Background: Psoriasis is a common chronic immune-mediated disease resulting from interactions of a genetic background with environmental triggering factors such as stress and infection. So far, there is very limited information available about the impact of vaccine stimuli on psoriasis course. Objective: To collect cases of psoriasis flares occurring after vaccination through a national survey. Methods: We investigated cases of onset or flare of psoriasis occurring within 3 months following the 2009 monovalent H1N1/seasonal vaccination during the campaign of the 2009-2010 flu seasons in France. Results: Ten patients, 6 men and 4 women with a median age of 44 years (range 9-88), were reported with a psoriasis of new onset (n = 7) or with a worsening of previously diagnosed psoriasis (n = 3) within a median time period of 8 days following vaccination. Nine of them presented with a mixed guttate/plaque clinical phenotype, and 1 showed 2 successive generalized pustular psoriasis (GPP) flares after 2 different vaccine injections. Conclusion: The short time interval between vaccination and onset of psoriasis flares, the lack of other triggers and the flaring sequence following 2 different vaccines in a GPP patient suggest a possible association between the 2009 monovalent H1N1/seasonal vaccination and psoriasis flaring in the collected cases. 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.

Keywords:
Psoriasis, Monovalent H1N1 vaccines, Flares, Survey
1.
Griffiths CE, Barker JN: Pathogenesis and clinical features of psoriasis. Lancet 2007;370:263-271.
2.
Nestle FO, Kaplan DH, Barker J: Psoriasis. N Engl J Med 2009;361:496-509.
3.
Owen CM, Chalmers RJ, O'Sullivan T, Grif-fiths CE: Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev 2000;2:CD001976.
4.
Lande R, Gregorio J, Facchinetti V, Chatterjee B, Wang YH, et al: Plasmacytoid dendritic cells sense self-DNA coupled with antimicrobial peptide. Nature 2007;449:564-569.
5.
Geeraedts F, Goutagny N, Hornung V, Severa M, de Haan A, et al: Superior immunogenicity of inactivated whole virus H5N1 influen- za vaccine is primarily controlled by Toll- like receptor signalling. PLoS Pathog 2008;4:e1000138.
6.
Pattison E, Harrison BJ, Griffiths CE, Silman AJ, Bruce IN: Environmental risk factors for the development of psoriatic arthritis: results from a case-control study. Ann Rheum Dis 2008;67:672-676.
7.
Sbidian E, Tubach F, Pasquet B, Paul C, Jullien D, et al: Factors associated with 2009 monovalent H1N1 vaccine coverage: a cross-sectional study of 1,308 patients with psoriasis in France. Vaccine 2012;30:5703-5707.
8.
Marrakchi S GP, Renshaw BR, Puel A, Pei XY, Fraitag S, Zribi J, Bal E, Cluzeau C, Chrabieh M, Towne JE, Douangpanya J, Pons C, Mansour S, Serre V, Makni H, Mahfoudh N, Fakhfakh F, Bodemer C, Feingold J, Hadj-Rabia S, Favre M, Genin E, Sahbatou M, Munnich A, Casanova JL, Sims JE, Turki H, Bachelez H, Smahi A: Interleukin-36-receptor antagonist deficiency and generalized pustular psoriasis. N Engl J Med 2011;365:620-628.
9.
Bone A, Guthmann JP, Nicolau J, Levy-Bruhl D: Population and risk group uptake of H1N1 influenza vaccine in mainland France 2009-2010: results of a national vaccination campaign. Vaccine 2010;28:8157-8161.
10.
Telfer NR, Chalmers RJ, Whale K, Colman G: The role of streptococcal infection in the initiation of guttate psoriasis. Arch Dermatol 1992;128:39-42.
11.
Lewis HM, Baker BS, Bokth S, Powles AV, Garioch JJ, et al: Restricted T-cell receptor V beta gene usage in the skin of patients with guttate and chronic plaque psoriasis. Br J Dermatol 1993;129:514-520.
12.
Wilson AG, Clark I, Heard SR, Munro DD, Kirby JD: Immunoblotting of streptococcal antigens in guttate psoriasis. Br J Dermatol 1993;128:151-158.
13.
Leung DY, Travers JB, Giorno R, Norris DA, Skinner R, et al: Evidence for a streptococcal superantigen-driven process in acute guttate psoriasis. J Clin Invest 1995;96:2106-2112.
14.
Horiuchi N, Aiba S, Ozawa H, Sugawara S, Rikiishi H, et al: Peripheral blood lymphocytes from psoriatic patients are hyporesponsive to beta-streptococcal superantigens. Br J Dermatol 1998;138:229-235.
15.
Naldi L, Peli L, Parazzini F, Carrel CF: 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. J Am Acad Dermatol 2001;44:433-438.
16.
Diluvio L, Vollmer S, Besgen P, Ellwart JW, Chimenti S, et al: Identical TCR beta-chain rearrangements in streptococcal angina and skin lesions of patients with psoriasis vulgaris. J Immunol 2006;176:7104-7111.
17.
Gudjonsson JE, Karason A, Antonsdottir A, Runarsdottir EH, Hauksson VB, et al: Psoriasis patients who are homozygous for the HLA-Cw*0602 allele have a 2.5-fold increased risk of developing psoriasis compared with Cw6 heterozygotes. Br J Dermatol 2003;148:233-235.
18.
Besgen P, Trommler P, Vollmer S, Prinz JC: Ezrin, maspin, peroxiredoxin 2, and heat shock protein 27: potential targets of a streptococcal-induced autoimmune response in psoriasis. J Immunol 2010;184:5392-5402.
19.
Fry L, Baker BS: Triggering psoriasis: the role of infections and medications. Clin Dermatol 2007;25:606-615.
20.
Lowes MA, Bowcock AM, Krueger JG: Pathogenesis and therapy of psoriasis. Nature 2007;445:866-873.
21.
Farkas A, Tonel G, Nestle FO: Interferon- alpha and viral triggers promote functional maturation of human monocyte-derived dendritic cells. Br J Dermatol 2008;158:921-929.
22.
Silva CA, Aikawa NE, Bonfa E: Vaccinations in juvenile chronic inflammatory diseases: an update. Nat Rev Rheumatol 2013;9:532-543.
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2014
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