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08/05/2024 | Press release | Distributed by Public on 08/05/2024 12:14

10 Medications That Can Cause Psoriasis Flare-Ups

Key takeaways:

  • Several prescription and over-the-counter (OTC) medications can trigger or worsen psoriasis. Common examples include beta-blockers, nonsteroidal anti-inflammatory drugs (NSAIDs), and terbinafine.

  • Psoriasis flares can happen weeks to months after starting a new medication. Some new cases of psoriasis have also been reported.

  • Stopping the medication may be enough to improve or reverse your psoriasis flare. But not all medications are safe to stop abruptly, so your healthcare professional can tell you specifically what to do.

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Psoriasis is a chronic autoimmune disorder that causes thick scales to build up on your skin. It's associated with other medical conditions, like heart disease and diabetes. For people living with psoriasis, many things can trigger worsening symptoms. Triggers can include specific foods, smoking, and stress. But medications are one of the most common causes of psoriasis flaring up.

In addition to worsening existing psoriasis symptoms, some medications can also cause new psoriasis. When this happens, it's called drug-induced psoriasis.

Let's review 10 common medications that can trigger psoriasis - and why.

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Keep in mind: The medications below don't cause psoriasis in everyone. And, there are other medications not included in this list that can trigger psoriasis.

1. Beta-blockers

Beta-blockers are a common class of medications used to treat high blood pressure, heart failure, and migraines. Examples include:

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Beta-blockers can worsen existing psoriasis. It's also possible they may cause new psoriasis, but the evidence for this is much less clear-cut.

2. Lithium

Lithium is a medication used to treat bipolar disorder. Studies have shown that lithium can cause psoriasis in some people who've never had it. It can also worsen skin symptoms in people who already have psoriasis.

3. Terbinafine

Terbinafine (Lamisil) is a pill used to treat fungal infections of the skin, hair, and nails. Some people have noticed their psoriasis flaring after starting terbinafine.

4. Antimalarials

Chloroquine and hydroxychloroquine (Plaquenil) are medications used to treat and prevent malaria, a serious blood disease transmitted by mosquitoes. Hydroxychloroquine is also used to treat some autoimmune disorders, like lupus and rheumatoid arthritis. Chloroquine and hydroxychloroquine have been linked to worsening psoriasis symptoms, and much less commonly, new psoriasis development.

5. Imiquimod

This is a medicated cream used to treat skin cancers, certain precancers, and genital warts. In some people, worsening psoriasis has been triggered after starting imiquimod (Aldara).

6. Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are a class of medications that treat pain and lower inflammation. They're used to treat many different conditions, like fever, headaches, and menstrual cramps. They can be applied directly on the skin (like gels), taken as pills, or received as injections. Examples include:

NSAIDs can trigger worsening psoriasis symptoms, although this isn't as common as other skin side effects.

7. TNF-alpha inhibitors

TNF-alpha inhibitors ("TNF blockers") are biologic medications used to treat inflammatory health conditions, like psoriasis and Crohn's disease. They work by blocking certain signals in your immune system. Examples include infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel), which are given as injections or intravenous (IV) infusions.

Even though many of these medications are used to treat psoriasis, they can also make psoriasis worse in some people. Other types of biologics, like vedolizumab (Entyvio) and rituximab (Rituxan), have been linked with developing psoriasis.

8. Anti-PD1 medications

Nivolumab (Opdivo) and pembrolizumab (Keytruda) are types of biologic medications used to treat different cancers, like liver cancer and some lung cancers. They're given as IV infusions, and they fight cancer by interfering with proteins called PD-1.

Some people have noticed psoriasis develop or get worse after starting these medications.

9. Bupropion

Bupropion (Wellbutrin, Zyban) is a pill used to treat depression and to help people stop smoking. Some people have noticed their psoriasis gets worse after starting bupropion.

10. Other medications

There are some other medications that can also cause a psoriasis flare. These are much less common, but they're good to know about:

How do medications make psoriasis worse?

Several different medications can make psoriasis worse or cause you to develop psoriasis. This can happen even if you've never had it before. Medications have been linked to all different types of psoriasis, from the most common (plaque psoriasis) to the least common (erythrodermic psoriasis).

It's not clear how most medications make psoriasis worse. Some medications may have a direct effect on your skin and cause worsening psoriasis patches or new patches to develop. Other medications may have an indirect effect by causing an allergic reaction or sun sensitivity that can then trigger psoriasis to develop.

When you stop the medication, sometimes the psoriasis will get better and sometimes it won't. Every person is different, and you may need additional psoriasis treatment to improve symptoms.

How fast does psoriasis flare up?

It depends. Psoriasis flares from a medication can vary depending on the person and the medication.

