Fondazione Corazza Psoriasi&Co.

Inflammation: what it is, how it works, and which food to eat

Inflammation (or phlogosis) is an innate and non-specific defence mechanism. It is a protective response by the body, one which aims to eliminate the initial cause of the cellular damage and begin the process of tissue repair. Inflammation is a prevalently local reaction, and the response to the damage is given by the cells which have survived its action. Damage can be caused by:

  • physical agents (injury, heat, radiation)
  • chemical agents (strong acids and bases)
  • biological agents (bacteria, viruses and parasites)
  • necrosis
  • hypoxia
infiammazione alla mano

Inflammation is classified depending on its timeframe into acute and chronic inflammation. Chronic inflammation may be a result of acute inflammation or be chronic in nature from the outset; it can be diffuse (chronic interstitial inflammation) or localised (chronic granulomatous inflammation).

The inflammatory response includes a vascular component (angiophlogosis) and a tissue component (histophlogosis), which combine in various proportions depending on whether the process is acute or chronic.

The main stages of acute inflammation occur in the following order:

  • vasodilation: causes an increase in blood flow with consequent hyperaemia
  • increased vascular permeability of the microcirculation, with consequent exit of the liquid component of the blood
  • formation of exudate: extravascular fluid rich in plasma proteins
  • diapedesis: migration of white blood cells (leukocytes) from the microcirculation to the extracellular compartment
  • Chemiotaxis: accumulation of leukocytes at the injury site following the release of chemical mediators (cytokines)
  • phagocytosis: ingestion and destruction of pathogenic microorganisms and cellular detritus by certain leukocytes (granulocytes, neutrophils and macrophages), followed by the resolution or chronicisation of the inflammatory process

Chronic inflammation differs from acute inflammation in the following ways:

  • a greater duration (possibly for years)
  • prevalence of macrophages, lymphocytes and fibroblasts (as opposed to granulocytes and neutrophils in acute phlogosis)
  • proliferation of blood vessels (neoangiogenesis) and fibrosis (vascularisation tissue)

The main symptoms of phlogosis are clinical manifestations of tissue changes, and occur in the following order:

  • calor (increase in local temperature due to increased vascularisation)
  • tumor (swelling caused by the formation of exudate)
  • rubor (reddening due to active hyperaemia)
  • dolor (pain caused by the compression and intense stimulation of the nerve endings by the inflammatory agent and the components of the exudate)
  • functio laesa (functional compromise of the affected area).

The sensation of pain is in turn regulated by the central nervous system centres. The perception of the pain associated with the injury is subjective and influenced by the external environment. The differing perceptions of pain may also be due to a release of endorphins (known as endogenous opioid analgesics) that differs from one person to the next.

The main cells involved in the inflammatory process are:

  • granulocytes (basophilsneutrophils and eosinophils)
  • monocytes (circulating) and macrophages (in the tissues)
  • mast cells
  • lymphocytes (T, B and NK)
  • endothelial cells
  • platelets and fibroblasts

The chemical mediators of phlogosis take the form of numerous molecules which trigger, maintain and in some cases limit the modifications to the microcirculation described previously. Some of these are contained in cellular organelles from which they are released following inflammatory stimuli (preformed mediators). Others are synthesised and secreted in response to phlogistic stimuli (newly synthesised mediators), while others still are formed in the blood starting from inactive precursors. The sensory nervous system in turn contributes to certain inflammatory manifestations through neuropeptides (such as substance P and neurokinins).

The main chemical mediators are:

  • cytokines (interleukins, chemokines, lymphokines)
  • leukotrienes
  • neurotransmitters (serotonin, histamine)
  • coagulation factors
  • platelet activation factor (PAF)
  • lysosomal enzymes
  • reactive oxygen species (ROS) and nitric oxide (NO)

Acute phase response: if the inflammation is particularly intense or involves a very large area of tissue, there may be a systemic response affecting the entire body.

