Do Vaccines Cause Psoriasis?

Even with all of the so-called vaccine-induced diseases that anti-vaccine folks come up with, few people likely think that vaccines cause psoriasis.

Some do though…

Do Vaccines Cause Psoriasis?

Bob Sears thinks that these kids shouldn’t be vaccinated because “vaccines can trigger psoriasis or make existing psoriasis worse.”

He even provided a list of studies that he thinks support his case.

“Nevertheless, the likely very low incidence of psoriasis following vaccination emphasizes the safe profile and the relevance of vaccination strategies in psoriasis patients, especially in candidates for immunosuppressive treatments.”

Sbidian et al on National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines.

Do they?

“The risk of psoriasis was also increased in subjects who reported a history of a recent infectious episode. The analysis by individual diagnosis pointed to acute pharyngitis as the disease with the strongest association and the only one providing statistically significant results…”

Naldi et al on Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study

Let’s see, although I’m not sure he actually read more than the abstracts or understands that guttate psoriasis isn’t the same as plaque psoriasis…

1. Possible Triggering Effect of Influenza Vaccination on Psoriasis – a small group of patients (36) either had an exacerbation of their psoriasis, or new onset of psoriasis (7), within a couple of weeks to months after getting a flu shot.
2. Psoriasis triggered by tetanus-diphtheria vaccination – a case report of a 50-year-old with chronic psoriasis for 6 years who developed an exacerbation a week after getting a tetanus booster.
3. Psoriatic skin lesions induced by BCG vaccination – a case report of a 6-month-old who developed a BCG-induced tuberculid-like eruption accompanied by psoriatic skin changes one month after vaccination. They went away without treatment within 3 months.
4. Guttate psoriasis-like lesions following BCG vaccination – a case report of a 7-year-old who developed guttate psoriasis-like lesions one week after his BCG vaccination. He was treated with steroid creams and the rash went away within three weeks.
5. New Onset Guttate Psoriasis Following Pandemic H1N1 Influenza Vaccination – a case report of a 26-year-old who developed guttate psoriasis after getting a flu shot. Her rash went away within three weeks.
6. National survey of psoriasis flares after 2009 monovalent H1N1/seasonal vaccines – a small group of patients (10) who either developed new onset psoriasis or had an exacerbation after getting a flu shot.
7. Psoriasis vaccinalis; report of two cases, one following B.C.G. vaccination and one following vaccination against influenza – from 1955, two case reports of psoriasis after BCG vaccine and the flu shot.
8. Family history of psoriasis, stressful life events, and recent infectious disease are risk factors for a first episode of acute guttate psoriasis: results of a case-control study – a case control study that “confirmed that recent pharyngeal infection is a risk factor for guttate psoriasis. It also documented the strong association between guttate psoriasis and a family history of psoriasis. Finally, the study added evidence to the belief that stressful life events may represent risk factors for the onset of psoriasis.” The study doesn’t mention vaccines, but does remind us that “it has been estimated that only one third of cases of guttate psoriasis progress to chronic plaque psoriasis, whereas a history of guttate psoriasis is not frequent in patients with psoriasis.”
9. Genetic background of psoriasis – doesn’t mention vaccines.

So, none of Bob’s studies were in children, they are mostly about flu shots and the BCG vaccine (which isn’t used in the United States), they are mostly case reports (low on the hierarchy of evidence), and a few don’t mention vaccines…

And most aren’t about chronic psoriasis!

Explaining the Correlation of Psoriasis After Vaccines

Is there anything that might explain the case reports that do show an association between vaccines and psoriasis flares?

“Psoriasis can appear in areas of the skin that have been injured or traumatized. This is called the Koebner [KEB-ner] phenomenon. Vaccinations, sunburns and scratches can all trigger a Koebner response. The Koebner phenomenon can be treated if it is caught early enough.”

