A review of drugs that induce or exacerbate psoriasis

Background: Psoriasis is a common disorder of the skin, immune system, and joints that is influenced by genetic and environmental factors. It can be aggravated or induced by drugs. Objectives: To identify the major drugs implicated in inducing or exacerbating psoriasis and to discuss their characteristics. Methods: We performed a PubMed literature search for reviews and case reports on drugs that exacerbate or induce psoriasis. Articles were screened by title and abstract and then examined for their findings and references. Results: Drugs most often reported to exacerbate or induce psoriasis were β-blockers, lithium, synthetic antimalarials, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, interferons, tetracyclines, tumor necrosis factor-α inhibitors, and steroid withdrawal. Conclusions: Characterizing drugs that induce or exacerbate psoriasis by latency and type of psoriatic eruption can help guide clinical reasoning. Although a relatively uncommon occurrence, psoriatic lesions can be caused by drugs, allowing astute physicians to recognize and change their management plans accordingly. A review of drugs that induce or exacerbate psoriasis 1Mount Sinai School of Medicine, New York, New York; 2Albany Medical College, Albany, New York Corresponding author Daniel Bernstein, BS 1125 Crescent Dr. Tarrytown, NY 10591 Tel: 315.254.7454 E-mail: [email protected] Disclosures The authors have no conflicts of interest to declare. introduction Psoriasis is a chronic systemic, inflammatory disease that is manifested in the skin, nails, and joints. Although psoriasis is currently thought of as a disorder of the immune system, many environmental factors can affect the type and location of specific lesions. Of the several known triggers for psoriasis, drugs can exacerbate psoriasis even after long latency periods. This article focuses on several drugs associated with worsening or development of psoriasis. Those drugs most widely accepted as offenders are β-blockers, lithium, synthetic antimalarials, tetracyclines, and nonsteroidal anti-inflammatory drugs (NSAIDs); withdrawal from systemic corticosteroids can also be a trigger. Other drugs commonly reported to worsen or induce psoriasis include, but are not limited to, interferons, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor