The COVID-19 pandemic has presented unprecedented challenges in healthcare, particularly for individuals with chronic conditions like psoriasis. This chapter explores the complex relationship between COVID-19 infection, its vaccination, and psoriasis exacerbation. The immune dysregulation caused by SARS-CoV-2, along with the immune-modulating effects of vaccines, has been associated with both flare-ups and improvements in psoriatic symptoms. This chapter reviews current literature on the pathophysiological mechanisms linking viral infection and vaccination to psoriasis exacerbation. Additionally, it evaluates case reports and clinical studies, offering insights into the management of psoriasis during the pandemic. Understanding these interactions is critical for dermatologists, especially when advising patients on vaccination strategies and managing psoriasis in the context of COVID-19.