Skip to main content
SpringerLink
Log in

Drug-Induced Psoriasis

Recognition and Management

  • Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

As psoriasis is a common skin disorder, knowledge of the factors that may induce, trigger, or exacerbate the disease is of primary importance in clinical practice. Drug intake is a major concern in this respect, as new drugs are constantly being added to the list of factors that may influence the course of the disease. Drug ingestion may result in exacerbation of pre-existing psoriasis, in induction of psoriatic lesions on clinically uninvolved skin in patients with psoriasis, or in precipitation of the disease in persons without family history of psoriasis or in predisposed individuals. In view of their relationship to drug-provoked psoriasis, therapeutic agents may be classified as drugs with strong evidence for a causal relationship to psoriasis, drugs about which there are considerable but insufficient data to support the induction or aggravation of the disease, and drugs that are occasionally reported to be associated with aggravation or induction.

This review focuses on the most common causative agents for drug-induced, drug-triggered, or drug-aggravated psoriasis, such as ß-blockers, lithium, synthetic antimalarial drugs, nonsteroidal anti-inflammatory agents, and tetracyclines. Latency periods, pathogenetic mechanisms of action, clinical and histologic findings, and management guidelines for each drug are discussed to help clinicians to treat patients with suspected drug-influenced psoriasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. Tsankov N., Kazandjieva J., Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16: 333–351

    Article  PubMed  CAS  Google Scholar 

  2. Gaylarde P.M., Brocq A.P., Sarkany I. Psoriasiform changes in guinea pig skin from propranolol. Clin Exp Dermatol 1978; 3: 157–160

    Article  PubMed  CAS  Google Scholar 

  3. Wolf R., Shechter H., Brenner S. Induction of psoriasiform changes in guinea pig skin by propranolol. Int J Dermatol 1994; 33: 811–814

    Article  PubMed  CAS  Google Scholar 

  4. Leonard J.C. Oxprenolol and a psoriasis-like eruption. Lancet 1975; I: 630

    Article  Google Scholar 

  5. Cumberbatch JB. Skin reactions to beta-blockers. BMJ 1974; 4: 528

    Article  PubMed  CAS  Google Scholar 

  6. Hudson W.A., Finnis WA. Oxprenolol and a psoriasis-like eruption. Lancet 1975; 1: 932

    Article  PubMed  CAS  Google Scholar 

  7. Berowa N., Tsankov N., Gruev A. Arzneimittelexantheme bei der Behandlung mit Beta-blockern. Dtsch Dermatologe 1984; 32: 1082–1089

    Google Scholar 

  8. MacFarlane D.G., Settas L. Acute psoriatic arthropathy precipitated by oxprenolol. Ann Rheum Dis 1984; 43: 102–104

    Article  PubMed  CAS  Google Scholar 

  9. Assem E.S.K., Banks R.A. Practolol induced drug eruptions. Proc R Soc Med 1973; 66: 179–181

    PubMed  CAS  Google Scholar 

  10. Cohran R., Thomson J., Fleming K. The psoriasiform eruption induced by practolol: a clinicopathological study. J Cutan Pathol 1975; 2: 314–318

    Article  Google Scholar 

  11. Wright P. Untoward effects associated with practolol administration: oculo-mucocutaneous syndrome. BMJ 1975; 1: 595–598

    Article  PubMed  CAS  Google Scholar 

  12. Kauppinen K., Niemi K.M., Salo O.P. Cutaneous reactions to practolol. Clinical and histopathological study. Ann Clin Res 1976; 8: 232–240

    PubMed  CAS  Google Scholar 

  13. Sondergaard J., Vadskov S., Jensen He, et al. Aggravation of psoriasis and occurrence of psoriasiform cutaneous eruptions induced by practolol (Eraldin). Acta Dermatovenereol 1976; 56: 239–243

    CAS  Google Scholar 

  14. Neumann H.A.M., van Joost T. Adverse reactions of the skin to metoprolol and other beta-adrenoreceptor blocking agents. Dermatologica 1981; 162: 330–335

    Article  PubMed  CAS  Google Scholar 

  15. Gawkrodger D.J., Beveridge GW. Psoriasiform reaction to atenolol. Clin Exp Dermatol 1984; 9: 92–94

    Article  PubMed  CAS  Google Scholar 

  16. White W.B., Schulman P., McCabe E.J. Psoriasiform cutaneous eruptions induced by cetamolol hydrochloride. Arch Dermatol 1986; 122: 857–858

