Table of ContentsView AllTable of ContentsBeta-BlockersLithiumAntimalarialsInterferonsTerbinafineACE InhibitorsTNF BlockersTetracycline AntibioticsOther Drugs
Table of ContentsView All
View All
Table of Contents
Beta-Blockers
Lithium
Antimalarials
Interferons
Terbinafine
ACE Inhibitors
TNF Blockers
Tetracycline Antibiotics
Other Drugs
Some commonly used medications can triggerpsoriasisflares. If you already have psoriasis, these medications could cause an increase in the duration or severity of your symptoms. In other cases, medications can cause people who have never had psoriasis to develop it.
The reason some medications cause or worsen psoriasis is unclear. Some drugs are believed to “switch on” the autoimmune response, while others appear to trigger theKoebner response(a phenomenon where, in this case, a drug allergy can induce psoriasis at the site of the rash).
This article discusses 11 medications that may cause psoriasis flares.
6 Common Triggers of Psoriasis
Typically prescribed for high blood pressure,beta-blockersare among the drugs most commonly linked to psoriasis. According to a2010 review of studiesin theJournal of Clinical and Aesthetic Dermatology,beta-blockers were considered a major factor in triggering severe psoriasis in people hospitalized for the disease. These drugs can also provoke new outbreaks in people previously undiagnosed with psoriasis.
Oral beta-blockers are closely linked toplaque psoriasisandpustular psoriasisof the hands and feet. Topical beta-blockers used to treat glaucoma are closely tied tonail psoriasis. Of the beta-blockers recognized as psoriasis triggers, Inderal (propranolol) is the most common culprit.
Unlike some drugs, beta-blockers are associated with a long period of latency, wherein the time between the start of treatment and the appearance of psoriasis can be months apart.
If the beta-blocker triggering psoriasis is discontinued, the affected skin has a good chance of clearing up within a few weeks.Once a beta-blocker has caused a flare, it should not be used again unless the symptoms are mild and the benefits of treatment outweigh the risks.
There is high cross-reactivity between beta-blockers, meaning that a change of beta-blocker may not help. Even so, some beta-blockers may be less problematic than others. The choice of appropriate treatment is largely based on trial and error.
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Used to treat psychiatric illnesses such as bipolar disorder, lithium can trigger psoriasis in around 50% of people with known disease.
Like beta-blockers, lithium tends to have a very long latency period. While lithium is most commonly linked to psoriatic flares, it can also cause the onset of plaque psoriasis, pustular psoriasis, psoriatic arthritis, andpsoriasis of the scalpor nails.
Older studies have also suggested that the daily intake of omega-3 fatty acids, found in oily fish, nuts, and nutritional supplements, may also reduce the risk of lithium-induced flares.
Given the importance of lithium in treating mood disorders, the drug would not be discontinued unless the psoriasis symptoms are unmanageable.
Stopping a MedicationThough a drug may very well be impacting your psoriasis, never stop taking a prescribed medication without consulting your healthcare provider. Instead, contact your rheumatologist or dermatologist to schedule a complete evaluation. If a drug is identified as the culprit, the dose may be adjusted or treatment stopped based on symptoms and/or medical needs.
Stopping a Medication
Though a drug may very well be impacting your psoriasis, never stop taking a prescribed medication without consulting your healthcare provider. Instead, contact your rheumatologist or dermatologist to schedule a complete evaluation. If a drug is identified as the culprit, the dose may be adjusted or treatment stopped based on symptoms and/or medical needs.
Used to treat malaria as well as rheumatoid arthritis and lupus,antimalarial drugsare known to induce and aggravate psoriasis. Of the antimalarials commonly implicated, Plaquenil (hydroxychloroquine) and chloroquine pose the greatest risk. Most flares develop within weeks of starting treatment.
Chloroquine is closely linked to plaque psoriasis and pustular psoriasis. Both drugs are also known to prolong flares for months (particularly if there has been a pustular eruption). Chloroquine is also believed to exacerbate symptoms of psoriatic arthritis.
Interferons are a class of drug often used to treat hepatitis C and other diseases. Both interferon-alpha and interferon-beta have well-known associations with psoriasis.
Interferon-alpha, used to treat viral hepatitis, leukemia, kidney, cancer, and melanoma, is linked to plaque psoriasis and, to a lesser degree, psoriatic arthritis. Interferon-beta, used for multiple sclerosis, can induce a new psoriasis outbreak or exacerbate existing symptoms.
Generally speaking, if interferon-alpha or interferon-beta is indicated for treatment, it would only be discontinued if the psoriatic symptoms are intolerable.
