Medications That Can Trigger or Worsen Psoriasis: What Patients Should Know
Written by Dr. Michael Brooks, Cardiovascular & Chronic Disease Content Specialist
Reviewed for medical accuracy under the Ivermectinkart Editorial Policy
Introduction
Psoriasis is a chronic inflammatory condition that can improve, worsen, and flare at different times, sometimes without an obvious reason. One factor that can be overlooked is medication: certain medications that can trigger or worsen psoriasis have been reported in clinical practice and medical research. Lithium, beta-blockers, some antimalarial medicines, interferons, and several other drugs have been associated with new psoriasis or worsening existing disease, although the strength of evidence differs considerably between medications. A flare does not automatically mean your medicine caused it, because infections, stress, skin injury, smoking, weather, and other factors can also affect psoriasis. Most importantly, you should not suddenly stop a prescribed medicine because you suspect it is affecting your skin. Understanding which medicines have stronger associations, when symptoms may appear, and what to discuss with your healthcare professional can help you manage psoriasis without putting treatment for another condition at risk.
Can Medications Really Trigger or Worsen Psoriasis?
Yes, certain medicines have been associated with either triggering psoriasis for the first time or making existing psoriasis worse. However, proving that a particular medication caused an individual flare can be difficult, and the evidence is much stronger for some drugs than for others.
Medication-related psoriasis can occur in several ways. A medicine may:
Trigger psoriasis in someone who has never previously developed visible psoriasis.
Cause psoriasis to appear on previously unaffected skin in someone who already has the condition.
Make established psoriasis more severe.
Produce a psoriasis-like, or “psoriasiform,” skin eruption.
The American Academy of Dermatology (AAD) identifies medication as one of several possible psoriasis triggers. Its guidance on medications and psoriasis flare-ups specifically advises patients not to stop a suspected medicine on their own, but instead to speak with the clinician who prescribed it.
This distinction is important because a medication may be controlling a serious condition such as high blood pressure, heart disease, bipolar disorder, or an autoimmune disease. The risk from suddenly discontinuing that treatment may be greater than the psoriasis concern.
A psoriasis flare that begins after starting a medicine is worth investigating, but timing alone does not prove causation. The medication, the illness being treated, infections, stress, and other psoriasis triggers may overlap, so medication changes should be made with the prescribing healthcare professional.
Which Medications Are Most Strongly Linked to Psoriasis?
Lithium, beta-blockers, synthetic antimalarial medicines, interferons, imiquimod, and terbinafine have traditionally had some of the stronger reported associations with drug-related psoriasis. Other medications have also been reported, but evidence for many of them is less consistent or based on smaller studies and individual cases.
Medicines commonly discussed in relation to psoriasis and the strength of the association
Medication or class | Common medical use | Relationship reported with psoriasis | Evidence context |
Lithium | Bipolar disorder and other psychiatric indications | New or worsening psoriasis | Traditionally strong association |
Beta-blockers | High blood pressure, heart conditions and other indications | New or worsening psoriasis/psoriasiform eruptions | Well-recognized association, although studies are not completely consistent |
Chloroquine/hydroxychloroquine | Malaria and certain autoimmune diseases | Can trigger or exacerbate psoriasis | Traditionally recognized association |
Interferons | Selected viral, neurological and cancer-related conditions | New or worsening psoriasis | Traditionally recognized association |
Imiquimod | Certain skin conditions | Can provoke psoriasis | Recognized association |
Terbinafine | Fungal infections | New or worsening psoriasis reported | Recognized association |
NSAIDs | Pain and inflammation | Worsening reported | Evidence less consistent |
ACE inhibitors | High blood pressure and cardiovascular conditions | New or worsening psoriasis reported | Association reported; evidence varies |
TNF inhibitors | Inflammatory diseases, including conditions for which these drugs may normally be therapeutic | Paradoxical new psoriasis can occur | Uncommon but recognized paradoxical reaction |
Immune checkpoint inhibitors | Cancer | New or worsening psoriasis reported | Increasingly recognized with modern cancer immunotherapy |
A peer-reviewed clinical review of drug-induced psoriasis notes that well-conducted systematic research is limited and that evidence for many suspected medicines consists largely of reports rather than strong causal studies. This is why a long list of “psoriasis-causing drugs” can be misleading without explaining the strength of the evidence.
How Can Lithium, Beta-Blockers, and Antimalarials Affect Psoriasis?
Lithium, beta-blockers, and antimalarial drugs are among the medicines most frequently discussed when clinicians investigate possible medication-related psoriasis. Each is prescribed for legitimate medical reasons, so a suspected association requires a risk-benefit discussion rather than automatic discontinuation.
Lithium and psoriasis
Lithium is used primarily in the management of bipolar disorder and has a long-recognized association with psoriasis. It may exacerbate existing psoriasis or be associated with psoriasis appearing after treatment begins.
The time between starting lithium and developing skin changes can vary. This means the connection may not always be obvious, particularly when someone has been taking lithium for months.