National Psoriasis Association on Causes and Triggers

Experts also talk about Th1- and Th17-predominant immunologic responses of flu shots and the BCG vaccine’s Th17 activity. It is known that Th17 cells play a role in psoriasis.

Are there any other studies about vaccines and psoriasis that Dr. Bob left out?

1. Yellow fever vaccine used in a psoriatic arthritis patient treated with methotrexate: a case report – “A case of yellow fever vaccine used in a 27-year-old Slovenian male with psoriatic arthritis during treatment with methotrexate is described. We demonstrate a positive case, since there were no adverse effects in concurrent administration of yellow fever vaccine and methotrexate.”
2. Live attenuated varicella vaccine: A new effective adjuvant weapon in the battlefield against severe resistant psoriasis, a pilot randomized controlled trial – a study of 35 patients which found that the “use of chickenpox vaccine with low-dose cyclosporine seems to have value for the treatment of resistant psoriasis.”
3. [Psoriasis is no obstacle to smallpox vaccination] – (I haven’t found the full article yet, but the title is intriguing, since eczema is a contraindication to getting the smallpox vaccine…)
4. Factors associated with 2009 monovalent H1N1 vaccine coverage: a cross sectional study of 1,308 patients with psoriasis in France – mentions that more than twice as many people with psoriasis in France got a flu shot than the general population.
5. Immune response to pneumococcus and tetanus toxoid in patients with moderate-to-severe psoriasis following long-term ustekinumab use – vaccines work when you have psoriasis!
6. From the Medical Board of the National Psoriasis Foundation: monitoring and vaccinations in patients treated with biologics for psoriasis – addresses vaccination practices for folks with psoriasis.
7. Challenges in the treatment of psoriasis with biologics: vaccination, history of malignancy, human immunodeficiency virus (HIV) infection, and pediatric psoriasis – actually talks about how UNDERVACCINATION is a challenge in treating kids with psoriasis, as you might have to interrupt therapy to get them caught up!
8. Vaccinations in patients with immune-mediated inflammatory diseases – is very clear that the “Clinical evidence indicates that immunization of IMID patients does not increase clinical or laboratory parameters of disease activity. Live vaccines are contraindicated in immunocompromized individuals, but non-live vaccines can safely be given.”

The bottom line is that experts that treat people with psoriasis recommend that they be fully vaccinated.

“Psoriasis is a treatable, chronic dermatosis. The very low absolute risk of new-onset or relapsed psoriasis following influenza vaccination should not change its universal recommendation, particularly for patients with psoriasis on immunosuppressive therapy. We present this case to highlight clinical manifestations of this rare association.”

Shi et al on Widespread psoriasis flare following influenza vaccination

There is even talk of development of a vaccine to treat psoriasis!

It should be clear that neither psoriasis nor a family history of psoriasis should be a reason to get a medical exemption for vaccines.

More on Vaccines and Psoriasis

• Bob Sears Doubles Down Against California Vaccine Laws
• Why Should Medical Exemptions Be Based on CDC Contraindications
• Autoimmunity as a Contraindication to Getting Vaccinated
• Is a Family History of Altered Immunocompetence a Contraindication to Getting Vaccinated
• Precautions vs Contraindications When Vaccinating Your Kids
  Contraindications to Vaccination
• CDC – Contraindications and Precautions
• National Psoriasis Association – Causes and Triggers
• National Psoriasis Association – Flu season threat greater for people with psoriasis and psoriatic arthritis on immunosuppressive drugs
• National Psoriasis Association – Report: Vaccinating While On Biologics Requires Special Care
• Study – Widespread psoriasis flare following influenza vaccination
• A possible role for vaccination in the treatment of psoriasis?
• Psoriasis–a possible candidate for vaccination
• Psoriasis and infection. A clinical practice narrative
• Influenza vaccination rate among patients with moderate to severe psoriasis
• CDC – What is psoriasis?
• Dr. Bob’ Sears Accused Of Issuing Invalid Vaccine Medical Exemptions–Again