A 73-year-old man who had had plaque psoriasis for more than 20 years on the arms, legs, and scalp presented for consultation on a new rash. He had been using topical steroid creams and shampoos to control occasional psoriatic flares. The patient had undergone acupuncture for lower back pain 2 months before presentation, and shortly thereafter new guttate psoriasis developed in the areas directly punctured with needles. Skin examination revealed multiple discrete, erythematous, scaly, indurated papules on the lower back and buttocks, areas which had not previously been affected. He reported no upper respiratory symptoms. Irritation and infection are rare complications of acupuncture when performed to established standards. Needling of the skin can produce trauma that is sufficient to cause Koebner’s phenomenon and subsequent guttate psoriatic flare.