  • fever and shivering
  • leukocytosis (increase in number of white blood cells)
  • fatigue and general malaise
  • tachycardia (increase in heart rate above 90 bpm)
  • lack of appetite and cachexia (weight loss, wasting)
  • increase in acute phase proteins

There are three possible outcomes of the inflammatory process:

  1. Necrosis, caused by the destruction of cells by the lysosomal enzymes which not only damage the microorganisms but also the tissues, leading to tissue death.
  2. Chronicisation, which sets in when the inflammatory reaction has not completely eliminated the underlying cause of the inflammatory process.
  3. Healing: the liquid part of the exudate is reabsorbed, while the leukocytes undergo programmed cell death after having phagocytised and destroyed the pathogenic agents.

Often found in clinical practice are cases of silent inflammation, a chronic, low grade inflammation generally not accompanied by symptoms in the affected organs. Its presence is sometimes revealed by changes in certain blood chemistry parameters, such as modest increases in PCR (C-reactive protein), ESR (erythrosedimentation rate), fibrinogen, uric acid, and ferritin.

A key factor in the genesis and perpetuation of the inflammatory state is NF-kB (nuclear factor-kB), comparable to a sort of “switch” that must be kept in the “off” position. If it is activated for some reason, the conditions are created for the onset of numerous diseases such as:

  • obesity
  • cardiovascular diseases
  • diabetes
  • metabolic syndrome
  • gout

Food can also be a source of inflammation. A diet rich in cooked foods, chemically treated, high in refined sugars and saturated fats leads to an alteration of the gut microbiota and a worsening of the inflammatory state.

medico con della frutta e della verdura in mano

A diet high in antioxidants (omega-3, zinc, selenium, vitamins B12, C, D, E, coenzyme Q) mainly found in fresh fruit and vegetables, low in saturated fat and with a low glycaemic index plays a vital role in reducing systemic inflammation. The beneficial effect of this diet acts in synergy with that of anti-inflammatory drugs, regular physical activity, and a reduction in smoking and alcohol consumption.

Article by Dr. Giovanni Cappella

Psoriasis: improve your skin with thermal water

While those suffering from psoriasis require personalised and long-term medical care, sometimes these patients also need self-care treatments to help them “switch off” from the hectic pace of daily life.

In this perspective, conventional medical care and relaxation should not be considered two separate concepts, but two different sides of the same coin: conventional medical care can be accompanied by crenotherapy (thermal water treatment) to increase its efficacy.

Crenotherapy plays a key role in the treatment of psoriasis, because it meets a variety of patient needs, clinical and non-clinical, and physicians themselves can direct sufferers to the most suitable treatment centre, depending on the specific needs of their skin.

Italy has many thermal centres renowned for their water, and thanks to the partnership of selected facilities with the Foundation, patients can count on our support at all times, even when on holiday!

Thermal waters vary in their characteristics:

  • Sulfate waters: recommended mainly for liver, digestive and gastrointestinal disorders, these waters can be drunk, or applied as mud packs.
  • Sulphur waters: particularly widespread in Italy, they are used to treat many skin and respiratory disorders, via inhalation or applied as mud packs.
  • Sodium – chloride waters: these waters contain chloride and sodium which help to improve bone and joint health, as well as helping to combat rheumatic and vascular ailments.
  • Radioactive waters: these waters are rich in elements from rocks and minerals.
  • Salt-bromide-iodine waters: these waters are characterised by their salt, iodine, bromide and sodium chloride content. Recommended for skin and gynaecological problems.
  • Bicarbonate waters: these waters aid digestion, and are often found on as drinking waters on our dinner tables.
  • Sea water – thalassotherapy: recommended for the treatment of skin imperfections, particularly cellulite, and to keep the airways clear.

For details of the thermal centres in Emilia Romagna and elsewhere offering discounts for the supporters of the Natalino Corazza Foundation, click here.

Fondazione Corazza Psoriasi&Co.

Food poisoning: what it is and how to avoid it

The WHO has declared that over 600 million people each year fall ill due to bacteria or viruses.

Is it true that food can transmit illnesses?

Yes. Food and water can contain bacteria, pathogenic microorganisms which contaminate foods if added accidentally or deliberately, and which can cause disease if they succeed in breaking through the body’s defences, especially in children and the elderly, or individuals with immune system compromise due to stress or illness.

How does contamination occur?

