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

If you have psoriasis and are taking a beta-blocker for high blood pressure or heart issues, your skin flare-ups might not be random. They could be linked to the medication itself. While beta-blockers save lives by lowering heart rate and blood pressure, they’re also one of the most common drugs known to make psoriasis worse - sometimes even triggering it in people who never had it before.

How Beta-Blockers Can Trigger Psoriasis Flares

Beta-blockers like metoprolol, propranolol, and atenolol work by blocking adrenaline from binding to beta receptors in your heart and blood vessels. That’s good for your cardiovascular system. But those same receptors are also found in your skin. When beta-blockers interfere with them, they disrupt the normal balance of skin cell growth and inflammation.

Research shows this happens because beta-blockers lower levels of cyclic AMP (cAMP), a molecule that helps regulate how skin cells behave. Lower cAMP means skin cells multiply too fast and immune cells in the skin get overactive - two hallmarks of psoriasis. This isn’t just theory. Case studies show people developing pustular psoriasis or even full-body redness (erythroderma) after starting beta-blockers, especially topical ones like timolol eye drops used for glaucoma.

It’s not always immediate. Flares can show up anywhere from one to 18 months after you start the medication. That delay is why many patients never connect their worsening skin to their heart pill. One man on Reddit shared that after six months on metoprolol, his psoriasis went from covering 5% of his body to 30%. He thought it was stress - until his dermatologist asked about his meds.

Which Beta-Blockers Are Most Likely to Cause Problems?

Not all beta-blockers are created equal when it comes to skin risk. The ones most often linked to psoriasis flares are:

• Propranolol (Inderal)
• Metoprolol (Lopressor, Toprol-XL)
• Bisoprolol
• Atenolol (Tenormin)
• Pindolol (Visken)
• Timolol (eye drops for glaucoma)

Metoprolol is the most commonly prescribed beta-blocker in the U.S., with over 63 million prescriptions filled in 2023 alone. That means millions of people with psoriasis could be taking it without knowing the risk. DermNet NZ reports that about 20% of people with existing psoriasis see their condition worsen after starting one of these drugs. And in some cases, people without prior psoriasis develop it for the first time.

Here’s the twist: some beta-blockers seem safer. Nebivolol and carvedilol, for example, have fewer reports of skin side effects. But if one beta-blocker triggers your psoriasis, chances are another one will too. Banner Health’s 2023 guidance says doctors usually won’t try switching to a different beta-blocker - they’ll look for a whole different class of medication.

What Does the Evidence Really Say?

There’s conflicting science. A 2010 study in the Journal of the American Academy of Dermatology found beta-blockers were a major trigger for severe psoriasis flare-ups. But another paper from the same year argued that cumulative exposure to beta-blockers wasn’t a strong risk factor. Why the contradiction?

It comes down to individual biology. Genetics play a big role. People with the HLA-C*06:02 gene variant - which is linked to early-onset plaque psoriasis - may be more likely to react badly to beta-blockers. A 2024 study at Johns Hopkins and Mayo Clinic is testing whether this gene can predict who’s at highest risk. Early results suggest it might.

Also, not everyone reacts the same. Some patients take beta-blockers for years with no skin issues. Others flare up after just a few months. That variability makes it hard to spot the connection without a doctor’s help.

What Should You Do If You Suspect Your Med Is Causing Flares?

If you’ve noticed your psoriasis getting worse since starting a beta-blocker, don’t stop the medication on your own. Stopping suddenly can cause dangerous spikes in blood pressure or heart rate.

Instead, talk to both your dermatologist and cardiologist together. Bring a list of your medications and note when your skin changes started. Your dermatologist may ask: “When did you start this pill?” - a question most patients don’t expect.

If beta-blockers are the culprit, switching is usually the best option. Alternatives with lower psoriasis risk include:

• Calcium channel blockers like amlodipine
• ARBs like losartan or valsartan

Be careful: ACE inhibitors (like lisinopril) can also trigger psoriasis in some people, so they’re not always a safe swap. Your doctor will pick the best alternative based on your heart health, kidney function, and other conditions.

How Is Beta-Blocker-Induced Psoriasis Treated?

Once the trigger is removed, skin often improves - but not always right away. Treatment still follows standard psoriasis protocols:

• Topical steroids to reduce inflammation
• Vitamin D analogues like calcipotriene to slow skin cell growth
• Phototherapy (UVB light) for moderate to severe cases
• Systemic drugs like methotrexate or biologics if the flare is widespread

Many patients find that once the beta-blocker is out of their system, their skin responds better to these treatments. One woman on MyPsoriasisTeam wrote: “I switched from metoprolol to amlodipine. Within three months, my plaques were half the size. I finally slept through the night without itching.”

Why This Matters for Millions of People

Psoriasis affects over 8 million Americans. Beta-blockers are prescribed over 150 million times a year in the U.S. That means tens of thousands of people with psoriasis are on these drugs - and many don’t know the connection.

MedicalNewsToday’s 2023 survey found that 37% of psoriasis patients on beta-blockers reported worsening skin, compared to just 12% on other blood pressure meds. That’s a big difference. Yet most guidelines still list beta-blockers as a standard option for hypertension, even in patients with psoriasis.

The European Academy of Dermatology and Venereology now recommends that dermatologists always ask patients with new or worsening psoriasis: “Are you on any heart medications?” This simple question could prevent months of unnecessary suffering.

What’s Next? Better Options on the Horizon

Drug companies are working on new beta-blockers that target only the heart’s beta-1 receptors and leave skin receptors alone. Early animal studies show promise. If successful, these could be available in the next 5-7 years.

In the meantime, awareness is key. If you have psoriasis and are on a beta-blocker, ask your doctor: “Could this be making my skin worse?” If you’re on a beta-blocker and just developed psoriasis, ask: “Could this be drug-induced?”

There’s no shame in needing heart medication. But there’s power in knowing how your drugs affect your whole body - not just your heart.