    Article  PubMed  CAS  Google Scholar 

  17. Gold M.H., Holy A.K., Roenigk H.H. Beta-blocking drugs and psoriasis. J Am Acad Dermatol 1988; 19: 837–841

    Article  PubMed  CAS  Google Scholar 

  18. Van Joost T.H., Smitt H.S. Skin reactions to propranolol and cross sensitivity to ß-adrenoreceptor blocking agents. Arch Dermatol 1981; 117: 600–601

    Article  PubMed  Google Scholar 

  19. Puig L., Goni F.J., Roque A.M., et al. Psoriasis induced by ophthalmic timolol preparations. Am J Ophthalmol 1989; 108: 455–456

    PubMed  CAS  Google Scholar 

  20. Coignet M., Sayag J. Collyre beta-bloquant et psoriasis. Nouv Dermatol 1990; 9: 552

    Google Scholar 

  21. Puig L., Goni F.J., Roque A.M., et al. Psoriasis induced by ophthalmic timolol preparations. Am J Ophthalmol 1989; 108: 455–456

    PubMed  CAS  Google Scholar 

  22. Carter T.N. The relationship of lithium carbonate to psoriasis. Psychosomatics 1972; 13: 325–327

    PubMed  CAS  Google Scholar 

  23. Skott A., Mobacken H., Starmark J.E. Exacerbation of psoriasis during lithium treatment. Br J Dermatol 1977; 96: 445–448

    Article  PubMed  CAS  Google Scholar 

  24. Bakker J.B., Pepplinkhuitzen L. More about the relationship of lithium to psoriasis. Psychosomatics 1976; 17: 143–146

    PubMed  CAS  Google Scholar 

  25. Hanada K., Tasaki M., Hashimoto I., et al. Development of psoriasis-like syndrome following lithium therapy. Biol Trace El Res 1978; 14: 169–177

    Article  Google Scholar 

  26. Slagel G.A., James WD. Plaquenil induced erythroderma. J Am Acad Dermatol 1985; 12: 857–862

    Article  PubMed  CAS  Google Scholar 

  27. Baker H. The influence of chloroquine and related drugs on psoriasis and keratoderma blenorrhagicum. Br J Dermatol 1966; 78: 161–166

    Article  Google Scholar 

  28. Friedman S.S. Pustular psoriasis associated with hydroxy chloroquine. J Am Acad Dermatol 1987; 16: 1256–1257

    Article  PubMed  CAS  Google Scholar 

  29. Bielicky T., Kvicalova E. Photosensitive psoriasis. Dermatologica 1964; 129: 339–348

    Article  PubMed  CAS  Google Scholar 

  30. Kuflik E.G. Effect of antimalarial drugs on psoriasis. Cutis 1980; 26: 153–156

    PubMed  CAS  Google Scholar 

  31. Powles A.W., Griffithis C.E.M., Seifert M.H., et al. Exacerbation of psoriasis by indomethacin. Br J Dermatol 1987; 117: 799–800

    Article  PubMed  CAS  Google Scholar 

  32. Lazarova A., Tsankov N., Zlatkov N.B. Psoriasis induced by topically applied indomethacin. Clin Exp Dermatol 1989; 14: 260–261

    Article  PubMed  CAS  Google Scholar 

  33. Ellis C.N., Fallon J.D., Heezen J.L., et al. Topical indomethacin exacerbates lesions of psoriasis. J Invest Dermatol 1983; 80: 362

    Google Scholar 

  34. Reshod.H., Hargreaves G.K., Vickers C.F. Generalized pustular psoriasis precipitated by phenylbutazone and oxyphenylbutazone. Br J Dermatol 1983; 109: 111–113

    Article  Google Scholar 

  35. Tsankov N., Krasteva M. Rifampin therapy in severe forms of psoriasis. J Dermatol Treat 1992; 3: 69–71

    Article  Google Scholar 

  36. Tsankov N., Kamarashev J. Rifampin in dermatology. Int J Dermatol 1993; 32: 401–406

    Article  PubMed  CAS  Google Scholar 

  37. Flandin F. L’action de la pénicilline dans le psoriasis. Bull Soc Fr Dermatol Syphiligr 1959; 66: 494–500

    Google Scholar 

  38. Rosenberg E.W., Noah P.W., Zanolli M.D., et al. Use of rifampin with penicillin and erythromycin in the treatment of psoriasis. J Am Acad Dermatol 1986; 14: 761–764