Bacteria may be present in foods at source, such as in meat from infected animals, or in vegetables grown in contaminated terrain or irrigated with contaminated water. Alternatively, foods can become contaminated during the various stages of processing, due to handling with dirty hands, contact with aerial secretions, using water not fit for drinking, or due to contact with contaminated foods.

How does food cause infection (food poisoning)?

These microorganisms become harmful through ingestion of food contaminated by the infectious agents (for example salmonella), or due to poisoning from toxins produced by the food itself (as in the case of botulism).

There are more than 250 types of food poisoning known throughout the world, with different symptoms and caused by different pathogens, mainly bacteria, viruses and parasites. New pathogens (the “emerging pathogens”, such as campylobacter jejuni, Escherichia coli 157:H7, Listeria monocytogenes, Yersinia enterocolitica, etc.) are being identified all the time, some of which are also spread by the increase in trade; the increased use of canteens, restaurants and eating out; travel, and large-scale industrial farming operations.

What are the most frequent illnesses, and what are their symptoms?

  • Botulism

An extremely serious type of food poisoning which occurs between 12 and 36 hours after eating contaminated food

Symptoms include dry mouth, muscle weakness, blurred vision, and difficulty swallowing.

Nausea or diarrhoea may also be present, but not always.

The foods responsible are fruit and vegetables prepared at home, sausages, more rarely tinned food.

  • Salmonellosis

Onset occurs 6 – 72 hours after eating contaminated food, with nausea, vomiting, diarrhoea, and fever.

The foods responsible are milk, eggs, meat and derivatives, and poultry.

  • Staphylococcus aureus

Symptoms are the same as those of salmonellosis, but occur between 30 minutes and 7 hours after consuming contaminated foods.

The foods responsible are milk, cream, unpasteurised cheeses, raw eggs (ice-cream, sauces) and undercooked meat.

  • Clostridium perfigens poisoning

Onset occurs 6 – 24 hours after eating contaminated food, with abdominal cramps and diarrhoea.

The foods responsible are meat, poultry, and fish prepared and then left at room temperature for a long time (improperly stored).

  • Bacillus cereus poisoning (poorly virulent)

Widespread in the environment, especially in soil.

This type of food poisoning causes abdominal cramps, 10-15 hours after eating contaminated food.

Foods containing rice, starchy foods, and foods stored at room temperature for a long time after cooking are the main culprits.

With the exception of botulism, the symptoms of food poisoning are the same as those of common ailments affecting the stomach and intestines.

Do not treat your symptoms by yourself – consult your doctor who will be able to prescribe the correct medicine when necessary.

How can food poisoning be prevented?


  1. Buy quality foods from trusted suppliers whenever possible.
  2. Check that the facilities are clean, the packaging is not damaged, check the expiry dates and ingredients.
  3. Avoid buying meat and fish from unrefrigerated displays. Check that frozen food packages are not wet or covered with frost or ice: this means that the cold chain has been broken (that the food has been allowed to thaw during transport or storage).
  4. Milk should be pasteurised, and fresh cheeses should be displayed in a refrigerator.


  1. If the product is not used immediately, it is best stored in the fridge for 3 to 5 days at 4°C.
  2. Wrap foods separately in aluminium foil or freezer bags to prevent them from coming into contact with each other.
  3. Fish should be stored in the coldest part of the fridge.
  4. Clean fridges regularly.
  5. Eggs should be washed. Do not use if the shell is broken.
  6. Food not intended to be eaten within a few days should be frozen for up to 6 months.


  1. Frozen meat or fish should be thawed in the fridge or the microwave. Avoid thawing foods at room temperature.
  2. Chicken should be well cooked, and pieces of shellfish that do not open should be thrown away. Sauces containing raw eggs should be put in the refrigerator immediately in sealed containers, and used as soon as possible.
  3. Do not prepare meat, fish and vegetables on the same work surface.
  4. Utensils should be thoroughly washed with soap and hot water.

The introduction of foods such as sushi and sashimi into the Western diet, along with the many new restaurants that offer this type of cuisine, means that the consumption of raw fish has increased greatly. Although there is little difference between raw and cooked foods in nutritional terms, from a hygiene standpoint the likelihood of ingesting bacteria or pathogens is much lower when food is well-cooked. Observing hygiene standards is necessary for all foods, but greater caution is required when preparing seafood.

