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Can Proton Pump Inhibitors Cause Psoriasis?

Medically reviewed by Jazmin N. McSwain, PharmD, BCPS
Posted on March 8, 2024

Certain proton pump inhibitors (PPIs) for heartburn may be linked to psoriasis. Some research points to a relationship between heartburn medications and the risk of developing psoriasis. It’s important to remember that a relationship between a medication and a health condition doesn’t necessarily mean the medication causes the health condition. More study is needed to understand the connection between PPIs and psoriasis.

In this article, we’ll discuss the link between PPIs and psoriasis and whether these medications are causing your skin condition. Understanding the connection between PPIs and psoriasis may help you manage your
psoriasis flare-ups.

What Are PPIs?

PPIs are a type of medicine that reduces how much stomach acid you make. While stomach acid is important for breaking down food and killing harmful germs, too much can be uncomfortable and cause ulcers (open sores) in your stomach.

PPIs work by targeting the cells in your stomach that produce stomach acid, called parietal cells. These cells use a pump called a proton pump to secrete the acid into the stomach. PPIs block the proton pump from working, preventing the cells from releasing excess acid into the stomach. This can prevent infections with Helicobacter pylori (H. pylori) bacteria, which are responsible for causing ulcers.

Proton pumps are replaced in your stomach regularly. This means that PPIs need to be taken regularly and before meals to effectively block acid production unless another medication is used to treat the cause (such as antibiotics for H. pylori infection).

PPIs can be prescribed or found over the counter (OTC) at drug stores. OTC PPIs include:

  • Esomeprazole (Nexium)
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Omeprazole plus sodium bicarbonate (Zegerid)

PPIs that require a prescription include:

  • Dexlansoprazole (Dexilant or Kapidex)
  • Pantoprazole (Protonix)
  • Rabeprazole (AcipHex)

What Are PPIs Used For?

PPIs are used to treat symptoms of chronic acid reflux, also called gastroesophageal reflux disease (GERD). PPIs also treat ulcers in your stomach and duodenum (part of your small intestine) and H. pylori infections in your stomach.

GERD occurs when your stomach produces too much acid, causing it to back up in your throat. This is why you may experience chest discomfort and heartburn. Ulcers in your stomach or duodenum can be caused by excessive stomach acid production. Long-term infection with H. pylori can also increase stomach acid production, leading to acid reflux and ulcers if left untreated. PPIs work to reduce acid secretion and ease symptoms — long-term use of PPIs may affect your psoriasis.

Is There a Link Between PPI Use and Psoriasis?

Some research has shown a connection between taking PPIs and developing psoriasis. A 2021 study from Taiwan found an increased risk of developing psoriasis in people who took PPIs regularly.

People who took more than 120 consecutive doses had an increased risk of psoriasis. This means that the study found a strong association between taking PPIs frequently and developing psoriasis. A strong association, however, does not mean that there is enough evidence to determine that PPIs definitely cause psoriasis.

The study looked at people with all different types of psoriasis, including plaque psoriasis, psoriatic arthritis, guttate psoriasis, and inverse psoriasis.

A very small study looking at esomeprazole, another PPI, found that people who took the drug saw improvements in their skin. The researchers wanted to study this medication in psoriasis because of properties that might help reduce inflammation.

More research is needed to make a strong conclusion about the relationship between PPIs and psoriasis.

If You Took a PPI Before Being Diagnosed With Psoriasis, Is It To Blame?

The exact cause of psoriasis in a specific individual is not easy to pinpoint and there is still more study needed to fully understand if PPIs can cause psoriasis.

Psoriasis occurs when your immune system causes your skin cells to grow too fast. This leads to a buildup of skin cells in patches, which create plaques or scales on the body. However, certain environmental factors can trigger psoriasis in people with a genetic predisposition for the condition. The triggers for psoriasis may be different from person to person. These triggers include:

  • Alcohol consumption
  • Certain infections,
  • Cold weather
  • Smoking
  • Certain medications (e.g. some blood pressure or heart rate-controlling medications such as beta-blockers)

Why Are PPIs Linked to Psoriasis?

Scientists aren’t sure why PPIs are linked to psoriasis. They think there may be a connection between the gastrointestinal tract (gut and stomach) and skin diseases like psoriasis, but this is still being studied. There are other gastrointestinal disorders that are linked with psoriasis (including Crohn’s disease and celiac disease).

PPIs can change the bacteria that live in your gut, which may lead to changes in your immune response. Because your immune system causes psoriasis flares, this could be the connection between PPIs and psoriasis. However, scientists are still working on understanding this completely.

Does It Matter How Frequently You Take PPIs?

The length of time that you are on PPIs can affect your risk of developing psoriasis. In the Taiwan study, individuals who took PPIs for fewer than 120 consecutive doses were not found to develop psoriasis. In fact, the study found that people who used PPIs more frequently were more likely to develop psoriasis than those who took them only for a short amount of time. This means that the amount of time you take PPIs may affect your risk of developing psoriasis.

Is There a Difference in Risk Between OTC and Prescription PPIs?

The 2021 Taiwan study found that there was a strong connection between taking lansoprazole, which is available as an OTC drug and a prescription, and developing psoriasis. However, the study found that other PPI medications, including both OTC and prescription options, weren’t strongly connected to psoriasis onset. More research is needed to understand how PPIs are related to psoriasis, and if there is any difference between specific PPIs.

What Should You Do if You’re Concerned About Taking PPIs?

If you have a history of acid reflux and have taken PPIs frequently in the past, speak to your doctor or health care professional about any side effects, risks, or complications with continuing these medications. Doctors such as rheumatologists (doctors who specialize in autoimmune disorders and immunology), dermatologists (doctors who specialize in skin disorders), or primary care providers may be able to help you find alternative medications to help with acid reflux.

Methotrexate and PPIs

Tell your doctor if you take PPIs while on methotrexate for your psoriasis. Methotrexate is a medication that suppresses your immune system to prevent psoriasis flare-ups. Studies have found that taking PPIs regularly can raise blood levels of methotrexate more than normal. PPIs can also cause methotrexate to stay in your body longer, leading to higher doses in your blood for a longer period of time than your doctor may have intended.

Methotrexate can have serious side effects if blood levels of the drug are too high, so it’s important to speak to your doctor if you’re taking it and have acid reflux. Your doctor can help make sure you’re taking safe dosages of all your medications to prevent any side effects.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 126,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you experienced long-term acid reflux? Post your experience or suggestions in the comments below, or start a conversation on your Activities page.

Posted on March 8, 2024
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Jazmin N. McSwain, PharmD, BCPS completed pharmacy school at the University of South Florida College of Pharmacy and residency training at Bay Pines Veterans Affairs. Learn more about her here.
Melanie McKell, Ph.D. received her doctorate in immunology from the University of Cincinnati in 2021. Learn more about her here.

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