Terbinafine is a synthetic antifungal used to treat athlete’s foot, jock itch, and other common fungal skin infections. Available in both topical and oral formulations, terbinafine has been linked to more widespread psoriatic flares.
Angiotensin-converting enzyme (ACE) inhibitorslike Lotensin (benazepril) and Vasotec (enalapril) are used to control hypertension. Their association with psoriasis is less certain, althoughpeople over 50appear to be at greatest risk.
While ACE inhibitors are believed to induce or exacerbate psoriasis, there is evidence that the effect may be limited to people with a family history of psoriasis and specific genetic subtypes of the angiotensin-converting enzyme.
If psoriasis was to occur during treatment, a TNF blocker would only be stopped if the symptoms are severe. More likely,topical treatmentswould be used to minimize symptoms until immune control is achieved.
Tetracycline antibiotics like doxycycline, tetracycline, and minocycline have been considered triggering for psoriasis, but more data (outside of case reports or retrospective studies) is still needed to confirm this.
In addition to the above-listed drugs, other medications can trigger new or recurrent symptoms. These include:
Summary
Toavoid psoriatic flaresand other complications, be sure to advise yourrheumatologistor dermatologist about all drugs you are taking. These include prescription, over-the-counter, and recreational drugs. Be sure to mention supplements and herbal remedies as well.
How Psoriasis Is Treated
8 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kashat M, Caretti K, Kado J.Etanercept-induced cystic acne.Cutis. 2014;94(1):31-32.Kronemeyer R.Find the Difference: Drug-Related Psoriasis.Dermatology Times, Psoriasis Supplement. 2021;42(2).National Psoriasis Foundation.Causes and triggers.Afshar M, Martinez AD, Gallo RL, Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: a review and analysis of 36 cases.J Eur Acad Dermatol Venereol. 2013;27(6):771–778. doi:10.1111/j.1468-3083.2012.04582.xToussirot E, Béreau M, Bossert M, Malkoun I, Lohse A.Occurrence of psoriatic arthritis during interferon beta 1a treatment for multiple sclerosis.Case Rep Rheumatol. 2014;2014:949317. doi:10.1155/2014/949317Chiu HY, Chang WL, Tsai TF, Tsai YW, Shiu MN.Risk of psoriasis following terbinafine or itraconazole treatment for onychomycosis: A population-based case-control comparative study.Drug Saf. 2018;41(3):285–295. doi:10.1007/s40264-017-0614-2Gupta R, Debbaneh MG, Liao W.Genetic epidemiology of psoriasis.Curr Dermatol Rep. 2014;3(1):61-78. doi:10.1007/s13671-013-0066-6Tsai YC, Tsai TF.A review of antibiotics and psoriasis: induction, exacerbation, and amelioration.Expert Rev Clin Pharmacol. 2019;12(10):981-989. doi:10.1080/17512433.2019.1665027Additional ReadingBalak DM, Hajdarbegovic E.Drug-induced psoriasis: clinical perspectives.Psoriasis(Auckl). 2017;7:87-94. doi:10.2147/PTT.S126727Kim GK, Del Rosso JQ.Drug-provoked psoriasis: is it drug induced or drug aggravated? Understanding pathophysiology and clinical relevance.J Clin Aesthet Dermatol.2010;3(1):32-8.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Kashat M, Caretti K, Kado J.Etanercept-induced cystic acne.Cutis. 2014;94(1):31-32.Kronemeyer R.Find the Difference: Drug-Related Psoriasis.Dermatology Times, Psoriasis Supplement. 2021;42(2).National Psoriasis Foundation.Causes and triggers.Afshar M, Martinez AD, Gallo RL, Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: a review and analysis of 36 cases.J Eur Acad Dermatol Venereol. 2013;27(6):771–778. doi:10.1111/j.1468-3083.2012.04582.xToussirot E, Béreau M, Bossert M, Malkoun I, Lohse A.Occurrence of psoriatic arthritis during interferon beta 1a treatment for multiple sclerosis.Case Rep Rheumatol. 