Fish can be hazardous when eaten raw, because its intestines contain an extremely dangerous intestinal parasite known as anisakis.

However, this parasite is killed when the fish is immediately gutted and blast chilled, meaning that we can safely enjoy a dish of marinated anchovies, tuna carpaccio, or sea bass tartare.

Bivalve molluscs such as oysters have no intestine and therefore do not contain anisakis. Crustaceans too should only be eaten if they have been blast chilled.

But what is “blast chilling”?

Blast chillers are devices similar to a freezer, which rapidly chill foods to temperatures of between -20 and -40°C. Fish must be kept at these temperatures for a period ranging from a few hours to several days, depending on the blast chiller used and the temperatures involved. This is the only way to destroy the larvae. 

The greatest risks come from restaurants which do not observe the 2004 European regulation which obliges the use of blast chilling for all businesses which sell or serve raw fish.

Fondazione Corazza Psoriasi&Co.

Mineral water: the 5 most frequently asked questions

Water makes up 45% to 99% of the mass of every being on Earth. In humans, the percentage varies from 75-80% in newborns, falling to 40-50% in the elderly; indeed, the first sign of ageing is the gradual loss of water from the tissues.

1.  Is it true that water should not be drunk at mealtimes?

No. On the contrary – drinking sufficient water  (600-700 mg/l of fixed residue) helps to improve digestion. However, at mealtimes it should be drunk in moderation, because it dilutes our gastric juices and our saliva, reducing the ability of the latter to kick start the digestive process, and making certain foods – especially certain proteins – more difficult to digest.

2. Will drinking water make me gain weight?

No. Both still and sparkling water contain zero calories. “Any short-term variation in body weight due to a greater loss or retention of fluid is momentary and misleading” (guidelines issued by the Italian National Research Institute for Food and Nutrition). An excess of carbonated water can lead to bloating.

3. Will drinking water make me lose weight?

Unfortunately not. It doesn’t “wash away” fats and sugars. However, it appears that drinking water on an empty stomach and before meals causes people to consume fewer calories. It is not clear whether this is due to a full stomach reducing the feeling of hunger or some other reason, but the mineral content of certain types of water would appear to cause a feeling of fullness, especially if carbonated.

4. Is it true that drinking a lot of water causes fluid retention?

No. Fluid retention is caused by electrolytes and other substances contained in the foods we eat, and in particular by the functioning of certain internal organs.

5. Is it true that sparkling water is harmful?

Neither carbonated water or water with a natural gas content are harmful, however it depends on the quantity drunk at any one time.

A few suggestions for choosing a mineral water

Opt for:

  • waters rich in calcium (more than 100mg/l), magnesium (more than 20mg/l) and sulphates (more than 15mg/l)
  • waters with a medium mineral content (500-1500 of fixed residue)
  • waters low in lithium and manganese
  • water in glass bottles


  • water at temperatures lower than 14°
  • jugs and bottles left open in the fridge
  • waters with a high CO2 content

Remember to drink 8 -10 glasses of water a day (1.5 – 2 litres) and drink even when you don’t feel thirsty.

How to read the label

The main information that should be included on the label:

  • name
  • place of origin
  • storage instructions
  • batch number and conductivity
  • content
  • bar code
  •  classification based on fixed residue, into one of four types:
    • minimally mineralised water
    • water with a trace mineral content
    • water with a medium mineral content
    • water rich in mineral salts
  • microbiologically pure, certifying the absence of hazardous germs and pollution indicators
  • chemical analysis which must show the constituent elements, expressed in mg per litre
  • properties beneficial for health, qualities such as “stimulates digestion”, “may have laxative or diuretic effects”, “may facilitate the excretion of uric acid”, and so on. The law does not permit companies to make claims such as “properties which prevent or cure a disease”.

It is important to note the quantities of HCO3 and O2 given on the label.

Mineral WaterCalciumMagnesium
Courmayeur515 mg67 mg
Sangemini303 mg18 mg
Lindos Bognanco108 mg356 mg
Santa Lucia105 mg66 mg
Ferrarelle390 mg25 mg
Uliveto173 mg25 mg
Boario122 mg40 mg
Cerelia23 mg12 mg
Kaiserwasser182 mg40 mg
Levissima19 mg 2 mg

Is there one mineral water that is better than the others?

