What are the other Names for this Condition? (Also known as/Synonyms)

• Medication-Induced Psoriasis

What is Drug-Induced Psoriasis? (Definition/Background Information)

• Psoriasis is a common chronic inflammatory skin disease that develops from a genetic defect. This condition causes the skin to grow abnormally, resulting in the formation of skin lesions. Psoriasis can run in families but is not contagious
• Drug-Induced Psoriasis occurs secondary to the use of certain medication as an adverse reaction of the body to the drugs. However, in some cases, discontinuing the offending medications still causes a progression of psoriasis. This is known as drug-aggravated psoriasis
• Stopping or discontinuing the use of such medications may decrease the progression of Drug-Induced Psoriasis and/or may result in the resolution of the condition. Considering adequate treatment of psoriasis and stoppage of the offending medication can help yield good outcomes

Who gets Drug-Induced Psoriasis? (Age and Sex Distribution)

• Individuals of all ages may be affected by Drug-Induced Psoriasis. However, psoriasis commonly develops during teenage or into old age
• Both males and females are affected
• Worldwide, individuals of all racial and ethnic groups may be affected. In general, Caucasians have a higher prevalence of psoriasis compared to other racial groups

What are the Risk Factors for Drug-Induced Psoriasis? (Predisposing Factors)

The key risk factor for Drug-Induced Psoriasis is the use of certain medications that cause the condition as a side effect. The following class of medications have been implicated:

• Adrenergic antagonists
• Angiotensin-converting enzyme (ACE) inhibitors
• Antibiotics such as amoxicillin
• Antimalarials such as hydroxychloroquine and chloroquine
• Beta blockers such as propranolol and metoprolol - noted in 20% of the cases
• Gold salts
• Lithium drugs (mood stabilizers prescribed for mental health issues) - seen in nearly 50% of the cases
• Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen 
• Tumor necrosis factor-alpha (TNF-α) inhibitors

The following factors are known to contribute to an increased risk for the condition:

• Being obese
• Chronic smoking
• Dyslipidemia (abnormally-high fat levels in blood)
• High blood pressure (hypertension)
• Poorly-controlled diabetes
• Personal or family history of psoriasis is a key predisposing factor for drug-aggravated psoriasis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Drug-Induced Psoriasis? (Etiology)

Psoriasis develops from the uncontrollable proliferation of skin cells known as keratinocytes. However, the exact cause of psoriasis development is still unknown.

• Drug-Induced Psoriasis develops from the use of certain medications/drugs that are administered for various health conditions. It is believed that the offending drug potentially causes an abnormal cell-mediated immune response in the body 
• Sometimes, the appearance of signs and symptoms due to the drug may not be observed immediately after starting the medication. The condition may arise after a period of time

What are the Signs and Symptoms of Drug-Induced Psoriasis?

The signs and symptoms of Drug-Induced Psoriasis may vary from one individual to another. It may also be mild or severe and related to the type and usage of the drug. The condition is known to get better after stoppage of the offending medication.

The following forms of psoriasis may develop from Drug-Induced Psoriasis or drug-aggravated psoriasis:

• Psoriasis that is localized to a body region and presenting plaque formation; the involvement of the knees, elbows, scalp, groin, and buttocks region is seen
• Psoriasis that is generalized (distributed over many locations of the body) with plaque formation being noted
• Erythrodermic psoriasis, which is a serious form of psoriasis that involves most of the body’s surface

The onset of Drug-Induced Psoriasis may be slow or rapid. In some cases, it may not be immediately observed but may take a long period of time to manifest following intake of the medication.

How is Drug-Induced Psoriasis Diagnosed?

The diagnosis of Drug-Induced Psoriasis may be difficult, especially if the individual is on multiple medications and the onset of signs and symptoms are noted several months to years after administration of the offending medications.

The following tests and exams may be used in the diagnosis of Drug-Induced Psoriasis:

• Complete physical examination and thorough medical history evaluation (including current and past medication use)
• Assessment of the presenting signs and symptoms
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed), and microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Drug-Induced Psoriasis?

If Drug-Induced Psoriasis is left untreated, it can result in certain complications. Some of the complications include:

• Severe skin symptoms
• Worsening of the existing psoriasis
• Emotional stress from cosmetic concerns
• Recurrence/relapse of the condition
• Treatment challenges

How is Drug-Induced Psoriasis Treated?

Following a diagnosis of Drug-Induced Psoriasis, the treatment provided may include:

• Discontinuing the medication responsible for the side effect, where possible, which may result in a cure or improvement of the condition
• Undertaking a treatment of psoriasis through:
  • Topical therapy using creams and lotions
  • Oral medications that may include steroids, psoralens, and acitretin
  • Phototherapy
  • Immunosuppressive medications
  • Biologic medications

Follow-up care with screening and check-ups is important at regular intervals.

How can Drug-Induced Psoriasis be Prevented?

Current medical research has not established a method of preventing Drug-Induced Psoriasis. However, the following measures may be considered to help lower one’s risk for the condition:

• Drugs that cause the condition may be discontinued or alternative medication prescribed; nevertheless, this has to be decided by the healthcare expert
• If the use of certain medications places an individual at an elevated risk for this skin condition, it is advisable to check with the physician on the same
• Avoid self-medication or bringing about any changes to one’s medication dosage without consulting the healthcare provider
• Inform your physician if you are allergic to any medication

Periodic monitoring or follow-up of the condition with the healthcare provider is recommended.

What is the Prognosis of Drug-Induced Psoriasis? (Outcomes/Resolutions)

• The prognosis for Drug-Induced Psoriasis is usually good in many cases upon discontinuation of the medication and adequate treatment of the condition
• In a majority of cases, the condition resolves within a few weeks of stopping the offending medication. In some individuals, however, the condition may not resolve completely or may take a long period to regress and improve

Additional and Relevant Useful Information for Drug-Induced Psoriasis:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/skin-disorders/