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.

Flare

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

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)

 

Blood pressure gauge and medications

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)

 

Non-steroidal anti-inflammatory drugs

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.

Woman thinking about flare-ups

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]

Perfect storm

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.

Reference (1)

Reference (4)

Reference (5)

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

9 – https://www.medicinenet.com/interferon/article.htm


Jennifer Fugo

Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.


Follow Us

Medical Disclaimer

Skinterrupt offers health, wellness, fitness and nutritional information which is designed for educational purposes only. You should not rely on this information as a substitute for, nor does it replace, professional medical advice, diagnois, or treatment. If you have any concerns or questions about your health, you should always consult with a physician or other health care professional. Do not disregard, avoid, or delay obtaining medical or health related advise from your physician or other health care professional because of something you may have seen or read on our site, or in our advertising, marketing, or promotional materials. The use of any information provided by Skinterrupt is solely at your own risk.

Nothing stated or posted on our site, or in our advertising, marketing or promotional materials, or through any of the services we offer, as intended to be, and must not be taken to be, the practice of medicine or counseling care. For purposes of this disclaimer, the practice of medicine or counseling care includes, without limitation, nutritional counseling, psychiatry, psychology, psychotherapy, or providing health care treatment, instruction, diagnosis, prognosis, or advice.