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Does a Bad Flare Mean You’ll Always Flare That Bad?
from Nancy M.

Back in June/July, I wrote that I was about 99% clear [Still Faring Well on Enbrel]. I've been on Enbrel since January, 2004, and I continued to be clear up until December. I had strep throat, and although I went on a round of antibiotics, I really didn't feel much better.   Fast forward about 6 weeks:  Our entire family was diagnosed with strep again!  Turns out the 18 month-old had perianal strep, which I'd thought was just a long lasting nasty diaper rash. Turns out she was infecting us over and over!  So, as you'd expect, my guttate psoriasis is just plain out of control. This all happened to coincide with a health insurance change, and about  one month off Enbrel.

So, I'm back at square one. Only difference is my scalp hasn't yet started to flake. I'll be thankful for small things, I guess.

My question is this, do you happen to know of people who have a post strep flare, and then actually improve?  It seems like I'm not seeing results.  I do recall that it took a long long long time to show results with Enbrel.

Anyway, I'm looking into a tonsillectomy. Seems I get strep at least 3 times every year, and from everything I read, I think it has played a major role in my ongoing battle with P.

Thank you, -Nancy M.

*****

Ed’s Response:  Good to hear from you, Nancy, though I'm sorry to learn about the relapse.  I'm glad you finally discovered your baby's perianal strep.  Had it not been diagnosed, I wonder how long the vicious cycle could have continued? 

To your question:  Do people who have post-strep flares actually improve?  Your question isn't easily answered (and I imagine you know that!).  "The line" is that psoriasis waxes and wanes — even if you don't do anything with it or to it.  (The exception to this may be psoriatic arthritis, which I understand can be continuously degenerative.)  The implication in your question that I can't answer is this:  If strep — or anything, for that matter — made your psoriasis MUCH worse than it ever had been before, will it ever go back to being what it was before?  Forget about waxing and waning for a minute.  What that question means is, when you flare in the future, is it likely to always be as bad as it got after the strep?  Or was the post-strep flare an exception?

I thought back over my own P history.  It started ... it started waxing and waning based on seasons, meds, etc. ... it would get worse ... it would continue to wax and wane but, when it waxed, it got as bad as it had been at its worst — or worse.  Did its waxing times ever get better than they were at their worst?  No.  Not really.

On the other hand, I've found better meds; I've changed this or that about my lifestyle — in short, perhaps I've made the "wane" times last longer than the "wax" times.  And I'm usually able to catch a flare early on and apply tricks to thwart it.

This is my answer for now.  It will be interesting to see what others think about this.  Good question, Nancy!  -Ed

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