    Article  PubMed  CAS  Google Scholar 

  39. Botev-Zlatkov N., Tsankov N. Tonev S., et al. Drug therapy deteriorates the course of psoriasis [abstract]. 17th World Congress of Dermatology, Part II, West Berlin: Springer 1987: 216

    Google Scholar 

  40. Cohen-Tervaert W.C., Esseveld H. A study of the incidence of haemolytic streptococci in the throat in patients with psoriasis vulgaris with reference to their role in the pathogenesis of this disease. Dermatologica 1970; 140: 289–290

    Google Scholar 

  41. Tsankov N., Vassileva S., Lazarova A., et al. Onset of psoriasis coincident with tetracycline therapy. Aust J Dermatol 1988; 29: 111–112

    Article  CAS  Google Scholar 

  42. Tsankov N., Botev-Zlatkov N., Lazarova A., et al. Psoriasis and drugs: influence of tetracyclines on the course of psoriasis. J Am Acad Dermatol 1988; 19: 629–632

    Article  PubMed  CAS  Google Scholar 

  43. Tsankov N., Lazarova A. Psoriasis and tetracyclines. [reply.] J Am Acad Dermatol 1990; 23: 770–771

    Article  Google Scholar 

  44. Tsankov N., Lazarova A., Nikolova A. Psoriasis vulgarte et tétracyclines. A propos de deux cas. Nouv Dermatol 1995; 14: 393–395

    Google Scholar 

  45. Tsankov N., Gantcheva M., Pecheva M., et al. Doxycicline induced psoriasis vulgaris. Dermatol i Venerol (Sofia) 1994; 33: 31–32

    Google Scholar 

  46. Gupta A., Sibbald R.G., Knowles S., et al. 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. J Am Acad Dermatol 1997; 36: 858–862

    Article  PubMed  CAS  Google Scholar 

  47. Halevy S., Livni E. Psoriasis and psoriasiform eruptions associated with propranolol — the role of an immunological mechanism. Arch Dermatol Res 1991; 283: 472–473

    Article  PubMed  CAS  Google Scholar 

  48. Raftery E.B., Denman A.M. Systemic lupus erythematosus syndrome induced by practolol. BMJ 1973; 2: 452–455

    Article  PubMed  CAS  Google Scholar 

  49. Voorhees J.J., Duell E.A. Psoriasis as a possible defect of the adenyl cyclase-cyclic AMP cascade; a defective chalone mechanism? Arch.Dermatol 1971; 104: 352–358

    Article  PubMed  CAS  Google Scholar 

  50. Voorhees J.J. Psoriasis as a possible defect of the adenyl cyclase-cyclic AMP cascade. Arch.Dermatol 1982; 118: 862–88

    Article  PubMed  CAS  Google Scholar 

  51. Steinkraus V., Mensing H. Psoriasis und Beta-blockade. Hautarzt 1992; 43: 179–183

    PubMed  CAS  Google Scholar 

  52. Paduart O., Heenen M. Pharmacological action of lithium in the pathogenesis of psoriasis, Eur J Dermatol 1995; 5: 413–415

    Google Scholar 

  53. Skoven I., Thormann J. Lithium compound treatment and psoriasis. Arch Dermatol 1979; 115: 1185–1187

    Article  PubMed  CAS  Google Scholar 

  54. Di Giovanna J.J., Aoyagai T., Taylor R.T. Inhibition of epidermal adenyl cyclase by lithium carbonate. J Invest Dermatol 1981; 76: 259–263

    Article  Google Scholar 

  55. Beyaert R., Schulze-Osthoff K., Van Roy F. Synergic induction of interleukin-6 by tumor necrosis factor and lithium chloride in mice: possible role in the triggering and exacerbation of psoriasis by lithium treatment. Eur J Immunol 1992; 22: 2181–2184

    Article  PubMed  CAS  Google Scholar 

  56. Wolf R., Schiavo A.L. Is transglutaminase the mediator between antimalarial drugs and psoriasis? Int J Dermatol 1997; 36: 10–13

    Article  PubMed  CAS  Google Scholar 

  57. Lammers A.M., Van de Kerkof P.C.M. Leucotriene B4 fails to induce penetration of polymorphonuclear leucocytes into psoriatic lesions. Br J Dermatol 1987; 117: 541–544

