Psoriasis is a complex autoimmune skin condition that affects up to 11 percent of adults.(1) Symptoms include patches of skin that are dry, sore, itchy, red, and inflamed. Sometimes it also affects the nails and joints.
There are two main components that cause and worsen psoriasis.
The first component is your genes.
Some genes make you more susceptible to certain medical conditions. Psoriasis is one condition that has a genetic component. But, just because you inherited the genes for a particular disease doesn’t necessarily mean you’re guaranteed to get it.
Scientists think that about 10 percent of people have one or more genes that can lead to psoriasis, yet only two or three percent of people ever show symptoms of it.(2)
So this begs the question of what makes some people with the “psoriasis genes” get it and not others?
This is where that second component comes into play.
In one word: TRIGGER
If you have the genes for psoriasis you may not experience symptoms until you’re exposed to a “trigger” that activates those genes!
Some triggers for psoriasis include(2):
- Stress
- Skin injury
- Infection
- Some medications
Yes, you read that right.
There are medications that can trigger psoriasis as well as other medications that worsen psoriasis!
The most surprising part is that most of these medications aren’t even applied to your skin! They’re used for psychiatric disorders, infections, heart conditions, and sometimes even psoriatic arthritis.
What’s most concerning is that, if you have psoriasis, taking these medications can increase the risk of flares by up to 50 percent!(2)
That’s huge!
To be clear, medications may not be what's keeping your psoriasis present (or making it worse). But they could be a trigger within your perfect storm that leads to developing or worsening of your psoriasis.
Now that you know that psoriasis needs both genes AND a trigger, let’s dive into the medications that can worsen psoriasis so you can see if it’s part of what’s driving your symptoms.
How medications can flare psoriasis
Your skin is ultimately connected to everything else in your body: nutrient deficiencies, hormonal imbalances, and immune issues can all show up on your skin.
This is exactly why I recommend pushing your doctor to go beyond a quick glance and scrape and insist on getting lab tests done for your skin conditions.
Because psoriasis is an autoimmune disease, it underscores the importance of looking deeper through a root cause approach. This helps you to find triggers (like using one of these medications, for example) to address what's driving the autoimmune process.
[CLICK HERE to read more about alternative ways to address Psoriasis]
Interestingly, some scientists are finally calling out to doctors to pay more attention to these medication-psoriasis reactions:
“In daily clinical practice, there may be insufficient attention to potential involvement of medication-related causes for psoriasis induction, exacerbation, or treatment-resistance.”(1,3)
Some of the ways medications trigger psoriasis flares are through (1,4,5):
- Allergic or hypersensitivity immune reactions
- Provoking inflammation
- Altering skin cells (e.g. causing them to multiply or making them more sensitive to the sun)
- The “rebound effect”
If you didn’t know that some medications have these psoriasis side effects, you are not alone!
Medications that worsen psoriasis
Many types of medications have reports of psoriasis flares – most notably lithium, anti-infection medications, and some blood pressure medications. Many of these affect a large number of people and the skin reactions sometimes happen weeks (or months) after starting them.
1 – Lithium
Lithium is commonly prescribed for psychiatric disorders like manic depression. Lithium medications have skin-related side effects (including psoriasis and acne) in up to 45 percent of people who take them.(2,4) These effects can show up 20 or more weeks after starting therapy with lithium.(1,4)
As an aside, there is some interesting research showing that supplemental inositol may be helpful in bringing about a fairly rapid improvement of lithium-flared psoriasis. Obviously, discuss this with your doctor before taking action to avoid any potential negative drug-supplement interactions.
2 – Anti-infection medications
Certain medications (e.g. Plaquenil, Quinacrine, and (Hydroxy)chloroquine) can cause psoriasis to flare in 31 percent of people with psoriasis.(2,4,5) These flares can happen three, or up to 40, weeks after starting the medication.(4,5)
Plaquenil is an immunosuppressive disease-modifying anti-rheumatic drug (DMARD).(6) It is specifically used in treatment with lupus, rheumatoid arthritis, and other autoimmune conditions. Aside from the potential issues with psoriasis, it can permanently damage the visual field of your eyesight (which I learned while working for many years under my dad who is an ophthalmologist).
