feel better really soon. I hate the "enhanced' jetlag (which really doesn't even come close to describing it) and pain I get when having to do this so I know how you are feeling. I travel frequently to Houston and Florida and it has always taken a toll on me.

Elaine

I just want to THANK YOU for this! I always thought I was crazy! Everyone I know LOVES rainy days and I can't stand it. I definitely get depressed if its not sunny. When the days get shorter, I sleep more and get sad more often. I thought it was because I lived in AZ for almost my entire life, but this makes so much sense to me. I also get extremely overtired and fatigued in certain situations, get the "chills" like I can't warm up, and it takes me a few days to "regulate myself" when things have been out of the ordinary (off schedule, etc).

Anyway - THANK YOU!!!!

[Ihurt]

Your very welcome. Glad I could help. No your not crazy, it really does happen. There's also something else you might want to look into. It's a disorder called SAD-Seasonal Affective Disorder. They sell lamps for it, and anti depressants work for it as well. Talk to your doc.

Elaine