Drug Safety

, Volume 42, Issue 12, pp 1507–1513 | Cite as

Psoriasis After Exposure to Angiotensin-Converting Enzyme Inhibitors: French Pharmacovigilance Data and Review of the Literature

  • Brahim AzzouzEmail author
  • Aurore Morel
  • Lukshe Kanagaratnam
  • Emmanuelle Herlem
  • Thierry Trenque
Original Research Article



Angiotensin-converting enzyme inhibitors (ACEIs) can induce or aggravate psoriasis. This risk is not specified in the Summary of Product Characteristics (SmPC) of some drugs of this class, such as captopril or enalapril. We aimed to investigate the association between psoriasis and ACEI exposure.


We analyzed spontaneous reports recorded in the French national Pharmacovigilance Database (FPVD) from 1985 to 31 December 2018. The association between psoriasis and ACEI exposure was assessed using the case/non-case method. We also reviewed literature reports.


One hundred reports of psoriasis after ACEI exposure were registered in the FPVD. The reporting odds ratio (ROR) was 2.40 (95% CI 1.96–2.95). Time to onset was < 1 year in 67% of reports. Outcome was favorable in 73% of reports after ACEI discontinuation. Almost all ACEIs were concerned. In the literature, we found 21 published reports of psoriasis with ACEIs. Time to onset ranged from 1 week to 4 months. Outcome was also favorable after ACEI discontinuation in over half of the literature reports.


We found a statistically significant association between psoriasis and ACEI, which constitutes a potential safety signal. The risk of psoriasis is a class effect, time to onset is less than 1 year, and outcome is favorable after ACEI discontinuation. Psoriasis should be mentioned in the SmPCs of all ACEIs, and healthcare professionals should be informed about this risk.



The authors thank Fiona Escarnot (EA3920, University Hospital Besancon, France) for translation and editorial assistance. We also thank all team members of the 31 French Pharmacovigilance Centres as well as the French Drug Safety Agency (ANSM) for the availability of the data.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this study.