For example, some medications (like terbinafine) can cause psoriasis to flare within 2 weeks, while others (like beta-blockers) can take up to 12 months.

Since this can vary so much from person to person, it may be difficult to know which medications - if any - are causing your psoriasis to worsen.

How long does a psoriasis flare-up last?

This also depends. For some people, a psoriasis flare will go away a few weeks after stopping the offending medication. For others, the flare-up may last even longer or not go away at all.

Will drug-induced psoriasis go away?

Yes. For many people, drug-induced psoriasis will go away after the medication is stopped. In some situations, however, treatment is needed to get the flare under control.

What to do if your medication triggers your psoriasis

Psoriasis that is caused or worsened by a medication can look similar to regular psoriasis. So, it can be hard to know if a medication is to blame for your flare. It's important to keep in mind that other things - like stress or an illness - can also trigger psoriasis.

If you think a medication is making your psoriasis worse, your first step is to talk to your prescriber about your options for treating your psoriasis flare-up. It's important that you don't stop any medications on your own. Your prescriber will help you come up with a plan to stop the medication and start a new one if needed.

In some situations, just stopping the medication will improve or reverse the psoriasis flare. In other situations, you'll need to treat the psoriasis even after stopping the medication. If this happens, your healthcare professional will help you come up with the best treatment plan for you.

Frequently asked questions

What makes psoriasis worse?
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Many things can make psoriasis worse - from the medications you take to the foods you eat. Other psoriasis triggers include:

  • Smoking

  • Alcohol

  • Stress

  • Skin injuries

  • Everyday common illnesses

Your triggers are unique to you. Knowing and avoiding them can help keep your psoriasis from getting worse.

What is the biggest trigger for psoriasis?
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There's no single biggest psoriasis trigger. Psoriasis triggers are different for different people. Paying attention to your everyday habits and psoriasis symptoms can help you identify what makes your psoriasis worse.

How do you calm down a psoriasis flare-up?
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The first step is to cut out any known or suspected triggers you have identified. This might be enough to turn things around. But if that doesn't work, you may need a short course of prescription medications. The most common medication is a steroid cream or ointment. When steroids aren't doing the trick, there are other prescription medications that can help.

Can steroids worsen psoriasis?
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Steroid creams (like triamcinolone) are one of the most effective treatments for psoriasis. But if stronger steroids are used, like those given as pills or a shot, some people will experience a psoriasis flare when the medication is stopped.

This is known as a rebound effect. Because of this, stronger steroids aren't recommended to treat psoriasis. If you experience a psoriasis flare after taking a strong steroid, you may need additional treatment with another medication (like a biologic) to get it under control.

The bottom line

Psoriasis is a common autoimmune skin condition. There are certain medications that can worsen psoriasis, and even cause new psoriasis in people who've never had it before. Three examples are beta-blockers, NSAIDs, and terbinafine. Stopping the medication may be enough to improve or reverse the psoriasis flare. But see your dermatologist if you think a medication could be worsening your psoriasis.

References

Balak, D. M. W., et al. (2017). Drug-induced psoriasis: Clinical perspectives. Psoriasis: Targets and Therapy.

Centers for Disease Control and Prevention. (2024). About malaria.

View All References (11)
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Cox, N. H., et al. (2002). Generalized pustular and erythrodermic psoriasis associated with bupropion treatment. British Journal of Dermatology.

De Bock, M., et al. (2018). Psoriasis vulgaris exacerbation during treatment with a PD-1 checkpoint inhibitor: Case report and literature review. Case Report in Dermatology.

Gupta, A. K., et al. (1997). Terbinafine therapy may be associated with the development of psoriasis de novo or its exacerbation: Four case reports and a review of drug-induced psoriasis. Journal of the American Academy of Dermatology.

Kresch, M., et al. (2023). Risk of rebound psoriasis flare from systemic corticosteroid use in patients with psoriasis. Journal of the American Academy of Dermatology.

Machler, B., et al. (2011). Imiquimod induced psoriasis: A case report, review of the literature, and pathophysiologic mechanism. Journal of the American Academy of Dermatology.

National Psoriasis Foundation. (2022). Causes and triggers.

National Psoriasis Foundation. (2024). Locations and types.

Pan, K., et al. (2021). Association of benzodiazepine receptor agonist use with changes in psoriasis severity in adult population: A population-based study. Frontiers in Pharmacology.

Song, G., et al. (2021). A systematic review and meta-analysis of angiotensin-converting enzyme inhibitor use and psoriasis incidence. Scientific Reports.

Wölfer, L. U., et al. (1996). Interferon-alpha-induced psoriasis vulgaris. Der Hautarzt.

Wu, B. (2017). Drug-induced psoriasis. DermNet.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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