Navigating life with psoriasis means living with a skin condition that’s as unpredictable as it is challenging. While you’re probably well-versed in the usual suspects that can aggravate your skin — stress, weather changes, certain foods — you may not realize that some medications may also trigger your psoriasis.

“Is anyone on medication and noticed it’s causing a flare?” asked one member of MyPsoriasisTeam. Another replied. “That has happened to me, too, unfortunately.”

This article discusses common medications that may affect your psoriasis. It aims to provide insight that you and your loved ones can use to help navigate these potential psoriasis triggers.

1. Beta-Blockers

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

• Propranolol (Inderal)
• Metoprolol (Lopressor, Toprol XL)
• Atenolol (Tenormin)
• Nadolol (Corgard)
• Sotalol (Betapace)
• Carvedilol (Coreg)

Each of these beta-blockers works by blocking the effects of adrenaline (a hormone secreted by the adrenal glands), leading to a slower heart rate and reduced blood pressure.

For some people, beta-blockers can cause psoriasis or make it worse. This reaction happens because of the way these drugs interact with the immune system and the skin cells. Generally, this trigger can be seen anywhere from one to 18 months after beginning the beta-blocker. For this reason, it’s difficult to immediately link the onset of psoriasis symptoms with starting the medication.

The most challenging aspect of this interaction is that your psoriasis symptoms may improve after you discontinue the beta-blocker — but they might not fully go away. This partial response could be due to the leftover effects of the drug on the body’s immune system or the chronic (ongoing) nature of psoriasis itself.

When considering whether to use beta-blockers for your psoriasis, you and your health care provider need to weigh the pros and cons. The cardiovascular benefits may outweigh the chance of a psoriasis flare.

2. Lithium

Lithium has been used for more than 50 years to treat mood conditions like bipolar disorder. But, like many medications, it comes with a risk of side effects, one of which may involve skin changes.

A 2009 study from the Journal of Clinical Psychopharmacology on more than 30,000 people found that individuals being treated with lithium over a long time had a slightly higher chance of developing psoriasis. A 2008 review found that lithium can trigger new cases of psoriasis or worsen existing cases, even when used in low to normal doses.

If you’re taking lithium and notice skin changes, talk to your dermatologist or your other health care providers. They can help figure out how to best manage your skin symptoms and mood disorder.

3. Antimalarial Drugs

Antimalarial drugs treat and prevent malaria. They are also used for rheumatologic and dermatologic diseases like cutaneous lupus erythematosus (a type of lupus that affects the skin). This class of medications includes drugs like hydroxychloroquine (Plaquenil), chloroquine, and quinacrine (Mepacrine).

Researchers have found connections between taking antimalarials and the onset or worsening of psoriasis. For example, a study from the Journal of the Academy of Dermatology looked into cases of individuals taking hydroxychloroquine during the COVID-19 pandemic and its effect on psoriasis symptoms. Although this review examined only 18 people, it showed that 50 percent of those experiencing psoriasis after hydroxychloroquine treatment had no prior history of psoriasis. The remaining individuals reported either worse psoriasis symptoms or a psoriasis flare-up after hydroxychloroquine treatment.

If your doctor recommends antimalarials, make sure they are aware that you also have psoriasis. This information will help them weigh the pros and cons of an antimalarial medication for your situation.

4. Antibiotics

Antibiotics are commonly prescribed for bacterial infections. Some antibiotics have been found to potentially trigger psoriasis, but the research on this topic is not conclusive because other antibiotics are believed to help improve psoriasis symptoms. Furthermore, researchers aren’t sure whether the antibiotic or the underlying bacterial infection triggers the psoriasis.

Scientists have explored how a class of antibiotics called tetracyclines might affect psoriasis. Tetracyclines include doxycycline, minocycline, and tigecycline. These medications cause higher skin sensitivity to sunlight, and sunburn is a common psoriasis trigger. One theory is that people who already have psoriasis might experience worse symptoms when they take tetracycline and get too much sun exposure. For this reason, some researchers have recommended that those with psoriasis avoid using tetracyclines.

Researchers have discovered associations between the use of another class of antibiotics — penicillins, including amoxicillin — and the worsening of psoriasis, but these cases are rare. Scientists are uncertain about whether it’s the antibiotic or the infection that caused psoriasis symptoms to get worse.

5. Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) include prescription and over-the-counter drugs and are used to treat pain and other symptoms. Some common NSAIDs include ibuprofen (Advil), naproxen (Aleve), and aspirin.

Studies from the Journal of Clinical and Aesthetic Dermatology have found that NSAID medications may cause or worsen psoriasis. Oral naproxen and topical 1 percent indomethacin cream are among the biggest culprits. However, the connection between psoriasis symptoms and NSAID ingestion may be coincidental, and more research is needed to confirm a link.

6. ACE Inhibitors

Angiotensin-converting enzyme inhibitors, or ACE inhibitors, are commonly prescribed for hypertension (high blood pressure) and heart failure. Within the past decade, there have been potential links found between this class of drugs and psoriasis.

ACE inhibitors don’t seem to cause psoriasis. However, they’re still considered a potential trigger for psoriasis symptoms. Certain genetic factors and having a family history of psoriasis might contribute to your risk of psoriasis from ACE inhibitors.

People with psoriasis have a higher risk of developing high blood pressure. If you take an ACE inhibitor for high blood pressure, make sure your doctor knows about your psoriasis. This information may factor into their treatment decisions. If it seems like your ACE inhibitor makes your psoriasis worse, tell your doctor. They may switch you to a different ACE inhibitor or change your psoriasis treatment plan.

7. TNF-Alpha Inhibitors

Tumor necrosis factor (TNF)-alpha inhibitors target a specific part of the immune system called tumor necrosis factor. They’re commonly prescribed to people with psoriasis and psoriatic arthritis. This drug class includes medications like:

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

When people using TNF-alpha inhibitors to treat psoriasis suddenly experience worse symptoms, that reaction is called paradoxical psoriasis. The word “paradoxical” is meant to describe the fact that these drugs are designed to help treat psoriasis, but that in some cases, they may cause a flare.

Although researchers aren’t yet sure what may cause this flare, they believe some of the proteins in the medication that are meant to suppress inflammation may cause it to get worse.

Challenges in Diagnosing and Managing Drug-Induced Psoriasis

Diagnosing drug-induced psoriasis can be tricky, especially if you’re taking multiple medications. The onset of psoriasis symptoms may occur months or even years after starting a drug, so a full medical history is a key factor in diagnosing drug-induced or drug-related psoriasis.

Managing this diagnosis can also be tricky. Your doctor may have you stop or switch the offending medication, but that’s not always possible. Plus, your psoriasis symptoms may stick around even after you’ve stopped taking a medication.

Managing Psoriasis Flares and Triggers

Treatment options for psoriasis may include corticosteroids applied to the skin, phototherapy, and biologics, among others. Although some cases of drug-induced psoriasis resolve within weeks of stopping the medication, others may take longer or may not resolve completely.

Identifying and managing your psoriasis triggers is crucial for controlling the skin condition. If you suspect a medication is causing your psoriasis to flare, consult with your health care provider immediately. Don’t stop taking any medications without medical advice.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam, more than 127,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you ever had psoriasis as the result of a medication? What was your experience like? Share in the comments below, or start a conversation by posting on your Activities page.