This article explains why medication may affect psoriasis and the specific drugs to be aware of.
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6 Common Triggers for Psoriasis
How Medications Cause Psoriasis
Although scientists have greatly expanded their knowledge about thecauses and risks of psoriasis, the conditions that trigger flares remain something of a mystery. It is unclear why some people with psoriasis respond to certain triggers but not others, or which factors (environmental or genetic) increase a person’s sensitivity to a trigger and when.
Even with regard to medications, the ways in which a drug may induce flares can vary greatly from one person to the next. Among the examples:
Why Does Your Body Flare Up?Medical researchers are not sure why some people have a response to psoriasis triggers. Possible reasons include hypersensitivity to a drug, drug allergy, reaction to an irritant, orphototoxicity(skin reaction due to ultraviolet radiation).
Why Does Your Body Flare Up?
Medical researchers are not sure why some people have a response to psoriasis triggers. Possible reasons include hypersensitivity to a drug, drug allergy, reaction to an irritant, orphototoxicity(skin reaction due to ultraviolet radiation).
Drugs That Trigger or Worsen Psoriasis
Several drugs or classes of drugs have been shown to induce or worsen psoriasis symptoms.
Antifungal
Lamisil (terbinafine) is acommon antifungalused to treat everything from ringworm to athlete’s foot. Lamisil is taken as a tablet or as granules mixed into soft food.It can both induce and exacerbate certain types of psoriasis, includingplaque psoriasis,pustular psoriasis, andinverse psoriasis.
Other antifungal medicines come in the form of a cream, gel, ointment, spray, liquid, or injection.Not all antifungal creams will make psoriasis worse. Some antifungal agents are used to treatseborrhoeicdermatitis(a flaky white-yellowish skin condition) and scalp psoriasis. They can also be used in areas where psoriasis involves folds in the skin.
Beta Blockers
The beta blocker Inderal (propranolol) is known to worsen symptoms in 25% to 30% of people with psoriasis who take it.
Used to treat high blood pressure, Inderal can exacerbate symptoms within several weeks of starting the drug. Otherbeta blockerscan also worsen symptoms, so substituting one beta blocker for another may not prevent this side effect.
Corticosteroids
Prednisone is a corticosteroid steroid used to control systemic inflammation (throughout the body) that is associated with a variety of conditions and diseases. It is believed that systemic steroids like prednisone should be avoided in psoriasis due to the possibility of a rebound pustular flare. However, recent studies and literature reviews have questioned how commonly psoriasis flares occur, noting further research is needed.
Lithium
Used to treat bipolar disorders, lithium can worsen psoriasis in 45% of people who take it.Men tend to be more affected than women. Lithium can even trigger psoriasis in people previously undiagnosed, sometimes as late as 15 months after starting treatment.
The time it takes for lithium to cause a flare ranges from a few weeks to several months.
Antimalarials
Plaquenil (hydroxychloroquine), Quinacrine (mepacrine), and chloroquine, used to treat malaria and autoimmune disorders likelupusorrheumatoid arthritis, can induce flares in over 30% of people with psoriasis who take them.New or exacerbated symptoms usually occur two to three weeks after starting treatment.
A 2022 study found hydroxychloroquine was the third most common drug to cause psoriasis adverse events.
Angiotensin-Converting Enzyme (ACE) Inhibitors
There is a significant association betweenACE inhibitorslike Altace (ramipril), captopril, enalapril, and psoriasis, which usually devleops within a year of starting the ACE inhibitor.
These medications are used to treat high blood pressure and other heart, blood vessel, and kidney problems.
Biologic Drugs
Newer-generationbiologic drugsused to treat autoimmune disorders have recently been implicated as triggers for psoriatic flares. These include Humira (adalimumab), Cimzia (certolizumab pegol), and Enbrel (etanercept).
Psoriasis may occur following a single biologic therapy administration or following several years of treatment. Complete resolution of psoriasis symptoms occurs when treatment is stopped.
The most commonly cited biologic drug to trigger psoriasis is Remicade (infliximab), a tumor necrosis factor (TNF) inhibitor. The effect is considered paradoxical given that the treatment of one autoimmune disorder somehow instigates psoriasis.
Cancer Immunotherapy Drugs
Keytruda (pembrolizumab) and Opdivo (nivolumab) are two humanized antibodies used to treat certain cancers. Both have been implicated in new onset psoriasis as well as the exacerbation of pre-existing psoriasis.
Interferons
Interferons are often used to treathepatitis Cand can aggravate existing disease or trigger new cases of psoriasis. For some, the symptoms may not improve once treatment is stopped.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
Tivorbex (indomethacin) is anonsteroidal anti-inflammatory drug (NSAID)used to treat mild to moderate arthritis.It is not known to induce new onset psoriasis but may worsen psoriasis symptoms in some. If this occurs, your healthcare provider will likely substitute Tivorbex for another NSAID. However, NSAIDs like phenylbutazone, meclofenamate, and evenAdvil (ibuprofen)have also been known to trigger flares.
Benzodiazipines
Benzodiazepines, such as Xanax (alprazolam), Valium (diazepam), and Ativan (lorazepam), can trigger or slightly worsen psoriasis in people with mild forms of psoriasis. However, benzodiazepines may slightly improve psoriasis in people with severe cases, according to a 2021 study.
Imiquimod
Imiquimod treatment can lead to psoriasis exacerbation (usually plaque-type psoriasis) in adult individuals already diagnosed with psoriasis.
Less common drug triggers includetetracycline antibiotics, the antidepressant Wellbutrin (bupropion), and Lopid (gemfibrozil) used to treat high cholesterol.
Summary
How a Skin Injury Can Trigger Psoriasis
20 Sources
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