Psoriasis and Beta-Blockers: What You Need to Know About Skin Flare Risk

If you have psoriasis and were recently prescribed a beta-blocker for high blood pressure or heart issues, your skin flare might not be bad luck-it could be the medication. Around 20% of people with existing psoriasis see their symptoms get worse after starting drugs like metoprolol, propranolol, or atenolol. Even more troubling, some people develop psoriasis for the first time after taking these common heart meds. The connection isn’t always obvious, because the flare-up can show up months after you start the pill-sometimes as late as 18 months later. That delay makes it easy to miss the link unless you’re looking for it.

How Beta-Blockers Trigger Psoriasis Flares

Beta-blockers work by slowing your heart rate and lowering blood pressure. They do this by blocking adrenaline from binding to beta receptors in your heart and blood vessels. But those same receptors are also found in your skin. When beta-blockers interfere with them there, they disrupt how skin cells grow and how inflammation is controlled.

Research shows these drugs lower levels of cyclic AMP (cAMP), a chemical that helps keep skin cells from multiplying too fast and keeps immune cells in check. When cAMP drops, skin cells start piling up, forming those thick, scaly patches. At the same time, immune cells in the skin get overactive, causing redness, itching, and swelling. This isn’t just theory-it’s been seen in biopsies of patients who developed psoriasis after starting beta-blockers.

Not all beta-blockers carry the same risk. Propranolol and metoprolol are the most commonly reported offenders. Even eye drops containing timolol-for glaucoma-can trigger flares because some of the drug gets absorbed into your bloodstream through your eye. Pindolol has been linked to rare but severe cases, like turning regular plaque psoriasis into pustular psoriasis, where pus-filled bumps appear across large areas of skin.

Who’s Most at Risk?

It’s not everyone. Some people take beta-blockers for years with no skin issues. Others see a flare within weeks. What makes the difference? Genetics may play a role. Early results from a 2024 study at Johns Hopkins and Mayo Clinic suggest people with the HLA-C*06:02 gene variant are more likely to develop psoriasis after taking beta-blockers. This gene is already known to increase risk for plaque psoriasis, so having it might make your skin more sensitive to drug triggers.

People with moderate to severe psoriasis before starting beta-blockers are also more likely to have a major flare. One patient on Reddit shared that after six months on metoprolol, their psoriasis went from covering 5% of their body to 30%. Another user on MyPsoriasisTeam said they’d been stable for years-until they started a beta-blocker for anxiety-related palpitations. Within three months, their elbows and scalp were covered in new plaques.

Even if you don’t have psoriasis yet, you might still be at risk. About 12% of people who develop psoriasis for the first time report starting a beta-blocker shortly before the first flare. That’s why dermatologists now routinely ask: “Are you on any heart meds?” when someone comes in with unexplained skin changes.

What to Do If You Suspect a Medication Trigger

Don’t stop your beta-blocker on your own. These drugs are often critical for preventing heart attacks, strokes, or dangerous heart rhythms. Stopping suddenly can be life-threatening.

Instead, talk to both your dermatologist and cardiologist. Bring a photo of your skin before and after the flare, and note exactly when you started the medication. If your doctor suspects the beta-blocker is the cause, they may suggest switching to a different type of blood pressure medication.

Good alternatives include:

• Calcium channel blockers like amlodipine
• ARBs like losartan or valsartan
• Some diuretics (though thiazides can also trigger psoriasis in rare cases)

ACE inhibitors (like lisinopril) are sometimes suggested-but they’re not risk-free. They’ve also been linked to psoriasis flares in some studies, so they’re not always the answer.

Once you switch, it can take weeks to months for your skin to improve. Some patients see relief in four weeks. Others need three to six months. Patience is key, but improvement after stopping the drug is the clearest sign it was the trigger.

Managing the Flare While Switching Meds

In the meantime, your dermatologist will likely recommend treatments to calm your skin:

• Topical corticosteroids (like hydrocortisone or clobetasol)
• Vitamin D analogues (calcipotriene) to slow skin cell growth
• Moisturizers with ceramides or colloidal oatmeal to repair the skin barrier
• Phototherapy (UVB light treatment), especially if the flare is widespread
• For severe cases: biologics like adalimumab or ustekinumab

These treatments won’t fix the root cause-the medication-but they can give you relief while you work on switching safely.

Why This Isn’t Always Clear in the Literature

You might read conflicting studies. One 2010 paper said beta-blocker use isn’t a major risk for psoriasis. Another says it’s one of the top drug triggers. Why the confusion?

Part of it is study design. Some look at large populations and miss rare or delayed reactions. Others rely on patient recall, which can be inaccurate. Plus, many people take multiple medications at once-making it hard to isolate one culprit.

But real-world evidence is growing stronger. A 2023 survey of 187 psoriasis patients found 37% on beta-blockers reported worsening skin, compared to only 12% on other blood pressure drugs. That’s a big difference. And when doctors remove the beta-blocker and see improvement, it’s hard to ignore.

Practolol, an older beta-blocker, was pulled off the market in the 1980s because so many patients developed severe skin reactions. That’s why today’s versions are more selective-but they’re not harmless.

What You Can Do Now

If you’re on a beta-blocker and have psoriasis:

• Track your skin changes. Take photos monthly.
• Don’t assume new patches are stress or weather-related.
• Ask your doctor: “Could this medication be making my psoriasis worse?”
• Bring up the topic even if you’ve been on the drug for months or years.

If you’re starting a beta-blocker and have a history of psoriasis:

• Let your doctor know upfront.
• Ask if there’s an alternative with lower skin risk.
• Schedule a skin check 3-6 months after starting the drug.

The bottom line? Beta-blockers save lives-but they can also make psoriasis worse. That doesn’t mean you shouldn’t take them. It means you need to be informed. With the right conversation and a smart switch, you can protect both your heart and your skin.