If your psoriasis suddenly gets worse, the cause may not always be obvious. Along with common triggers like stress or infections, certain medications may bring on a flare.

Medications can sometimes trigger new psoriasis or make existing psoriasis worse. This is often called drug-induced or drug-aggravated psoriasis.

Because a flare may not appear until weeks or months after starting a medication, it can be difficult to tell whether it’s a drug-related reaction. Here are 10 medications that have been linked to psoriasis flares.

Beta-blockers are a class of medications used to help manage blood pressure and some heart-related issues. They include drugs such as:

• Atenolol
• Carvedilol
• Metoprolol
• Nadolol
• Propranolol
• Sotalol

For some people, beta-blockers can trigger psoriasis or make existing psoriasis worse. A flare may not happen right away. Symptoms may develop months after treatment starts, and in some cases, even a year later.

Psoriasis may improve after the beta-blocker is stopped, although skin lesions sometimes remain, especially when the medication has worsened existing psoriasis.

If you think a beta-blocker may be affecting your psoriasis, talk with your healthcare provider before making any changes. They can help weigh the benefits of the medication against the possible risk of worsening psoriasis and discuss whether another treatment may be appropriate.

Lithium is commonly used to treat bipolar disorder. Studies have found that it may trigger new psoriasis or worsen existing psoriasis. A large 2009 study found that long-term lithium use was linked to a small increase in the risk of psoriasis.

If you’re taking lithium and notice skin changes, talk with your dermatologist or another healthcare provider.

Some antimalarial drugs, particularly hydroxychloroquine and chloroquine, are used to treat malaria and autoimmune conditions such as lupus. They’ve also been linked to new or worsening psoriasis, although the exact risk is unknown.

If you have psoriasis and your doctor recommends an antimalarial drug, let them know about your psoriasis. They can help you weigh the benefits and possible risks.

Antibiotics treat bacterial infections. Some antibiotics have been linked to psoriasis flares, but the connection isn’t clear. In many cases, the infection itself may trigger psoriasis symptoms.

Tetracycline antibiotics, such as doxycycline and minocycline, have been linked to psoriasis flares in some reports. These medications can also make your skin more sensitive to sunlight, and a sunburn can trigger psoriasis in some people.

Having psoriasis doesn’t mean you should avoid antibiotics when you need them. If you’re concerned about a possible flare, talk with your healthcare provider about the risks and ways to protect your skin.

Nonsteroidal anti-inflammatory drugs (NSAIDs) include prescription and over-the-counter drugs used to treat pain and inflammation. Common NSAIDs include ibuprofen, naproxen, and aspirin.

NSAIDs have been reported to cause or worsen psoriasis in some people. Naproxen and indomethacin have been linked to psoriasis flares, but it’s unclear whether they’re more likely than other NSAIDs to trigger psoriasis.

ACE inhibitors are commonly prescribed for hypertension (high blood pressure) and heart failure. They’re considered possible but uncommon psoriasis triggers.

A direct link between ACE inhibitors and psoriasis hasn’t been confirmed, but ACE inhibitors are still considered a potential trigger for psoriasis symptoms. Certain genetic factors and a family history of psoriasis may affect this risk.

If an ACE inhibitor seems to worsen your psoriasis, tell your doctor. They can discuss whether switching medications or adjusting your psoriasis treatment may be appropriate.

Tumor necrosis factor (TNF)-alpha inhibitors target a specific part of the immune system and are commonly prescribed to treat psoriasis and psoriatic arthritis. This drug class includes medications such as:

• Adalimumab (Humira and its biosimilars)
• Certolizumab pegol (Cimzia)
• Etanercept (Enbrel)
• Golimumab (Simponi)
• Infliximab (Remicade and its biosimilars)

In some people, TNF-alpha inhibitors can unexpectedly trigger new or worsening psoriasis. This reaction is known as paradoxical psoriasis because these medications are also used to treat psoriasis.

Researchers don’t fully understand why paradoxical psoriasis happens. Changes in immune system activity, including the activity of a protein called interferon-alpha, may play a role.

This reaction has been reported especially in people taking TNF-alpha inhibitors for conditions such as Crohn’s disease and rheumatoid arthritis. For many people, the benefits of treating the underlying condition may outweigh the risk of this reaction.

Interferons affect the immune system and may be used to treat certain cancers, infections, and other conditions. These medications have been linked to new or worsening psoriasis in some people. Because they change immune activity, interferons may activate pathways involved in psoriasis.

Imiquimod is applied to the skin to treat certain skin conditions. This medication activates the immune system and has been linked to new or worsening psoriasis. The reaction may begin near the application site, although psoriasis can also appear elsewhere.

Terbinafine is an antifungal medication used for fungal infections, including nail infections. Terbinafine has been linked in reports to new or worsening psoriasis.

If your psoriasis changes after you start using terbinafine, contact your healthcare provider rather than stopping the medication on your own.

How Is Drug-Induced Psoriasis Diagnosed and Managed?

Diagnosing drug-induced psoriasis can be difficult, especially if you’re taking multiple medications. Symptoms may not begin until months or even years after a medication is started.

Your doctor may consider when symptoms started, whether a medication was recently added or changed, any other possible triggers, and whether symptoms improve after the medication is stopped.

Doctors may also consider whether the medication triggered new psoriasis or worsened an existing case. These situations can look similar.

Psoriasis may continue even after the suspected medication is stopped.

What Should You Do if a Medication Seems To Trigger a Flare?

Don’t stop taking the medication on your own. Some drugs can cause serious problems if stopped suddenly, and the medication may be treating an important health condition.

Write down when your flare began and any medications you recently started, stopped, or changed. Include prescriptions, over-the-counter medications, supplements, and creams. Share this list with your dermatologist, pharmacist, or prescribing healthcare provider.

Your healthcare provider may recommend continuing the medication while treating your psoriasis or switching medications if appropriate. They may also look for other triggers, such as an infection, stress, a skin injury, or sunburn.

How Are Psoriasis Flares and Triggers Managed?

Treatment options for psoriasis may include topical corticosteroids, phototherapy, and biologics.

Topical corticosteroids can be helpful when used as directed. However, suddenly stopping systemic corticosteroids or potent topical corticosteroids may sometimes cause a rebound flare.

Identifying your psoriasis triggers can help you manage the condition. If you think a medication is causing a flare, talk with your healthcare provider before making any changes.

Lists of “medications that cause psoriasis” can be misleading because some associations are uncommon or based on limited evidence. Your doctor can help weigh the possible risk of a flare against the benefits of a medication you need.