American Journal of Clinical Dermatology

, Volume 1, Issue 3, pp 159–165 | Cite as

Drug-Induced Psoriasis

Recognition and Management
  • Nikolai Tsankov
  • Irena Angelova
  • Jana Kazandjieva
Review Article


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.


Psoriasis Psoriatic Lesion Lithium Salt Pustular Psoriasis Lithium Compound 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Tsankov N., Kazandjieva J., Drenovska K. Drugs in exacerbation and provocation of psoriasis. Clin Dermatol 1998; 16: 333–351PubMedCrossRefGoogle Scholar
  2. 2.
    Gaylarde P.M., Brocq A.P., Sarkany I. Psoriasiform changes in guinea pig skin from propranolol. Clin Exp Dermatol 1978; 3: 157–160PubMedCrossRefGoogle Scholar
  3. 3.
    Wolf R., Shechter H., Brenner S. Induction of psoriasiform changes in guinea pig skin by propranolol. Int J Dermatol 1994; 33: 811–814PubMedCrossRefGoogle Scholar
  4. 4.
    Leonard J.C. Oxprenolol and a psoriasis-like eruption. Lancet 1975; I: 630CrossRefGoogle Scholar
  5. 5.
    Cumberbatch JB. Skin reactions to beta-blockers. BMJ 1974; 4: 528PubMedCrossRefGoogle Scholar
  6. 6.
    Hudson W.A., Finnis WA. Oxprenolol and a psoriasis-like eruption. Lancet 1975; 1: 932PubMedCrossRefGoogle Scholar
  7. 7.
    Berowa N., Tsankov N., Gruev A. Arzneimittelexantheme bei der Behandlung mit Beta-blockern. Dtsch Dermatologe 1984; 32: 1082–1089Google Scholar
  8. 8.
    MacFarlane D.G., Settas L. Acute psoriatic arthropathy precipitated by oxprenolol. Ann Rheum Dis 1984; 43: 102–104PubMedCrossRefGoogle Scholar
  9. 9.
    Assem E.S.K., Banks R.A. Practolol induced drug eruptions. Proc R Soc Med 1973; 66: 179–181PubMedGoogle Scholar
  10. 10.
    Cohran R., Thomson J., Fleming K. The psoriasiform eruption induced by practolol: a clinicopathological study. J Cutan Pathol 1975; 2: 314–318CrossRefGoogle Scholar
  11. 11.
    Wright P. Untoward effects associated with practolol administration: oculo-mucocutaneous syndrome. BMJ 1975; 1: 595–598PubMedCrossRefGoogle Scholar
  12. 12.
    Kauppinen K., Niemi K.M., Salo O.P. Cutaneous reactions to practolol. Clinical and histopathological study. Ann Clin Res 1976; 8: 232–240PubMedGoogle Scholar
  13. 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: 239–243Google Scholar
  14. 14.
    Neumann H.A.M., van Joost T. Adverse reactions of the skin to metoprolol and other beta-adrenoreceptor blocking agents. Dermatologica 1981; 162: 330–335PubMedCrossRefGoogle Scholar
  15. 15.
    Gawkrodger D.J., Beveridge GW. Psoriasiform reaction to atenolol. Clin Exp Dermatol 1984; 9: 92–94PubMedCrossRefGoogle Scholar
  16. 16.
    White W.B., Schulman P., McCabe E.J. Psoriasiform cutaneous eruptions induced by cetamolol hydrochloride. Arch Dermatol 1986; 122: 857–858PubMedCrossRefGoogle Scholar
  17. 17.
    Gold M.H., Holy A.K., Roenigk H.H. Beta-blocking drugs and psoriasis. J Am Acad Dermatol 1988; 19: 837–841PubMedCrossRefGoogle Scholar
  18. 18.
    Van Joost T.H., Smitt H.S. Skin reactions to propranolol and cross sensitivity to ß-adrenoreceptor blocking agents. Arch Dermatol 1981; 117: 600–601PubMedCrossRefGoogle Scholar
  19. 19.
    Puig L., Goni F.J., Roque A.M., et al. Psoriasis induced by ophthalmic timolol preparations. Am J Ophthalmol 1989; 108: 455–456PubMedGoogle Scholar
  20. 20.
    Coignet M., Sayag J. Collyre beta-bloquant et psoriasis. Nouv Dermatol 1990; 9: 552Google Scholar
  21. 21.
    Puig L., Goni F.J., Roque A.M., et al. Psoriasis induced by ophthalmic timolol preparations. Am J Ophthalmol 1989; 108: 455–456PubMedGoogle Scholar
  22. 22.
    Carter T.N. The relationship of lithium carbonate to psoriasis. Psychosomatics 1972; 13: 325–327PubMedGoogle Scholar
