Unraveling Psoriasis Flare-up and Dengue Infection.

Abstract

Importance: Dengue infection is an emerging global health concern. Understanding its impact on patients with a history of psoriasis is essential, particularly concerning its potential to trigger psoriasis flare-ups. Additionally, it is crucial to assess the influence of psoriasis treatments on the severity of dengue.

Objectives: This study aims to describe the effects of dengue infection on psoriasis exacerbations, in patients with pre-existing psoriasis and to assess whether prior psoriasis treatment influences dengue severity.

Design: A cross-sectional descriptive study.

Main outcomes and measures: Demographic, clinical, and treatment data were systematically collected.

Results: 25 dermatologists reported psoriasis flare-ups in 52 patients (67.3% male; median age 48 years, IQR 23-81). Among these patients, 63.5% (33 patients) experienced plaque psoriasis flare-ups, 19.2% (10 patients) developed guttate psoriasis, 11.5% (6 patients) progressed to erythroderma, 3.8% (2 patients) presented with plaque psoriasis and pustules, and one patient (1.9%) had an acute generalized pustular psoriasis flare-up. Overall, 63.5% of patients experienced moderate dengue, 30.8% had mild dengue, and 5.8% had severe dengue. Among the 19 patients receiving biologic treatments, 84.2% experienced moderate dengue, while 15.8% had mild dengue. Importantly, none of these patients required hospitalization for severe dengue. In the methotrexate-treated group, comprising seven patients, four experienced mild dengue and three had moderate dengue. Psoriasis flare-ups in this group included two severe cases, five moderate cases, one erythroderma, and six cases of plaque psoriasis.

Conclusions and relevance: Dengue infection appears to trigger psoriasis flare-ups in affected individuals. The most commonly observed type was plaque psoriasis. Our findings suggest systemic therapies for psoriasis may not exacerbate dengue severity and could be considered safe. Further prospective studies are necessary to elucidate the relationship between psoriasis severity and dengue outcomes.