My skin felt sensitive to the touch.
When skin irritation and burning woke me at the break of dawn, I knew I was dealing with overexposure to narrowband ultraviolet light (NUVB) from my phototherapy treatment the evening before. A couple decades of experience with light treatments told me as much.
After a bad skin burn, I’d avoided NUVB for a few years, until my doctors convinced me to try it again. When they explained how we could start at a lower dose than normally prescribed, then increase in small increments, I reluctantly agreed.
For almost two years this cautious approach helped me dodge a phototherapy burn. I also felt incredibly fortunate to have calm skin during the first month of the coronavirus shelter-in-place orders. I did wonder, though, when my good fortune would come to an end. That night it came to a screeching halt.
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What Triggered the Flare?
My psoriasis tends to improve and worsen in a cyclical way. Sometimes I can point to the key triggers, such as stress and anxiety, alcohol consumption, low humidity, infections, insomnia, a medication losing effectiveness, and skin damage.
This time I wondered if the ultraviolet light treatment had damaged my skin. If I could go back in time to the moment when I programmed my home phototherapy unit, I would have entered half my normal dose or less.
To make matters worse, I was at the end of the dose cycle for my biologic, Skyrizi (risankizumab-rzaa), so it might have offered me less protection against a flare.
I also wondered about the new asthma inhaler I’d begun using the week of the flare to help with breathing difficulties related to seasonal allergies. One concern I have with any new medication is whether it might photosensitize my skin, a possibility I am very aware of since enduring a bad phototherapy burn about 15 years ago.
But photosensitivity didn’t appear to be an issue that others had experienced using the same inhaler, so I decided it probably wasn’t the culprit.
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A Timely Message From My Dermatologist
During lockdown I’ve postponed visiting my dermatologist in person to avoid possible exposure to the coronavirus; instead, I've been sending her messages via a secure patient portal. After my skin flared, I wrote a detailed account of what happened and attached photos of my skin with the new, red, irritated plaques.
Within hours she replied. She first affirmed that most probably the phototherapy damaged my skin, which led to my psoriasis outbreak. Then she thought I might need to take Skyrizi even earlier than previously scheduled. Third, she laid out a plan for me to use phototherapy at a reduced dosage.
In my message I asked her if I should take Skyrizi later that week — about a week earlier than scheduled. She replied that I could inject it as soon as that day, which I did.
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The Flare Takes a Toll on My Emotional Health
My dermatologist’s responsiveness helped me mentally prepare for the next phase of the flare and reduced the time I anxiously wondered what to do next. She also assured me that the flare was not as bad as others she had seen, reminding me that I’d made it through worst outbreaks.
Still, that didn’t stop the the irritation, itchiness, and discomfort I was experiencing from raging psoriasis and eczema. The next few weeks my mood matched my inflamed skin. The stress of the coronavirus lockdown and anxieties related to it already left me on edge. My skin just made everything in life feel more difficult.
The flare especially impacted my relationships and work. For example, during one project I was collaborating on with my wife, I snapped at her. That afternoon she didn’t feel like sheltering at home with me as much. I also struggled with focus as my productivity took a nosedive.
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My Skin Calms Down (Finally)
I started to see improvements about a month after the flare began, with my mood lifting as my skin improved. I found a new equilibrium with my treatments where I could gain better control of both my skin and asthma conditions at the same time.
Thankfully, my eczema eventually responded to the lowered dose of phototherapy and the new psoriasis lesions that showed up during the flare slowly receded about two weeks after the Skyrizi injection. My breathing difficulties eased to the point where I no longer needed my rescue inhaler frequently.
I could once again go back to my routine without the burden of the psoriasis flare, albeit the very unfamiliar routine of sheltering at home.
Psoriasis flares can show up at the least opportune times. If you’re going through a flare right now, know that you aren’t alone. With an open communication channel to your healthcare professionals, flexibility to adjust treatments, and a measure of patience, they can be overcome.
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