  23. 23.
    Skott A., Mobacken H., Starmark J.E. Exacerbation of psoriasis during lithium treatment. Br J Dermatol 1977; 96: 445–448PubMedCrossRefGoogle Scholar
  24. 24.
    Bakker J.B., Pepplinkhuitzen L. More about the relationship of lithium to psoriasis. Psychosomatics 1976; 17: 143–146PubMedGoogle Scholar
  25. 25.
    Hanada K., Tasaki M., Hashimoto I., et al. Development of psoriasis-like syndrome following lithium therapy. Biol Trace El Res 1978; 14: 169–177CrossRefGoogle Scholar
  26. 26.
    Slagel G.A., James WD. Plaquenil induced erythroderma. J Am Acad Dermatol 1985; 12: 857–862PubMedCrossRefGoogle Scholar
  27. 27.
    Baker H. The influence of chloroquine and related drugs on psoriasis and keratoderma blenorrhagicum. Br J Dermatol 1966; 78: 161–166CrossRefGoogle Scholar
  28. 28.
    Friedman S.S. Pustular psoriasis associated with hydroxy chloroquine. J Am Acad Dermatol 1987; 16: 1256–1257PubMedCrossRefGoogle Scholar
  29. 29.
    Bielicky T., Kvicalova E. Photosensitive psoriasis. Dermatologica 1964; 129: 339–348PubMedCrossRefGoogle Scholar
  30. 30.
    Kuflik E.G. Effect of antimalarial drugs on psoriasis. Cutis 1980; 26: 153–156PubMedGoogle Scholar
  31. 31.
    Powles A.W., Griffithis C.E.M., Seifert M.H., et al. Exacerbation of psoriasis by indomethacin. Br J Dermatol 1987; 117: 799–800PubMedCrossRefGoogle Scholar
  32. 32.
    Lazarova A., Tsankov N., Zlatkov N.B. Psoriasis induced by topically applied indomethacin. Clin Exp Dermatol 1989; 14: 260–261PubMedCrossRefGoogle Scholar
  33. 33.
    Ellis C.N., Fallon J.D., Heezen J.L., et al. Topical indomethacin exacerbates lesions of psoriasis. J Invest Dermatol 1983; 80: 362Google Scholar
  34. 34.
    Reshod.H., Hargreaves G.K., Vickers C.F. Generalized pustular psoriasis precipitated by phenylbutazone and oxyphenylbutazone. Br J Dermatol 1983; 109: 111–113CrossRefGoogle Scholar
  35. 35.
    Tsankov N., Krasteva M. Rifampin therapy in severe forms of psoriasis. J Dermatol Treat 1992; 3: 69–71CrossRefGoogle Scholar
  36. 36.
    Tsankov N., Kamarashev J. Rifampin in dermatology. Int J Dermatol 1993; 32: 401–406PubMedCrossRefGoogle Scholar
  37. 37.
    Flandin F. L’action de la pénicilline dans le psoriasis. Bull Soc Fr Dermatol Syphiligr 1959; 66: 494–500Google Scholar
  38. 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: 761–764PubMedCrossRefGoogle Scholar
  39. 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: 216Google Scholar
  40. 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: 289–290Google Scholar
  41. 41.
    Tsankov N., Vassileva S., Lazarova A., et al. Onset of psoriasis coincident with tetracycline therapy. Aust J Dermatol 1988; 29: 111–112CrossRefGoogle Scholar
  42. 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: 629–632PubMedCrossRefGoogle Scholar
  43. 43.
    Tsankov N., Lazarova A. Psoriasis and tetracyclines. [reply.] J Am Acad Dermatol 1990; 23: 770–771CrossRefGoogle Scholar
  44. 44.
    Tsankov N., Lazarova A., Nikolova A. Psoriasis vulgarte et tétracyclines. A propos de deux cas. Nouv Dermatol 1995; 14: 393–395Google Scholar
  45. 45.
    Tsankov N., Gantcheva M., Pecheva M., et al. Doxycicline induced psoriasis vulgaris. Dermatol i Venerol (Sofia) 1994; 33: 31–32Google Scholar
  46. 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: 858–862PubMedCrossRefGoogle Scholar
  47. 47.
    Halevy S., Livni E. Psoriasis and psoriasiform eruptions associated with propranolol — the role of an immunological mechanism. Arch Dermatol Res 1991; 283: 472–473PubMedCrossRefGoogle Scholar
  48. 48.
    Raftery E.B., Denman A.M. Systemic lupus erythematosus syndrome induced by practolol. BMJ 1973; 2: 452–455PubMedCrossRefGoogle Scholar