No, however we can choose the one that best meets our individual needs, or the one we prefer in terms of flavour.

Water is an integral part of our diet, not only because it is essential for keeping our bodies functioning properly, but it can also act as a source of nutrition, providing various minerals.

For more information (italian):

Fondazione Corazza Psoriasi&Co.

Psoriatic arthritis: 6 ways to protect your joints

Psoriatic arthritis can be extremely invalidating and have a significant impact on everyday life, and those suffering from the disease are often unsure about what they can and cannot do, and how to find some relief for their condition. Here are 6 ways to protect your joints.

Psoriatic arthritis affects around 100,000 people in Italy, with an onset generally between 30 and 50 years of age. The disease can affect up to six different areas of the body, starting with peripheral joints such as the knees, wrists, ankles and shoulders, causing swelling, pain and stiffness. Although many effective drug treatments are now available, there is still no cure, and the disease can severely compromise the quality of life of its sufferers. To answer the most frequent doubts and questions of those suffering from psoriatic arthritis, the Natalino Corazza Foundation president Valeria Corazza has created a booklet explaining to patients how to protect their joints as they go about their daily lives. Here are the 6 most important rules.

1. Know your body

It is important to identify the times each day and the activities that trigger your pain or make it worse. Based on these observations, you can then find alternative ways to carry out your tasks.

2. Spread loads over the strongest joints

The larger the joint, the stronger it is, meaning the larger joints can support more weight than the smaller ones. Overloading the small joints can strain the joint structures and cause pain: this is especially true of the small hand joints, so if you have to wipe the table with a sponge, for example, use the palm of your open hand instead of just your fingers.

3. Try to avoid remaining immobile for too long in the same position

Staying in the same position for a long time is not ideal, because it tends to make the joints stiff. Prolonged immobilisation of a joint for days or weeks can also greatly weaken the muscle that moves it. If you notice your knees becoming stiff at the theatre or the cinema when you have been sitting for a while, try sitting on the aisle so you have space to stretch your legs out every so often.

4. Lighten the load on your joints

People who suffer from arthritis tend to limit their movement due to pain, which often leads to overweight and obesity, which then overloads the muscles and the joints, especially those in the lower part of the body (pelvis, knees and ankles). Losing weight helps to reduce pain, making you feel better and more energetic.

5. Maintain the correct posture

Keeping a posture that is too relaxed or too stiff, or remaining seated or standing for long periods in the same position can lead to back pain. Good posture is an effective strategy to prevent pain caused by arthritis: it might be hard work at the beginning, but over time it will become more natural and require a lot less effort.

6. Get moving!

Physical exercise plays an important role in controlling your weight and preventing cardiovascular disease. An exercise programme designed especially for you helps to reduce pain and improve joint function. Not all types of sport are suitable, but walking, swimming and cycling are generally safe activities you can do without any problems, although if you have arthritis, there are things you should do to exercise safely, such as warming up for longer beforehand. Consult a physiotherapist or occupational therapist for a tailor-made aerobic exercise programme that is both effective and suitable for you.

Vitamin D: how much do we need to take?

Professor Giampiero Girolomoni, head of the clinical dermatology department at the University of Verona, explains how we can determine how much vitamin D our skin produces:

Vitamin D is measured via a blood test, and when the quantity is less than 20 nanograms per millilitre, an oral supplement is recommended. A level of 45 nanograms upwards is considered normal. Diet alone does not provide a sufficient intake, because vitamin D is contained in the fatty part of foods, which we usually discard.

A little or a lot of sunshine? What’s best for our skin? What do you recommend?

Sunlight is always positive, as long as we protect our skin with suncreams with a minimum sun protection factor (SPF) of 30, or with coloured clothing.

But it would appear that the most popular suncreams on the market contain allergens or chemicals which can alter our hormonal system. Is this true?

No. Allergies are extremely rare, and sun protection products do not alter the hormonal system. They are safe, you could eat them.

Are you seeing more skin cancers or diseases linked to a lack of sun exposure compared to the past?

