Which Medicines Can Worsen Psoriasis?

9 Drug Types Implicated as Disease Triggers

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If you have psoriasis, you may be aware that certain substances or events can cause an outbreak of symptoms, known as a flare. These so-called "triggers" include stress, infections, skin trauma, and even extremely cold and dry temperatures. Also included on the list are certain medications that, for reasons unknown, can induce an acute psoriasis episode.

There are few defining characteristics as to the types of drugs that may cause flares. Moreover, not everyone with psoriasis will be affected by these drugs. Still, it important to know which drugs have the greatest potential for a flare, especially if you are struggling to identify your own personal triggers for the disease.

Causes

Although scientists have greatly expanded their knowledge about the causes 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 trigger but not others, or which factors (environmental or genetic) increase a person's sensitivity to a trigger and when.

Even with regards to medications, the ways in which a drug may induce flares can vary greatly from one person to the next. Among the examples:

  • A drug may trigger the first episode in someone with no prior history of the disease (de novo psoriasis).
  • A drug may trigger symptoms that will continue until the drug is stopped (drug-induced psoriasis)
  • A drug may not trigger a flare but cause an acute episode to worsen and persist even after the drug is stopped (drug-aggravated psoriasis).
  • A drug may induce symptoms secondary to the psoriatic skin lesions (such as psoriatic arthritis, nail arthritis, or a non-psoriatic autoimmune disease).

The diversity of responses is no less complex than the biological mechanisms that trigger them. To this day, no one is quite sure if drug hypersensitivity, drug allergy, irritant reaction, or phototoxicity is the ultimate cause.

With that being said, some scientists suspect that a substance that helps regulate the immune response, called interferon-alpha (INF-a), may be involved. INF-a is not only implicated in the development of psoriasis but is also influenced by many drugs that can stimulate its production, perhaps to an extent that can trigger an acute flare.

Drugs Associated With Psoriasis Flares

Several drugs or classes of drugs have been shown to induce or worsen psoriasis symptoms. The major players in this phenomenon include:

  • Beta-blockers: The beta-blocker Inderal (propranolol) is known to worsen symptoms in 25 to 30 percent of people with psoriasis who take it. Used to treat high blood pressure, Inderal can exacerbate symptoms within several weeks of starting the drug. Other beta blockers have the potential to do the same, so substituting one from one drug to another may not prevent this side effect. 
  • Lithium: Used to treat bipolar disorders, lithium can worsen psoriasis in 45 percent of people who take it. Men tend to be affected than women. LIthium can even trigger psoriasis in people previously undiagnosed, sometimes as late as 15 months after starting treatment.
  • Antimalarials: Plaquenil (hydroxychloroquine), Quinacrine (mepacrine), and chloroquine, used to treat malaria and autoimmune disorders like lupus or rheumatoid arthritis, can induce flares in over 30 percent of people with psoriasis who take them. New or exacerbated symptoms usually occur two to three weeks after starting treatment.
  • Angiotensin-converting enzyme (ACE) Inhibitors: ACE inhibitors like Capoten (captopril), Vasotec (enalapril), and Altace (ramipril) can cause psoriasis flares in as many as 58 percents of users, usually within four to eight weeks. These medications are used to treat high blood pressure.
  • Biologic drugs: Newer-generation biologic drugs used to treat autoimmune disorders have recently been implicated as triggers for psoriatic flares. These include Humira (adalimumab), Cimzia (certolizumab pegol), and Enbrel (etanercept). However, the drug most commonly cited is Remicade (infliximab). 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 de novo psoriasis as well as the exacerbation of pre-existing psoriasis.
  • Interferons: Interferons are often used to treat hepatitis C and can aggravate existing disease or trigger new cases of psoriasis. For some, the symptoms may not improve once treatment is stopped.
  • NSAIDs: Tivorbex (indomethacin) is a nonsteroidal anti-inflammatory drug (NSAID) used to treat mild to moderate arthritis. It is not known to induce de novo psoriasis but may worsen psoriasis symptoms in some. If this occurs, your doctor will likely substitute Tivorbex for another NSAID. However, NSAIDs like phenylbutazone, meclofenamate, and even Advil (ibuprofen) have also been known to trigger flares.

Less common drugs triggers include tetracycline antibiotics, the antidepressant Wellbutrin (bupropion), and Lopid (gemfibrozil) used to treat high cholesterol.

A Word From Verywell

If you have psoriasis, discuss this with each of the doctors who prescribe medications for you. This will help them to consider which drugs are least likely to cause side effects or interactions. If you experience a flare of psoriasis after starting treatment, report this to your doctor so that the drug can be replaced or the dose adjusted.

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