[Editor's Note: This article was published prior to the 2019-2020 COVID-19 pandemic. While some recommendations that may help you avoid the flu, such as hand washing, apply to COVID-19, there are many differences between these two viruses. This content relates only to the flu - not to COVID-19]
Cold and flu season has arrived, ushered in with a flurry of sneezes and coughs. But for those living with psoriasis and psoriatic arthritis (PsA), these everyday ailments can mean more than just a few days of tissues and chicken noodle soup.
The use of immunosuppressive drugs, such as biologics, can mean a greater risk of getting sick, while illness can trigger psoriasis flares. And those with the flu often have to go off biologics when they are sick.
“We clearly see more flares in the winter months,” says Jerry Bagel, M.D., director of the Psoriasis Treatment Center of Central New Jersey and NPF medical board member.
Part of the increase comes from a combination of decreased ultraviolet light and forced heat, causing skin to become extra dry and itchy. And being indoors means people are in closer contact and more prone to picking up germs.
“A more enclosed environment means more upper-respiratory infections,” Bagel says. “Even though it’s the upper-respiratory tract, we see infections with bacteria, and bacteria are known to exacerbate psoriasis.”
Some infections, such as strep throat, have been proven to trigger guttate psoriasis. But that doesn’t mean that people living with psoriasis have to spend the winter months fighting off illness and infection. There are ways to stay healthy this season.
Mark McGraw laughs when he explains his predicament. The 55-year-old from Sacramento has lived with psoriasis since he was 25. He was diagnosed with PsA when he was 45.
As a medical sales rep, he walks in and out of hospitals each day as he visits infectious disease departments as part of his rounds. The irony? “I’m a bit of a germaphobe,” he says. “I’m very aware of germs, so I’m a hand-washing fanatic.”
That approach is sound — the U.S. Centers for Disease Control and Prevention (CDC) actually refers to hand-washing as a “do-it-yourself vaccine.” In fact, a good lather and a 20-second scrub is one of the most important steps people can take to stay healthy, according to the CDC.
As a health care vendor, McGraw has to take several steps to avoid bringing illness into the departments he visits. That means being up-to-date on all vaccines, including the yearly flu vaccine.
Bagel also encourages his patients to get immunized against the flu each year. "But those on biologics should not take the live vaccine," he says. "That means they can do the shot, but not the spray."
“Especially if you are at a higher risk, you should talk to your doctor,” McGraw says. “Kids can’t go to school without being up-to-date on vaccines. If we can avoid infection, that’s important.”
It can be a tricky balancing act for those with psoriatic disease when it comes to illnesses and proper treatment.
“With psoriatic arthritis, I’m taking a lot of immune modulators trying to get my immune system back to normal,” says McGraw. “With psoriasis, your immune system is just a little off. And when you have a flare, everything is heightened. It’s like an immune storm.”
So those using immunosuppressive drugs have extra factors to consider.
Bagel says if people with psoriatic disease get a cold, even without a fever, it might make sense to start an antibiotic to “keep an infection from brewing.” If you do have to use an antibiotic, you need to stop using biologics during treatment and even for a few days after the illness clears, he says. It is best to speak with your doctor for guidance.
Those who contract the flu often have to stop their biologics while recovering, so it’s important to communicate with doctors during illness to avoid complications. If you think you have the flu, contact your health care provider as soon as possible. He can prescribe one of the three anti-viral drugs the CDC recommends for treating the flu during the 2018 to 2019 season. Safe anti-viral options exist for babies as young as 3 months old and pregnant women.
Make Winter Health a Top Priority
The CDC has several suggestions for preventing illness, including not touching your eyes, mouth or nose while out and avoiding close contact with people who are ill.
Other tips for staying healthy this season include:
- Pump some iron. “I exercise as often as I can,” McGraw says. “If I’m keeping myself healthy, my body can more easily fight infection.” McGraw bikes and lifts weights, but almost any exercise will help contribute to overall health and a stronger immune system.
- Consider vitamins. In addition to a daily multivitamin and fish oil for his joints, McGraw’s doctor recommended he add supplemental vitamin D — an immunity booster — “which is one of those things that everyone seems to be a little low on,” he says. Bagel recommends a healthy diet above supplementation, but says those curious about adding vitamins should first check with their doctor.
- Eat well. Maintaining a healthy diet can be a challenge, especially around the holidays, but sticking to nutritious foods has a lot of benefits. McGraw, for example, says that inflammation is a big problem for those with psoriatic disease, so he tries to keep his diet as healthy as possible. For overall better health, Bagel advises that those with psoriasis and psoriatic arthritis eat well-balanced meals and not consume too many calories. He recommends eating less red meat and more fish. In addition, it’s important to avoid alcohol, he says. Alcohol can cause flares, and overconsumption can contribute to dry skin and can also tax the immune system.
- Manage stress and get good rest. “One of the best things you can do for your immune system is to keep stress levels low,” says McGraw. “I know that’s easier to say than do, but sleep is huge — it’s the number one thing in controlling stress.” Between the itching and painful joints, good sleep can be especially challenging for people living with psoriasis and psoriatic arthritis, McGraw says. But because getting good sleep has a noticeable effect on his stress levels and immunity, he works hard to make it a priority, and advises others with psoriatic disease to do the same. “Make sure the room is a comfortable temperature, that there isn’t excess light — basically, do whatever you can do to improve your sleep conditions,” he says.
Editor’s note: This story was originally published in 2017 and has since been updated.