Skin cancers are caused by sun exposure during childhood, and develop 20 years later. They are on the increase in those aged 30-40, because they take a long time to develop, and we were used to sunbathing without the precautions we take today. Young people should protect themselves from the sun, as opposed to the elderly who need sun exposure but who tend to avoid it.

Psoriasis and the happiness deficit

No-one is happy to have an illness.

But for the Italians, there are illnesses which – probably due to stigma and to the difficulties of everyday living and personal relationships – may be even more difficult to bear.

This is the picture of Italy’s 1.5 million psoriasis sufferers that emerges from the World Psoriasis Happiness Report 2017, drawn up by the Happiness Research Institute. The report looked at more than 120,000 people in 184 countries who live with psoriasis, measuring their happiness deficit, comparing the general population and those with psoriasis in 19 countries, including Italy.

Itching, skin desquamation, and reddening of the skin are the symptoms reported in Italy as being the most bothersome and prone to interfere with interpersonal relationships (erroneously), especially if this is associated with motor difficulties. Difficulty walking is the factor which most affects wellbeing: a happiness deficit of 17.8 per cent.

The impact of diet on psoriasis

Last year, a team of researchers from the Department of Dermatology at the faculty of medicine of the University of California-San Francisco (UCSF) published the results of a nationwide survey conducted to assess the impact of dietary choices on psoriasis.

More than 1200 members of the National Psoriasis Foundation answered the 61 questions in the survey, with results that were significant and at times surprising. The results of the survey give a clear idea of the dietary regimens most popular among patients, as well as of the foods that seem to cause an increase in the dermatological symptoms of psoriasis, and those which reduce them.

More than half of participants stated that reducing their consumption of alcohol, gluten and solanaceae – foods belonging to the family of vegetables that includes tomatoes, potatoes, aubergines (eggplant) and peppers – led to a clear improvement in symptoms. The addition of fish oil, vegetables and vitamin D also proved useful.

The participants also indicated that different dietary regimens were particularly effective at alleviating their symptoms: the Pagan diet (based on the principle that psoriasis is caused by a build-up of toxins, also known as “intestinal permeability”), the vegan diet, and the paleo diet. Gluten-free, Mediterranean, and vegetarian diets were identified as beneficial by participants.

Il Dr. John Y.M. Koo, director of the psoriasis, phototherapy and skin treatment clinic at the University of California-San Francisco, and co-author of the study, has noticed that the common factor linking this wide variety of diets is that all lead to weight loss.

Although there is not yet any effective data demonstrating with certainty which of these diets is most effective for patients with psoriasis, all participants reported a common benefit: weight loss”, Koo says. “Given that vegan, paleo and gluten-free diets aid with weight loss, it is worth experimenting with them.

What this means for your diet

The data extrapolated from the survey do not provide any definitive conclusions, Koo says. He does, however, believe that the results are significant. “Since the survey is based on real-life data – on that which works and doesn’t work for psoriasis sufferers – the results may be encouraging for patients,” he says. “They can try eliminating one of the foods on the list that activates the inflammatory response, or follow one of the dietary regimens reported in the survey as being the most effective, and monitor their own physical response over time.”

To do this, patients should keep a food diary and proceed by trial and error, “keeping an open mind, and remembering that what works for one person may not work for another,” explains Dr. Wilson Liao, the main author of the study. “They should also consider consulting a nutritionist, or a physician with nutritional expertise, to create a suitable dietary regimen based on their personal preferences and on their clinical history.”

According to Koo, it is reasonable to speculate that patients could also respond differently to various dietary strategies depending on the sub-type of psoriasis they are suffering from. Identifying the right combination of diet and disease sub-type is just one of the interesting challenges for future research.

Ideally, the data gathered through this survey could be used to develop rigorous clinical studies which are needed to properly clarify the relationship between diet and psoriasis.


Our information booklet no.5 is out now!

The new edition of our booklet is now available!

The results of the home phototherapy project have been very positive, while the research financed by our foundation into T lymphocytes and psoriasis is ongoing, with interesting new discoveries.

We will continue to provide psychological support for psoriasis sufferers in 2019, and the “Natalino Corazza Prize” will be awarded this year too, bringing it to its third edition. Last year’s prize saw the participation of many young artists from Bologna’s Fine Arts Academy, who unleashed their creativity on the theme of skin “patches”.

