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, you’re not alone-and you’re not imagining things if your skin suddenly got worse. Thousands of people with psoriasis report flares after starting medications like metoprolol or propranolol. The connection isn’t just anecdotal. It’s backed by clinical studies, dermatology guidelines, and real patient experiences. The question isn’t whether it can happen-it’s whether it’s happening to you, and what to do next.

How Beta-Blockers Can Trigger Psoriasis Flares

Beta-blockers are a common class of drugs used to treat high blood pressure, irregular heartbeats, and even anxiety. They work by blocking the effects of adrenaline on your heart and blood vessels, which slows your heart rate and lowers blood pressure. But they don’t just affect your heart. These drugs also interact with receptors in your skin, and that’s where things go wrong for some people.

Research shows that beta-blockers can interfere with the normal function of skin cells. They reduce levels of a signaling molecule called cyclic AMP (cAMP), which helps control how fast skin cells grow and how your immune system behaves in the skin. When cAMP drops, skin cells multiply too quickly, and inflammation ramps up-two hallmarks of psoriasis. This isn’t just theory. A 2020 review in PubMed Central (PMC7398737) confirmed this mechanism is behind many drug-induced psoriasis cases.

Not all beta-blockers carry the same risk. Propranolol, metoprolol, bisoprolol, and atenolol are the most commonly linked to flares. Even eye drops containing timolol-used for glaucoma-can cause problems because enough of the drug gets absorbed into your bloodstream to affect your skin. One case report described a patient whose psoriasis turned into a full-body red, scaly rash after using timolol eye drops for months.

Who’s Most at Risk?

If you already have psoriasis, you’re more likely to see a flare. DermNet NZ reports that about 20% of people with existing psoriasis experience worsening symptoms after starting a beta-blocker. But it’s not just about having the condition. Some people develop psoriasis for the first time after taking these drugs.

The timing is tricky. Symptoms don’t show up right away. You might start the medication in January and not notice a flare until June-or even a year later. That delay is why so many people don’t connect their skin changes to their pills. One Reddit user, u/PsoriasisWarrior2024, shared that after six months on metoprolol, their psoriasis went from covering 5% of their body to 30%. They thought it was stress, not medication.

Genetics may play a role too. Early findings from a 2024 study at Johns Hopkins and Mayo Clinic suggest people with the HLA-C*06:02 gene variant-common in those with plaque psoriasis-are more likely to have a flare triggered by beta-blockers. This could one day help doctors choose safer medications before even prescribing.

What the Evidence Really Says

There’s some debate in the medical literature. A 2010 study (PMC2921739) concluded that long-term use of beta-blockers isn’t a major cause of new psoriasis. But that same study also found beta-blockers were a major factor in triggering flares in people who already had the disease. Another study published in the Journal of the American Academy of Dermatology looked at 110 hospitalized patients with severe psoriasis and found beta-blockers were among the top triggers.

What’s clear is this: if you develop psoriasis or your existing psoriasis gets worse after starting a beta-blocker, and your symptoms improve after stopping it, that’s a strong sign the drug is the cause. Clinical improvement after withdrawal is one of the most reliable ways to confirm the link.

Still, not everyone reacts the same. Some people take beta-blockers for years with no skin issues. That’s why doctors often say it’s about individual risk-not a universal rule. But if you’re one of the 20% who reacts, the consequences can be serious-especially if the flare turns into pustular or erythrodermic psoriasis, which are rare but dangerous forms.

What to Do If You Suspect a Trigger

If you notice your skin getting worse after starting a beta-blocker, don’t stop the medication on your own. These drugs are often critical for heart health. Instead, talk to both your dermatologist and cardiologist. They can work together to find a solution.

Here’s what your doctors might consider:

1. Switch beta-blockers-but only if necessary. If one beta-blocker caused a flare, chances are another will too. Banner Health advises against trying a different one unless absolutely unavoidable.
2. Switch to a different class of blood pressure medication. Calcium channel blockers like amlodipine or ARBs like losartan are often safer for people with psoriasis. ACE inhibitors can also trigger flares, so they’re not always the best alternative.
3. Manage the flare. Topical steroids, vitamin D creams, and light therapy can help control symptoms while you adjust your meds. For severe cases, systemic treatments like biologics may be needed.
4. Track your symptoms. Keep a journal of when your skin flares, what medications you’re on, and any other changes. This helps your doctors spot patterns.

One patient on MyPsoriasisTeam wrote, “I didn’t realize my blood pressure pill was making my psoriasis worse until my dermatologist asked if I was on beta-blockers.” That question saved her months of unnecessary suffering.

What About New-Onset Psoriasis?

Can beta-blockers cause psoriasis in someone who never had it before? The evidence is mixed, but it’s possible. GoodRx and Healthline both note that while new cases are less common than flares in existing patients, they do happen. The American Academy of Dermatology includes beta-blockers in its list of drugs most likely to trigger psoriasis, whether new or existing.

There’s a historical example: Practolol, an older beta-blocker, was pulled from the market in the 1980s because so many users developed severe skin reactions, including psoriasis-like rashes. That’s how serious this link can be.

What’s Being Done to Fix This?

Researchers are looking for better solutions. Some pharmaceutical companies are working on new beta-blockers that target only the heart’s beta-1 receptors and avoid skin receptors altogether. Others are testing topical formulations with minimal absorption to reduce side effects.

The European Academy of Dermatology now recommends that dermatologists ask every patient with new or worsening psoriasis: “Are you taking any beta-blockers?” That simple question is becoming standard practice. It’s a small step-but it can change lives.

Real Numbers, Real Impact

In the U.S., about 63 million prescriptions for metoprolol are filled each year. Around 8.1 million Americans have psoriasis. That means tens of thousands of people with psoriasis are likely on these drugs right now. A 2023 survey by MedicalNewsToday found that 37% of psoriasis patients on beta-blockers reported worsening skin, compared to just 12% of those on other blood pressure meds. Even if the sample size was small, the pattern is hard to ignore.

The American Heart Association still recommends beta-blockers for certain heart conditions-but they now advise doctors to consider skin health when choosing medication, especially for patients with a history of psoriasis.

Bottom Line: Know Your Meds, Know Your Skin

Psoriasis is already hard to manage. Adding a medication that makes it worse feels unfair. But you’re not powerless. If you’re on a beta-blocker and your skin is flaring, talk to your doctors. Don’t assume it’s stress, weather, or diet. Ask: Could this be my medication?

There are alternatives. Your heart health matters-but so does your skin. With the right team and the right questions, you can find a balance that keeps both in check.