Stopping lithium abruptly without psychiatric guidance can carry significant risks. If lithium is suspected, the dermatologist and the clinician managing the psychiatric condition can consider the severity of the psoriasis, the importance of lithium treatment, and whether other management options are appropriate.
Beta-blockers and psoriasis
Beta-blockers are widely used for cardiovascular conditions and have also been associated with psoriasis and psoriasiform skin eruptions. Examples of medicines in this class include propranolol and metoprolol, although an association with a drug class does not mean every person taking one will develop psoriasis.
Evidence is not entirely uniform. Some observational studies have failed to find the same association, illustrating why an individual's symptoms and medication history need clinical evaluation rather than assuming causation.
Antimalarial medicines and psoriasis
Synthetic antimalarial medicines such as chloroquine and hydroxychloroquine have long been reported as possible psoriasis triggers or aggravating medicines.
Hydroxychloroquine is also used for autoimmune conditions such as lupus and rheumatoid arthritis. Because those underlying diseases may require ongoing treatment, patients should discuss psoriasis history with the prescribing clinician rather than stopping therapy themselves.
What Other Medicines May Be Associated With Psoriasis Flares?
Several additional medicines have been reported in connection with psoriasis, but an association does not always mean the drug directly caused the condition. For many suspected medications, the evidence is weaker than it is for the traditionally recognized groups.
NSAIDs and some cardiovascular medicines
Nonsteroidal anti-inflammatory drugs (NSAIDs), ACE inhibitors, and some other cardiovascular medicines have appeared in reviews of potential psoriasis triggers. However, the available evidence does not establish the same level of certainty for every drug.
This is particularly relevant because cardiovascular disease and psoriasis can coexist. Changing cardiovascular medication solely because of a suspected skin association therefore requires careful consideration of the patient's overall health.
Terbinafine and other reported medicines
Terbinafine, an antifungal medicine, has a recognized association with drug-related psoriasis in clinical literature. Interferons and topical imiquimod have also been reported to induce or exacerbate psoriasis.
Other medications have appeared in reports and reviews, but evidence can range from observational research to isolated case reports. A medicine appearing on a list of reported triggers should therefore not be interpreted as proof that it commonly causes psoriasis.
Can a psoriasis treatment paradoxically cause psoriasis?
Surprisingly, yes. TNF inhibitors are medicines used to treat inflammatory diseases, including psoriasis, yet they can occasionally cause a new psoriasis-like eruption. This phenomenon is known as paradoxical psoriasis.
Newer cancer immunotherapies, including PD-1 and PD-L1 immune checkpoint inhibitors, have also been associated with new or worsening psoriasis.
These situations usually require specialist assessment because simply stopping an important immune or cancer treatment may not be the safest option.
Why Can Stopping Corticosteroids Suddenly Be a Problem?
Rapid withdrawal of systemic corticosteroids has traditionally been recognized as a possible trigger for psoriasis worsening, so these medicines should not be stopped suddenly without medical guidance. Current AAD clinical guidance continues to list withdrawal of systemic corticosteroids among factors that may trigger or exacerbate psoriasis.
Corticosteroids such as prednisone affect immune activity throughout the body. Depending on the reason for treatment, dose, and duration, suddenly stopping systemic corticosteroids can also create health risks unrelated to psoriasis.
The American Academy of Dermatology psoriasis clinical guideline identifies systemic corticosteroid withdrawal among recognized psoriasis exacerbating factors.
This does not mean everyone with psoriasis must avoid systemic corticosteroids under all circumstances. There are medical situations in which corticosteroids may be necessary, and treatment decisions should account for the condition being treated and the individual's risks.
What to do—and what not to do—if you suspect a medicine is worsening psoriasis
Do | Don't |
Write down when the new medicine was started | Stop an important prescription suddenly |
Note when your psoriasis began or worsened | Assume timing alone proves the medicine caused the flare |
Photograph changes in your skin if useful for tracking | Restart or change prescription doses yourself to “test” the connection |
Tell your dermatologist about prescription, OTC, and topical medicines | Forget to mention supplements and nonprescription medicines |
Ask the prescribing clinician whether alternatives are appropriate | Assume every medicine within a drug class affects everyone equally |
Seek prompt care for severe or rapidly spreading symptoms | Delay care while waiting for a suspected medicine to leave your system |
How Can You Tell Whether a Medication Is Causing Your Psoriasis Flare?
There is no single routine test that can prove a particular medicine caused a psoriasis flare. Clinicians generally assess the timing of medication exposure, psoriasis history, other possible triggers, appearance of the skin eruption, and what happens after treatment changes when those changes are medically appropriate.
One difficulty is latency—the time between starting a medicine and developing symptoms. A medication-related flare does not necessarily begin immediately.
The AAD notes that some patients may flare a few weeks after starting a triggering medication, but latency can differ substantially depending on the drug and individual.