This skin reaction is common enough that some health authorities specifically recommend against the use of one type of antibiotic class of medications called fluoroquinolones in people with psoriasis.(4) Drugs in this class include levofloxacin (Levaquin), ciprofloxacin (Cipro), ciprofloxacin extended-release tablets, moxifloxacin (Avelox), ofloxacin, gemifloxacin (Factive) and delafloxacin (Baxdela) and “more than 60 generic versions.”(7) Aside from the potential skin issues, the FDA put out new warnings about these drugs in 2018.(8)
Tetracycline is another type of antibiotic (anti-bacterial) medication that is linked with psoriasis.(4)
Anti-fungal medications like Terbinafine are also linked with new and aggravated cases of psoriasis. These skin reactions occur 1-3 weeks after starting the medication and go away after the medication has been discontinued.(4)
3 – Blood pressure medications
Some blood pressure drugs known as “beta blockers” (e.g. Inderal, Propranolol, Oxprenolol, Practolol, Metoprolol, Atenolol, Cetamolol, Timolol, and Nadololones) can trigger or worsen psoriasis flares for up to 30 percent of people with psoriasis.(1,2,4) These skin effects manifest a few days, or even up to 12 months, after starting the medication.(1,4)
Note: Beta-blockers may also be prescribed for other heart conditions (e.g. heart disease, arrhythmias, heart failure), thyroid conditions, glaucoma, and even anxiety disorders.(5)
Other blood pressure drugs known as “ACE-inhibitors” (e.g. Captopril, Enalapril, and Ramipril) and “Angiotensin Receptor Blockers” (e.g. Candesartan) can cause skin reactions in over 50 percent of patients within 4-8 weeks.(4)
4 – Interferons
Interferons (e.g. IFN-alpha and IFN-beta) are sometimes prescribed for some cancers, infections, and multiple sclerosis.(9) They can worsen psoriasis in as little as one week after starting the medication.(4)
5 – TNF-alpha inhibitors
These are new biologic medications (e.g Infliximab/Remicade, Etanercept, and Adalimumab/Humira) sometimes prescribed specifically to treat psoriasis and psoriatic arthritis.(4)
On rare occasions, they have been known to trigger psoriasis flares or new cases of psoriasis days, months, or even years after starting them.(4)
6 – Non-steroidal anti-inflammatory drugs
Non-steroidal anti-inflammatory drugs (NSAIDS) (e.g. Indomethacin, Phenylbutazone, Meclofenamate, Ibuprofen) can trigger or worsen psoriasis.(2,4)
These effects are not as common as with other medications mentioned above and that is why NSAIDs are still sometimes recommended for arthritis, including psoriatic arthritis.(2,4)
Adverse skin reactions with NSAIDS can occur as little as 1-2 weeks after starting the medication. While Indomethacin is the most studied NSAID for psoriasis reactions, there are also reports with other NSAIDs.(4)
It’s also worthwhile to mention that since psoriasis is an autoimmune disease, gut involvement must always be considered in your root cause approach. NSAIDS are well-known to increase gut permeability (aka. Leaky gut) and the risk of GI bleeding.
7 – Withdrawal from corticosteroids
Taking corticosteroids can improve symptoms of psoriasis on a short-term basis because they are anti-inflammatory medications. However, stopping them can trigger flares.(4) This is known as the “rebound effect.”
This rebound effect has been seen with pills because the medication travels throughout the body, but they’ve also been seen when topical corticosteroids are applied to large areas of skin.(4)
Though most people associate the rebound effect with topical steroid cream use in eczema, it also happens in psoriasis.
How to know if your psoriasis flare is from medication
Most of the time you can’t tell the difference between a psoriasis flare from a medication reaction versus a flare for any other reason – they often look and feel the same. They can be mild or severe.(1) It's possible that the meds can worsen existing psoriasis flares, trigger new ones, or trigger your very first flare.(1,4,5)
And what's worse, these medications can even cause your psoriasis to become more resistant to your usual treatment.(1,4,5)
Many times reducing the dosage or discontinuing the medication can help flares.
But, it’s possible that even if medications are discontinued, the flare may not completely go away. This doesn’t mean that the cause was not the medication.(1,5)
That's why it's important to review the time around when the symptoms started and what medications you were taking at the time. Keep in mind that your flare may have begun several days, weeks, or even months after you started the medication.
[LISTEN TO THESE INCREDIBLE INTERVIEWS ON PSORIASIS]
What to do if you suspect a medication is flaring your psoriasis
If you ever have a medical emergency, for this or anything else, you need to call 911 or visit your local hospital right away.
If this is not an emergency it’s important to speak with your pharmacist or prescribing doctor as soon as possible.
