Drugs That Exacerbate Psoriasis

Major Psoriasis-Exacerbating Medications

• Lithium can cause severe, even life-threatening deterioration of psoriasis in patients with pre-existing psoriasis, according to the British Medical Journal 1, 2
• Antimalarials, such as chloroquine and hydroxychloroquine, can severely worsen psoriasis in patients with a history of the condition 1
• Beta-blockers can exacerbate pre-existing psoriasis or trigger new onset in susceptible individuals, with long-term use showing a stronger association with psoriasis development, as reported by the Journal of the American Academy of Dermatology 1, 3
• Non-steroidal anti-inflammatory drugs (NSAIDs) can worsen existing psoriasis in patients with the condition 1
• Alcohol can precipitate or worsen psoriasis in individuals with a history of the condition, according to the British Medical Journal 1, 2
• TNF inhibitors can paradoxically trigger psoriasis in some patients, as reported by the Journal of the American Academy of Dermatology 4, 5

Clinical Presentation and Mechanisms

Management Recommendations

• Consider dermatology consultation for patients with severe psoriasis requiring systemic agents, as recommended by the British Medical Journal 1

Special Considerations

• Pediatric patients are less likely to have psoriasis triggered by medications like beta-blockers, lithium, antimalarials, NSAIDs, and tetracyclines compared to adults, according to the Journal of the American Academy of Dermatology 4, 6
• Severity assessment should consider both objective measures, such as body surface area, and the patient's perception of disability when evaluating drug-induced psoriasis, as reported by the British Medical Journal 1
• Hypertension management should not avoid all antihypertensive medications in psoriasis patients, as the preponderance of evidence does not support this approach, according to the Journal of the American Academy of Dermatology 3