    Article  PubMed  CAS  Google Scholar 

  58. Counis R., Koumanov K., Ranlin J., et al. Intepréetation du rôle antilipolytique de la tétracycline. Inhibition de l’adénylate cyclase in vitro. Eur J Biochem 1973; 37: 244–247

    CAS  Google Scholar 

  59. Forster S., Ilderton E., Summerly R., et al. The level of phospholipase A2 activity is raised in uninvolved epidermis of psoriasis. Br J Dermatol 1983; 108: 103–105

    Article  PubMed  CAS  Google Scholar 

  60. Boothe J.H. The tetracyclines. In: Hlavka J.J., editor. Handbook of experimental pharmacology. Vol 78. The Tetracyclines. Berlin: Springer-Verlag, 1985: 451

    Google Scholar 

  61. Wright A.L., Colver GB. Tetracyclines — how safe are they? Clin Exp Dermatol 1988; 13: 57–61

    Article  PubMed  CAS  Google Scholar 

  62. Powles A.V., Baker B.S., Rutman A.J., et al. Epidermal rupture is the initiating factor for the Koebner response in psoriasis. Acta Derm Venereol 1990; 70: 35–38

    PubMed  CAS  Google Scholar 

  63. Tsankov N., Pramatarov K., Kamarachev J. Psoriasis placata, die unter der Einwirkung der Beta-Blocker in eine Psoriasis pustulosa ubergeht. Dtsch Dermatologe 1992; 40: 1702–1706

    Google Scholar 

  64. Hu C.H., Miller C.M., Pepperkorn R., et al. Generalized pustular psoriasis provoked by propranolol. Arch Dermatol 1985; 121: 1326–1327

    Article  PubMed  CAS  Google Scholar 

  65. Wakefield P.E., Berger Tg., James W.D. Atenolol induced pustular psoriasis. Arch Dermatol 1990; 126: 968–969

    Article  PubMed  CAS  Google Scholar 

  66. White S.W. Palmoplantar pustular psoriasis provoked by lithium therapy. J Am Acad Dermatol 1982; 7 660–662

    Article  PubMed  CAS  Google Scholar 

  67. Lowe N.J., Ridgway HB. Generalized pustular psoriasis precipitated by lithium carbonate. Arch Dermatol 1971; 104: 352–358

    Article  Google Scholar 

  68. Rudolph R.I. Lithium induced psoriasis of the fingernails. J Am Acad Dermatol 1992; 26: 135–136

    Article  PubMed  CAS  Google Scholar 

  69. Lambert D., Beer F., Gisselman R., et al. Manifestations cutanées des therapeutiques par le lithium. Ann Dermatol Venereol 1982; 109: 19–24

    PubMed  CAS  Google Scholar 

  70. Abel E., Di Cicco L., Orenberg E., et al. Drugs in exacerbation of psoriasis. J Am Acad Dermatol 1986; 15: 1007–1022

    Article  PubMed  CAS  Google Scholar 

  71. Kammer G.M., Sotar N.A., Gibson D.J. Psoriatic arthritis: a clinical, immunologic, and HLA study of 100 patients. Semin Arthritis Rheum 1979; 9: 75–95

    Article  PubMed  CAS  Google Scholar 

  72. Tsankov N., Stoimenov A., Lazarova A. Psoriasis induit par la chloroquine chez un malade ayant un lupus erythemateux discoide. Rev Eur Dermatol MST 1990; 2: 453–458

    Google Scholar 

  73. Katayama H., Kawada A. Exacerbation of psoriasis induced by indomethacin. J Dermatol (Tokyo) 1981; 8: 323–327

    CAS  Google Scholar 

  74. Botev-Zlatkov N. Psoriasis. Sofia: Medizina I Fizkultura, 1987: 144

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Medical University Sofia, 1 St Georg i Sofiski Street, 1431, Sofia, Bulgaria

    Nikolai Tsankov, Irena Angelova & Jana Kazandjieva

Authors
  1. Nikolai Tsankov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irena Angelova
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jana Kazandjieva
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsankov, N., Angelova, I. & Kazandjieva, J. Drug-Induced Psoriasis. Am J Clin Dermatol 1, 159–165 (2000). https://doi.org/10.2165/00128071-200001030-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128071-200001030-00003

Keywords

Search

Navigation