drug-induced psoriasis

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Drugs that may exacerbate existing psoriasis include:

  • lithium
  • antimalarials such as chloroquine
  • mepacrine
  • NSAIDs
  • beta-blockers
    • a review of French pharmacovigilance database between 1985 and 2019 found 225 reports of psoriatic conditions after beta-blocker exposure, with a reporting odds ratio of 8.95 (95%CI 7.75 to 10.33) (1)
      • mean time to onset of symptoms was 5 months
      • outcome was favorable in 68% after beta-blocker discontinuation
      • authors note this was a class effect
  • alcohol
  • interferons (2)
  • imiquimod (2)
  • terbinafine (2)

Drugs that have been reported to precipitate psoriasis in patients with no previous history of the disease include (2,3):

  • lithium
  • beta-blockers

Notes (2):

  • more recently, new associations have been reported for monoclonal antibody- and small-molecule-based targeted therapies used for oncological and immunological indications, such as tumor necrosis factor-alpha antagonists and anti-programmed cell death protein 1 immune checkpoint inhibitors
  • available evidence supporting the associations of drug-related psoriasis with various drugs is limited predominantly to anecdotal single-case reports or retrospective case series. Exceptions to this are beta-blockers, lithium, and tumor necrosis factor (TNF)-alpha antagonists, for which the associations with drug-related psoriasis were assessed in large-cohort studies or case-control studies
  • management:
    • first step in the management of drug-related psoriasis is stopping and replacing the offending agent when possible
      • however, the psoriasis skin lesions may show no to minimal improvement upon treatment discontinuation of the suspected drug
      • when additional skin-directed therapy is needed, the treatment options that are normally available for psoriasis can be initiated
        • options include topical treatments with corticosteroids and/or vitamin D analogs, ultraviolet-based phototherapy and systemic treatments, such as methotrexate, acitretin, and fumaric acid esters, and biologics

Reference:

Last edited 03/2022 and last reviewed 05/2022

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