  49. 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: 352–358PubMedCrossRefGoogle Scholar
  50. 50.
    Voorhees J.J. Psoriasis as a possible defect of the adenyl cyclase-cyclic AMP cascade. Arch.Dermatol 1982; 118: 862–88PubMedCrossRefGoogle Scholar
  51. 51.
    Steinkraus V., Mensing H. Psoriasis und Beta-blockade. Hautarzt 1992; 43: 179–183PubMedGoogle Scholar
  52. 52.
    Paduart O., Heenen M. Pharmacological action of lithium in the pathogenesis of psoriasis, Eur J Dermatol 1995; 5: 413–415Google Scholar
  53. 53.
    Skoven I., Thormann J. Lithium compound treatment and psoriasis. Arch Dermatol 1979; 115: 1185–1187PubMedCrossRefGoogle Scholar
  54. 54.
    Di Giovanna J.J., Aoyagai T., Taylor R.T. Inhibition of epidermal adenyl cyclase by lithium carbonate. J Invest Dermatol 1981; 76: 259–263CrossRefGoogle Scholar
  55. 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: 2181–2184PubMedCrossRefGoogle Scholar
  56. 56.
    Wolf R., Schiavo A.L. Is transglutaminase the mediator between antimalarial drugs and psoriasis? Int J Dermatol 1997; 36: 10–13PubMedCrossRefGoogle Scholar
  57. 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: 541–544PubMedCrossRefGoogle Scholar
  58. 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: 244–247Google Scholar
  59. 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: 103–105PubMedCrossRefGoogle Scholar
  60. 60.
    Boothe J.H. The tetracyclines. In: Hlavka J.J., editor. Handbook of experimental pharmacology. Vol 78. The Tetracyclines. Berlin: Springer-Verlag, 1985: 451Google Scholar
  61. 61.
    Wright A.L., Colver GB. Tetracyclines — how safe are they? Clin Exp Dermatol 1988; 13: 57–61PubMedCrossRefGoogle Scholar
  62. 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: 35–38PubMedGoogle Scholar
  63. 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: 1702–1706Google Scholar
  64. 64.
    Hu C.H., Miller C.M., Pepperkorn R., et al. Generalized pustular psoriasis provoked by propranolol. Arch Dermatol 1985; 121: 1326–1327PubMedCrossRefGoogle Scholar
  65. 65.
    Wakefield P.E., Berger Tg., James W.D. Atenolol induced pustular psoriasis. Arch Dermatol 1990; 126: 968–969PubMedCrossRefGoogle Scholar
  66. 66.
    White S.W. Palmoplantar pustular psoriasis provoked by lithium therapy. J Am Acad Dermatol 1982; 7 660–662PubMedCrossRefGoogle Scholar
  67. 67.
    Lowe N.J., Ridgway HB. Generalized pustular psoriasis precipitated by lithium carbonate. Arch Dermatol 1971; 104: 352–358CrossRefGoogle Scholar
  68. 68.
    Rudolph R.I. Lithium induced psoriasis of the fingernails. J Am Acad Dermatol 1992; 26: 135–136PubMedCrossRefGoogle Scholar
  69. 69.
    Lambert D., Beer F., Gisselman R., et al. Manifestations cutanées des therapeutiques par le lithium. Ann Dermatol Venereol 1982; 109: 19–24PubMedGoogle Scholar
  70. 70.
    Abel E., Di Cicco L., Orenberg E., et al. Drugs in exacerbation of psoriasis. J Am Acad Dermatol 1986; 15: 1007–1022PubMedCrossRefGoogle Scholar
  71. 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: 75–95PubMedCrossRefGoogle Scholar
  72. 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: 453–458Google Scholar
  73. 73.
    Katayama H., Kawada A. Exacerbation of psoriasis induced by indomethacin. J Dermatol (Tokyo) 1981; 8: 323–327Google Scholar
  74. 74.
    Botev-Zlatkov N. Psoriasis. Sofia: Medizina I Fizkultura, 1987: 144Google Scholar

Copyright information

© Adis International Limited 2000

Authors and Affiliations

  • Nikolai Tsankov
    • 1
  • Irena Angelova
    • 1
  • Jana Kazandjieva
    • 1
  1. 1.Department of DermatologyMedical University SofiaSofiaBulgaria

Personalised recommendations