We’ve signed important agreements with some thermal centres here in Italy specialized in treating psoriasis.

We have also drawn up our activity programme for 2019, without forgetting the many initiatives held during World Psoriasis Day. There is still much to do, but we will continue our work without stopping!

Read our updated Information Booklet here for more information.

Vaccines and psoriasis

By Dr. Vera Tengattini  and Dr. Ilaria Denti

Vaccinations are important for everyone, but even more so for patients with psoriasis. Indeed, psoriasis and a number of treatments used to combat the disease can increase the risk of contracting certain illnesses, such as the flu; illnesses that vaccinations can prevent, at least in part.

Like all drugs, vaccines have their own contraindications. For the sake of clarity, a contraindication is defined:

A condition (a disease, for example) that the person receiving the vaccine has, and that increases the risk of severe reactions (1).

A vaccine should be administered with extreme caution when there is a contraindication, because the risk of adverse events may be greater than the potential advantages of the vaccination. Psoriasis itself is not an absolute contraindication to vaccination, but patients should consult their doctor before receiving any kind of vaccine, to evaluate the status of their illness, and the type of treatment they are receiving (2).

Generally, vaccines produced from inactive viruses or bacteria (the majority of vaccines, such as the split flu vaccine) cause no problems for people with psoriasis, while those obtained from live attenuated viruses or bacteria (such as the Rubella vaccine) must be used with extreme caution, particularly in patients taking systemic treatments  (e.g. methotrexate, ciclosporin,  or biological drugs) (3, 4). All vaccines should in any case be avoided during a flare-up of the disease (5); pricking the skin with a needle could cause a type of reaction called the Koebner response (named after the dermatologist who described it for the first time in the nineteenth century), regardless of the type of substance injected.

The Ministry of Health recommends that all patients in treatment with  immunosuppressants (e.g. azathioprine, ciclosporin, methotrexate, systemic corticosteroids, biological drugs) should receive the flu vaccine, including, therefore, the patients with psoriasis who are being treated with these drugs (6), since the annual flu vaccine in psoriasis patients in treatment with biological drugs is a safe and effective means of preventing the flu syndrome and its complications, as stressed by the Medical Board of the National Psoriasis Foundation (7). At the doctor’s discretion, the seasonal flu vaccine can be associated with the  anti-pneumococcal vaccine; these can be administered at the same time  (one in each arm), with no need to suspend treatment. A 2011 study published in the journal Arthritis Research and Therapy showed that the anti-herpes zoster vaccine (consisting of a live attenuated virus) is also safe for those with autoimmune diseases in treatment with biological drugs or immunosuppressants, as long as the patient’s immune system is not severely compromised (8).

If a patient is scheduled to begin long-term immunosuppressant treatment (longer than 28 days), routine and additional vaccinations should ideally be given before beginning immunosuppressant treatment, to allow the best possible response to the vaccine (5). It is therefore vital for patients to consult their dermatologist, in order to draw up the most suitable vaccination schedule, taking the start of systemic treatment and disease status into account.


  1. WHO. Vaccine safety basic learning course.
  2. Epidemiology and Prevention of Vaccine-Preventable Diseases The Pink Book: Course Textbook – 13th Edition (2015) CDC- Centers for Disease Control and Prevention
  3. Rahier JF et al. Vaccinations in patients with immune-mediated inflammatory diseases. Rheumatology (Oxford). 2010 Oct PMID: 20591834
  4. Rademaker M, at al. Psoriasis and infection. A clinical practice narrative. Australas J Dermatol. 2018 Aug 5. Review. PubMed PMID: 30079566
  5. Guida alle controindicazioni alle vaccinazioni. Quinta edizione – Febbraio 2018 A cura di Ministero della salute, Consiglio superiore di sanità
  7. Lebwohl m et al. From the medical Board of the Nation Psoriasis Foundation JAAS 2008
  8. Zhang J et al. The use, safety, and effectiveness of herpes zoster vaccination in individuals with inflammatory and autoimmune diseases: a longitudinal observational study. Arthritis Res Ther. 2011 PMID: 22024532