Conflict of interest

Brahim Azzouz, Aurore Morel, Emmanuelle Herlem, Lukshe Kanagaratnam and Thierry Trenque have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol JEADV. 2017;31(2):205–12.CrossRefGoogle Scholar
  2. 2.
    Lowes MA, Suárez-Fariñas M, Krueger JG. Immunology of psoriasis. Annu Rev Immunol. 2014;32:227–55.CrossRefGoogle Scholar
  3. 3.
    Griffiths CE, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet. 2007;370(9583):263–71.CrossRefGoogle Scholar
  4. 4.
    Chandra A, Ray A, Senapati S, Chatterjee R. Genetic and epigenetic basis of psoriasis pathogenesis. Mol Immunol. 2015;64(2):313–23.CrossRefGoogle Scholar
  5. 5.
    Tsankov N, Angelova I, Kazandjieva J. Drug-induced psoriasis. Recognition and management. Am J Clin Dermatol. 2000;1(3):159–65.CrossRefGoogle Scholar
  6. 6.
    Rongioletti F, Fiorucci C, Parodi A. Psoriasis induced or aggravated by drugs. J Rheumatol Suppl. 2009;83:59–61.CrossRefGoogle Scholar
  7. 7.
    Kim GK, Del Rosso JQ. Drug-provoked psoriasis: is it drug induced or drug aggravated? J Clin Aesthetic Dermatol. 2010;3(1):32–8.Google Scholar
  8. 8.
    Ferrari R, Guardigli G, Ceconi C. Secondary prevention of CAD with ACE inhibitors: a struggle between life and death of the endothelium. Cardiovasc Drugs Ther. 2010;24(4):331–9.CrossRefGoogle Scholar
  9. 9.
    Brown EG, Wood L, Wood S. The medical dictionary for regulatory activities (MedDRA). Drug Saf. 1999;20(2):109–17.CrossRefGoogle Scholar
  10. 10.
    Arimone Y, Bidault I, Dutertre J-P, Gérardin M, Guy C, Haramburu F, et al. Updating the French method for the causality assessment of adverse drug reactions. Thérapie. 2013;68(2):69–76.PubMedGoogle Scholar
  11. 11.
    Montastruc J-L, Sommet A, Bagheri H, Lapeyre-Mestre M. Benefits and strengths of the disproportionality analysis for identification of adverse drug reactions in a pharmacovigilance database. Br J Clin Pharmacol. 2011;72(6):905–8.CrossRefGoogle Scholar
  12. 12.
    Woolf B. On estimating the relation between blood group and disease. Ann Hum Genet. 1955;19(4):251–3.CrossRefGoogle Scholar
  13. 13.
    Brauchli YB, Jick SS, Curtin F, Meier CR. Lithium, antipsychotics, and risk of psoriasis. J Clin Psychopharmacol. 2009;29(2):134–40.CrossRefGoogle Scholar
  14. 14.
    Antonov D, Grozdev I, Pehlivanov G, Tsankov N. Psoriatic erythroderma associated with enalapril. Skinmed. 2006;5(2):90–2.CrossRefGoogle Scholar
  15. 15.
    Thakor P, Padmanabhan M, Johnson A, Pararajasingam T, Thakor S, Jorgensen W. Ramipril-induced generalized pustular psoriasis: case report and literature review. Am J Ther. 2010;17(1):92–5.CrossRefGoogle Scholar
  16. 16.
    Wolf R, Tamir A, Brenner S. Psoriasis related to angiotensin-converting enzyme inhibitors. Dermatologica. 1990;181(1):51–3.CrossRefGoogle Scholar
  17. 17.
    Wolf R, Dorfman B, Krakowski A. Psoriasiform eruption induced by captopril and chlorthalidone. Cutis. 1987;40(2):162–4.PubMedGoogle Scholar
  18. 18.
    Hamlet NW, Keefe M, Kerr RE. Does captopril exacerbate psoriasis? Br Med J Clin Res Ed. 1987;295(6609):1352.CrossRefGoogle Scholar
  19. 19.
    Hauschild TT, Bauer R, Kreysel HW. Initial manifestation of eruptive exanthematous psoriasis vulgaris caused by captopril medication. Hautarzt Z Dermatol Venerol Verwandte Geb. 1986;37(5):274–7.Google Scholar
  20. 20.
    Coulter DM, Pillans PI. Angiotensin-converting enzyme inhibitors and psoriasis. N Z Med J. 1993;106(963):392–3.PubMedGoogle Scholar
  21. 21.
    Gilleaudeau P, Vallat VP, Carter DM, Gottlieb AB. Angiotensin-converting enzyme inhibitors as possible exacerbating drugs in psoriasis. J Am Acad Dermatol. 1993;28(3):490–2.CrossRefGoogle Scholar
  22. 22.
    Eriksen JG, Christiansen JJ, Asmussen I. Postulosis palmoplantaris caused by angiotensin-converting enzyme inhibitors. Ugeskr Laeger. 1995;157(23):3335–6.PubMedGoogle Scholar
  23. 23.
    Stavropoulos PG, Kostakis PG, Papakonstantinou AMK, Panagiotopoulos A, Petridis AD. Coexistence of psoriasis and pemphigus after enalapril intake. Dermatol Basel Switz. 2003;207(3):336–7.CrossRefGoogle Scholar
  24. 24.
    Vena GA, Cassano N, Coco V, De Simone C. Eczematous reactions due to angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Immunopharmacol Immunotoxicol. 2013;35(3):447–50.CrossRefGoogle Scholar
  25. 25.
    Perrine AL, Lecoffre C, Blacher J, Olié V. L’hypertension artérielle en France: prévalence, traitement et contrôle en 2015 et évolutions depuis 2006. Bull Epidémiol Hebd. 2018;(10):170–9.
  26. 26.
    Bhosle MJ, Kulkarni A, Feldman SR, Balkrishnan R. Quality of life in patients with psoriasis. Health Qual Life Outcomes. 2006;4:35.CrossRefGoogle Scholar
  27. 27.
    Armstrong AW. Psoriasis provoked or exacerbated by medications: identifying culprit drugs. JAMA Dermatol. 2014;150(9):963.CrossRefGoogle Scholar
  28. 28.
    Hazell L, Shakir SAW. Under-reporting of adverse drug reactions: a systematic review. Drug Saf. 2006;29(5):385–96.CrossRefGoogle Scholar
  29. 29.
    Sehgal VN, Dogra S, Srivastava G, Aggarwal AK. Psoriasiform dermatoses. Indian J Dermatol Venereol Leprol. 2008;74(2):94.CrossRefGoogle Scholar
  30. 30.
    Cohen AD, Bonneh DY, Reuveni H, Vardy DA, Naggan L, Halevy S. Drug exposure and psoriasis vulgaris: case–control and case-crossover studies. Acta Derm Venereol. 2005;85(4):299–303.CrossRefGoogle Scholar
  31. 31.
    Brauchli YB, Jick SS, Curtin F, Meier CR. Association between beta-blockers, other antihypertensive drugs and psoriasis: population-based case–control study. Br J Dermatol. 2008;158(6):1299–307.CrossRefGoogle Scholar
  32. 32.
    Wu S, Han J, Li W-Q, Qureshi AA. Hypertension, antihypertensive medication use, and risk of psoriasis. JAMA Dermatol. 2014;150(9):957–63.CrossRefGoogle Scholar
  33. 33.
    Ceconi C, Francolini G, Olivares A, Comini L, Bachetti T, Ferrari R. Angiotensin-converting enzyme (ACE) inhibitors have different selectivity for bradykinin binding sites of human somatic ACE. Eur J Pharmacol. 2007;577(1–3):1–6.CrossRefGoogle Scholar
  34. 34.
    Tanhapour M, Falahi B, Vaisi-Raygani A, Bahrehmand F, Kiani A, Rahimi Z, et al. Angiotensin-converting enzyme insertion/deletion (rs106180) and angiotensin type 1 receptor A1166 C (rs106165) genotypes and psoriasis: Correlation with cellular immunity, lipid profile, and oxidative stress markers. J Cell Biochem. 2019;120:2627–33.CrossRefGoogle Scholar
  35. 35.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). Eur Heart J. 2013;34(28):2159–219.CrossRefGoogle Scholar
  36. 36.
    Balak DM, Hajdarbegovic E. Drug-induced psoriasis: clinical perspectives. Psoriasis Auckl NZ. 2017;7:87–94.Google Scholar
  37. 37.
    Campese VM, Lakdawala R. The challenges of blood pressure control in dialysis patients. Recent Adv Cardiovasc Drug Discov. 2015;10(1):34–59.CrossRefGoogle Scholar
  38. 38.
    ACE-inhibitors and psoriasis. Accessed 8 Oct 2018

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Regional Centre of Pharmacovigilance and PharmacoepidemiologyReims University HospitalReimsFrance
  2. 2.EA 3797, Faculty of MedicineUniversity of Reims Champagne-ArdenneReimsFrance
  3. 3.Department of Research and Public HealthReims University HospitalReimsFrance

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