What is responsible for this flare of psoriasis?

A 66-year-old woman’s psoriasis suddenly worsened after she underwent a biopsy of a tumor in her breast. The biopsy report revealed no evidence of breast cancer

What do you suspect?

A. An allergic reaction to one of the anesthetics.

B. An exaggerated allergic reaction to the preoperative povidone-iodine preparation.

C. A flare of psoriasis that is unrelated to the biopsy.

D. A flare caused by the psychological stress of the procedure.

(Answer on next page)

Answer: Psoriasis flare caused by stress

Psychological stress, D, is the primary trigger for psoriasis. This patient’s anxiety about the proce- dure and its potential outcome in- duced a major flare of her psoriasis. A short course of a selective sero- tonin reuptake inhibitor and aggres- sive topical corticosteroid therapy calmed the patient and the outbreak within a few weeks.