Another challenge is competing triggers. An infection, for example, can trigger psoriasis, yet the antibiotic prescribed for that infection might initially appear to be responsible simply because both occurred around the same time. DermNet specifically highlights this difficulty when discussing antibiotics and psoriasis.
What should you tell your dermatologist?
Bring a complete medication list rather than mentioning only medicines you consider relevant. Include prescription medicines, over-the-counter products, topical treatments, supplements, and recently stopped medicines.
It can also help to provide approximate start dates, recent dose changes, infections, major stress, and when your psoriasis changed. This timeline gives your healthcare team more information for judging whether a medicine is a plausible trigger.
What Should You Do If You Think a Medicine Is Worsening Psoriasis?
Do not stop a prescribed medicine on your own simply because your psoriasis has worsened. Contact the clinician who prescribed it and, when appropriate, your dermatologist so they can assess whether the medicine is a plausible trigger and whether continuing, modifying, or replacing treatment is safest.
The AAD patient guidance on psoriasis triggers explicitly advises patients who suspect a medication trigger not to stop taking the medicine before speaking with the prescriber.
Your healthcare team may consider several questions:
Did the psoriasis change after starting or changing the medicine?
Is the drug strongly or weakly associated with psoriasis?
Are there other likely triggers?
How severe is the skin disease?
How important is the medicine for the condition being treated?
Is an appropriate alternative available?
Can the psoriasis itself be treated while the necessary medication continues?
Sometimes the best option may be to continue the suspected medicine and manage the psoriasis. In other circumstances, the prescriber may determine that an alternative is appropriate. That decision depends on the individual clinical situation.
When Should You Seek Medical Care?
Contact your dermatologist or healthcare professional if psoriasis suddenly becomes substantially worse after starting or changing a medicine, spreads rapidly, becomes painful, or is no longer responding to your usual treatment.
Seek urgent medical attention for widespread redness accompanied by severe illness, fever, chills, dehydration, rapid heartbeat, or extensive pustules. Severe forms of psoriasis can require urgent assessment and should not be managed simply by stopping a suspected medicine at home.
You should also obtain prompt medical advice before stopping medicines that can cause serious problems when withdrawn suddenly. This is particularly important with medicines prescribed for psychiatric, cardiovascular, neurological, inflammatory, or other significant medical conditions.
If a new rash is accompanied by facial or throat swelling, difficulty breathing, blistering, peeling skin, or sores involving the mouth or eyes, seek urgent medical care. These findings may represent a serious drug reaction rather than an ordinary psoriasis flare.
Conclusion
Several medications that can trigger or worsen psoriasis have been identified, with lithium, beta-blockers, antimalarial medicines, interferons, imiquimod, and terbinafine among the more established associations. Other drugs have been reported too, but the strength of evidence varies, and a flare occurring after medication exposure does not automatically prove causation.
If your psoriasis changes after starting, stopping, or adjusting a medicine, document the timing and discuss it with your dermatologist and prescribing clinician. Do not abruptly discontinue prescription treatment on your own. A coordinated review can help balance psoriasis control with safe treatment of the medical condition for which the medicine was prescribed.
Frequently Asked Questions
1. What medications are most likely to worsen psoriasis?
Lithium, beta-blockers, synthetic antimalarials, interferons, imiquimod, and terbinafine have some of the more established associations with drug-related psoriasis. Other medicines have also been reported, but evidence varies. Taking one of these medicines does not mean you will necessarily develop a flare.
2. Can blood pressure medicine make psoriasis worse?
Some cardiovascular medicines, particularly beta-blockers, have been associated with new or worsening psoriasis, while ACE inhibitors have also been reported as possible triggers. Evidence is not equally strong for every medicine. Never stop blood pressure treatment without discussing the risks and alternatives with your prescriber.
3. Can hydroxychloroquine worsen psoriasis?
Yes, hydroxychloroquine and related synthetic antimalarial medicines have long been associated with triggering or exacerbating psoriasis in some people. This does not mean everyone with psoriasis must automatically stop or avoid them. Discuss your psoriasis history and treatment needs with the prescribing clinician.
4. How quickly can a medication cause a psoriasis flare?
The timing varies considerably depending on the medicine and individual, and symptoms may not appear immediately. Some medication-related flares develop weeks or even months after treatment begins. A healthcare professional can assess the timeline alongside infections, stress, and other possible psoriasis triggers.
5. Will psoriasis improve after stopping the triggering medication?
It may improve, but not always immediately or completely. Drug-associated psoriasis can sometimes persist even after the suspected medicine is withdrawn. Because stopping treatment can also be medically risky, the decision should be made with the prescribing clinician rather than used as a self-directed test.
6. Should I stop a medicine if I think it is causing psoriasis?
No, do not abruptly stop a prescribed medicine without medical advice. Some medications can cause significant health problems if suddenly discontinued, and the medicine may not actually be responsible for your flare. Contact the prescriber and dermatologist to review the timing, alternatives, and psoriasis treatment options.
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