What You Should Know About Vaccines with Psoriasis

Getting vaccines with psoriasis is important because some medications you may be taking for the condition can increase your risk for certain diseases that vaccinations help prevent.

There can, however, be side effects of immunizations. Knowing the whole story will help you make the right choices.

“Vaccines made from dead viruses are not usually a problem for people with psoriasis. Two live viral vaccines should be used with caution in psoriasis -- these are the shingles virus and the live flu virus. Fortunately, you can take the killed version of the flu virus,” explained Julie Anne Moore, MD, a dermatologist at Loyola University Gottlieb Memorial Hospital in Melrose Park, Ill.

The second thing you should know is that getting vaccines with psoriasis could cause psoriasis symptoms to flare, no matter what type of vaccine it is.

That’s because just putting a needle through your skin can cause a type of psoriasis reaction called a Koebner response, named after the German dermatologist who first described it in the 1800s.

Psoriasis and Complications From Live Vaccines

Despite lots of research, there is no evidence that any vaccine makes psoriasis worse. The reason you want to avoid live vaccines though is that they may be too strong for your body’s defense system, or your immune system, to handle.

This is especially true if you are taking medications that blunt your immune system like steroids or biologics. If your immune system is suppressed, you may actually get symptoms of the disease you are trying to prevent.

To prevent psoriasis vaccine complications while on treatment, your doctor may give you a series of vaccinations before you start a biological drug. This could include vaccinations for diseases like the flu, pneumonia, and hepatitis.

“The most common live virus vaccine is the one for the childhood diseases mumps, measles, and rubella, called MMR. Fortunately, most people with psoriasis are adults so they don’t have to worry,” said Dr. Moore.

The study reviewed vaccination safety in 551 people with autoimmune diseases, including psoriasis, who received the shingles vaccine. About 6 percent of these patients were also taking a biologic drug, and they had no more complications than any of the other patients.

Skin Reactions and Psoriasis: Tips to Avoid the Koebner Response

Any type of skin trauma can lead to formation of a psoriasis plaque, or Koebner reaction, in the area of the trauma. “The Koebner response may occur in anyone with psoriasis. It may sometimes cause the first symptoms of psoriasis or other skin diseases, like lichen planus. Cuts, scratches, tattoos, and vaccinations are common triggers for this response,” said Moore.

Other causes may include sunburn, poison ivy, or even a bug bite. These minor traumas can cause a psoriasis plaque to form at the site of trauma within one to two weeks of the injury. About 50 percent of people with psoriasis experience the Koebner response.

Psoriasis and Smallpox Vaccine Cautions

You may have heard concerns about psoriasis flares and smallpox vaccine. According to the National Psoriasis Foundation, smallpox vaccine is not recommended because smallpox -- not psoriasis -- can be passed from person to person through an open wound, which could occur if you have active psoriasis.

The Centers for Disease Control and Prevention (CDC) states that people with psoriasis should not get this vaccine unless they have been exposed to smallpox. Fortunately, your chances of being exposed are very small because smallpox has been eradicated all around the world by the vaccine. It no longer exists as a naturally occurring disease.

The vaccine may still be used for some people who are at risk for being exposed to smallpox as a weapon of bioterrorism. In 2002, the U.S. Department of Defense started a smallpox vaccination program for some selected military personnel and government workers who might be exposed to that threat.

Bottom Line: Staying Healthy With Psoriasis

A 2010 review of vaccinations in people with diseases caused by the immune system, including psoriasis, found that people with these diseases are often not getting all the vaccinations they need. The review noted that people with diseases like psoriasis may be at increased risk for diseases prevented by vaccinations.

“In most cases, vaccinations can be given safely to people with psoriasis and the benefits outweigh the risks,” said Moore.

A Koebner reaction is best avoided by avoiding any skin trauma, including vaccination, while you have an active psoriasis flare. You should be able to receive killed virus immunizations as long as you are not in the middle of a flare. Live vaccines need to be used with more caution, so talk to your doctor about them. In most cases, vaccines and psoriasis can go together safely.

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