2014;2014:949317. doi:10.1155/2014/949317Chiu HY, Chang WL, Tsai TF, Tsai YW, Shiu MN.Risk of psoriasis following terbinafine or itraconazole treatment for onychomycosis: A population-based case-control comparative study.Drug Saf. 2018;41(3):285–295. doi:10.1007/s40264-017-0614-2Gupta R, Debbaneh MG, Liao W.Genetic epidemiology of psoriasis.Curr Dermatol Rep. 2014;3(1):61-78. doi:10.1007/s13671-013-0066-6Tsai YC, Tsai TF.A review of antibiotics and psoriasis: induction, exacerbation, and amelioration.Expert Rev Clin Pharmacol. 2019;12(10):981-989. doi:10.1080/17512433.2019.1665027Additional ReadingBalak DM, Hajdarbegovic E.Drug-induced psoriasis: clinical perspectives.Psoriasis(Auckl). 2017;7:87-94. doi:10.2147/PTT.S126727Kim GK, Del Rosso JQ.Drug-provoked psoriasis: is it drug induced or drug aggravated? Understanding pathophysiology and clinical relevance.J Clin Aesthet Dermatol.2010;3(1):32-8.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Kashat M, Caretti K, Kado J.Etanercept-induced cystic acne.Cutis. 2014;94(1):31-32.Kronemeyer R.Find the Difference: Drug-Related Psoriasis.Dermatology Times, Psoriasis Supplement. 2021;42(2).National Psoriasis Foundation.Causes and triggers.Afshar M, Martinez AD, Gallo RL, Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: a review and analysis of 36 cases.J Eur Acad Dermatol Venereol. 2013;27(6):771–778. doi:10.1111/j.1468-3083.2012.04582.xToussirot E, Béreau M, Bossert M, Malkoun I, Lohse A.Occurrence of psoriatic arthritis during interferon beta 1a treatment for multiple sclerosis.Case Rep Rheumatol. 2014;2014:949317. doi:10.1155/2014/949317Chiu HY, Chang WL, Tsai TF, Tsai YW, Shiu MN.Risk of psoriasis following terbinafine or itraconazole treatment for onychomycosis: A population-based case-control comparative study.Drug Saf. 2018;41(3):285–295. doi:10.1007/s40264-017-0614-2Gupta R, Debbaneh MG, Liao W.Genetic epidemiology of psoriasis.Curr Dermatol Rep. 2014;3(1):61-78. doi:10.1007/s13671-013-0066-6Tsai YC, Tsai TF.A review of antibiotics and psoriasis: induction, exacerbation, and amelioration.Expert Rev Clin Pharmacol. 2019;12(10):981-989. doi:10.1080/17512433.2019.1665027
Kashat M, Caretti K, Kado J.Etanercept-induced cystic acne.Cutis. 2014;94(1):31-32.
Kronemeyer R.Find the Difference: Drug-Related Psoriasis.Dermatology Times, Psoriasis Supplement. 2021;42(2).
National Psoriasis Foundation.Causes and triggers.
Afshar M, Martinez AD, Gallo RL, Hata TR.Induction and exacerbation of psoriasis with Interferon-alpha therapy for hepatitis C: a review and analysis of 36 cases.J Eur Acad Dermatol Venereol. 2013;27(6):771–778. doi:10.1111/j.1468-3083.2012.04582.x
Toussirot E, Béreau M, Bossert M, Malkoun I, Lohse A.Occurrence of psoriatic arthritis during interferon beta 1a treatment for multiple sclerosis.Case Rep Rheumatol. 2014;2014:949317. doi:10.1155/2014/949317
Chiu HY, Chang WL, Tsai TF, Tsai YW, Shiu MN.Risk of psoriasis following terbinafine or itraconazole treatment for onychomycosis: A population-based case-control comparative study.Drug Saf. 2018;41(3):285–295. doi:10.1007/s40264-017-0614-2
Gupta R, Debbaneh MG, Liao W.Genetic epidemiology of psoriasis.Curr Dermatol Rep. 2014;3(1):61-78. doi:10.1007/s13671-013-0066-6
Tsai YC, Tsai TF.A review of antibiotics and psoriasis: induction, exacerbation, and amelioration.Expert Rev Clin Pharmacol. 2019;12(10):981-989. doi:10.1080/17512433.2019.1665027
Balak DM, Hajdarbegovic E.Drug-induced psoriasis: clinical perspectives.Psoriasis(Auckl). 2017;7:87-94. doi:10.2147/PTT.S126727Kim GK, Del Rosso JQ.Drug-provoked psoriasis: is it drug induced or drug aggravated? Understanding pathophysiology and clinical relevance.J Clin Aesthet Dermatol.2010;3(1):32-8.
Balak DM, Hajdarbegovic E.Drug-induced psoriasis: clinical perspectives.Psoriasis(Auckl). 2017;7:87-94. doi:10.2147/PTT.S126727
Kim GK, Del Rosso JQ.Drug-provoked psoriasis: is it drug induced or drug aggravated? Understanding pathophysiology and clinical relevance.J Clin Aesthet Dermatol.2010;3(1):32-8.
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