Bring them a copy of references (1, 4, & 5) below so you can show them the research on medications that worsen psoriasis because this is a real science-based possibility.
Work with your doctor to decide the best strategy for you to address the concern. As I always remind my clients, never just stop taking prescribed medications because you read something on the internet!
Keep in mind that medications may or may not be what's flaring your psoriasis. But they could be a trigger within your perfect storm.
LEAVE A COMMENT BELOW — I’d love to hear your experience with medications and psoriasis flares!
If you are looking for custom and targeted recommendations on how to handle psoriasis flares, let's discuss your root causes and start working on a more sustainable route forward.
References
1 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774610/
2 – https://www.psoriasis.org/about-psoriasis/causes
3 – https://www.ncbi.nlm.nih.gov/pubmed/24989499
4 – https://www.psoriasis.org/files/publications/forum/FORUM-SPRING-2012-drugs-that-induce-psoriasis.pdf
5 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921739/
6 – https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Treatments/Hydroxychloroquine-Plaquenil
7 – https://www.medpagetoday.com/infectiousdisease/generalinfectiousdisease/73954
8 – https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm
Very shortly after starting BP meds, Amlodipine, irbesartan, and others I no longer take, I developed a mild case of psoriasis.
I’ve been able to mostly mitigate it by taking high gamma vitamin E, along with oatmeal based skin creams.
I am sooo confused about the fundamental nature of all the conditions that are called “autoimmune diseases.” I can certainly accept the idea that in all such cases it involves some part of the immune system misbehaving in a way that causes it to damage what are otherwise healthy cells and/or the interstitial tissues and fluids that serve as the immediate supportive environment of those cells. Quite often I hear people talk about what they call “molecular mimicry,” which I think I understand as one potential way to throw the immune system out of whack. But surely what is commonly all lumped together as the “immune system” is so complex and has so many interacting components that there are plenty of other ways in which one part or another of it can malfunction in some damage-causing way. Then, of course, the trick is to figure out exactly what it is that is causing the malfunction, and address that root cause directly instead of just masking the overt symptoms. The real killer, I gather, is that very often what are superficially the same symptoms can have different root causes, and conversely the same functional cause can cause different symptoms in different people.
Now the problem for me is that I’m teaching myself about all this stuff from scratch, using whatever I can find on the internet and occasionally in books. I have no real mentor. And of all the stuff I’ve found so far, it’s either ridiculously oversimplified to the point of being useless or even misleading, or it’s target audience is people who already have a PhD in immunology. What I’m looking for is thorough overview of the entire immune system in all of its intricacies as it is understood to date, written for an audience of non-professionals like me. Does anybody know of any websites or books that I could turn to for that?
I have had plaque psoriasis for many years. It is getting increasingly worse, and I have had side effects to several of the psorasis treatments. I most recently was taking phototherapy treatments, which helped some, but if I had to stop for a vacation, illness, etc. I flared up ! I stopped it while researching other options, and changed doctors. My psoriasis is extensive.
I have severe problems with psoriasis on my hands, and psoriatic arthritis on several fingers, bad enough that it is hard to hold a pen or a coffee cup.
Most recently I developed guttate psoriasis mostly on my abdomen, upper chest and arms. . Someone told me that this was caused by the high-dose flu shot I got. Have you ever heard of that?
My husband only developed psoriasis when he was in the Gulf War and had a load of injections which he does not even know what was in them and also there wrreall the oil wells burning so definitely was his trigger, he is toxic right down to his cells.
He is plastered with it and the sun does not make it better like some people’s. I am trying to detox him from the bottom up ( excuse the pun) will be a long and costly process but even starting with high doses of turmeric for the inflammation has helped no end.
Onward and upward we go.
I was on Humira for my P for 9 years, of which 1/2 of those years I suffered the rebound affect (unbeknownst to me). My dermatologist and nurse literally laughed at my request to switch medication! He said it would be impossible to change
due to the insurance company.
I finally decided to see another dermatologist who had a biologic nurse on staff and she was more than happy to switch me to a different biologic…..Stelara. It’s been almost 2 years now and I am totally clear!
It’s the first time in my life that I’m not spending an hour spot treating my P!
I gave up wheat and sugar. Over the last year my psoriasis is 95% better. Much cheaper than the $20,000 a year med the dermatologist recommended. I also take vitamin D, omega3 oils and collagen. The dermatologists I’ve seen are worthless.