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-up might not be bad luck-it could be the medication. Around 20% of people with existing psoriasis see their symptoms get worse after starting a beta-blocker, according to DermNet NZ’s 2022 clinical update. That’s not rare. It’s common enough that dermatologists now ask about these drugs during every new or worsening psoriasis case.

How Beta-Blockers Trigger Psoriasis Flares

Beta-blockers like metoprolol, propranolol, and atenolol 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 the normal balance of skin cell growth and inflammation.

Here’s what happens inside your skin: beta-blockers lower levels of cyclic AMP (cAMP), a chemical that helps regulate how skin cells behave. Less cAMP means skin cells multiply too fast and don’t shed properly. At the same time, immune cells in the skin get more active, causing redness, scaling, and itching-the classic signs of psoriasis. This isn’t just theory. A 2020 review in PubMed Central (PMC7398737) confirmed this mechanism is behind many drug-induced psoriasis cases.

Some beta-blockers are worse than others. Propranolol and metoprolol top the list, followed by bisoprolol and pindolol. Even eye drops like timolol, used for glaucoma, can cause flares because enough of the drug gets absorbed into your bloodstream to affect your skin.

It’s Not Always Immediate-That’s the Problem

One of the biggest reasons this connection gets missed is timing. You might start a beta-blocker in January and not notice a flare until August-or even a year later. MyPsoriasisTeam users report symptoms showing up anywhere from one to 18 months after beginning the medication. That delay makes it easy to blame stress, weather, diet, or even a new soap. Most patients never connect the dots.

That’s why doctors need to ask. The European Academy of Dermatology and Venereology now recommends that dermatologists specifically check if patients are taking beta-blockers when they see new or worsening psoriasis. If you’ve been on a beta-blocker for months and your skin suddenly got worse, it’s worth talking about.

Who’s Most at Risk?

Not everyone with psoriasis will react to beta-blockers. But some people are more vulnerable. Research suggests those with the HLA-C*06:02 gene variant-a known genetic marker for plaque psoriasis-are more likely to have a flare triggered by these drugs. A 2024 study at Johns Hopkins and Mayo Clinic is actively testing whether this gene can predict who’s at highest risk. Early results are promising.

Also, people with more severe psoriasis before starting the drug tend to have bigger flares. One Reddit user, u/PsoriasisWarrior2024, shared that after six months on metoprolol, his psoriasis went from covering 5% of his body to 30%. He’d had mild plaques for years. The drug turned it into something unmanageable.

On the flip side, some people take beta-blockers for years with zero skin issues. That’s why it’s not a universal rule-but it’s a strong enough pattern that it can’t be ignored.

What to Do If You Suspect Your Medication Is the Culprit

If you think your beta-blocker is making your psoriasis worse, don’t stop taking it on your own. Stopping suddenly can cause dangerous spikes in blood pressure or heart rate. Instead, talk to both your dermatologist and cardiologist together. They can weigh the risks.

Here’s what typically happens next:

1. Your dermatologist confirms the flare matches the pattern of drug-induced psoriasis.
2. Your cardiologist reviews your heart health and whether the beta-blocker is truly necessary.
3. If they agree it’s likely the drug, they’ll consider switching you to another type of blood pressure medication.

Good alternatives include calcium channel blockers like amlodipine or ARBs like losartan. These are just as effective for blood pressure control and don’t carry the same skin flare risk. ACE inhibitors like lisinopril are sometimes used too-but they can also trigger psoriasis in some people, so they’re not always safer.

And here’s the key point: if one beta-blocker caused a flare, chances are high another one will too. Banner Health’s 2023 guidance says doctors usually won’t try switching between beta-blockers. The class as a whole is the problem.

How Psoriasis Is Managed After a Drug Trigger

Once the beta-blocker is stopped or switched, skin symptoms often improve-but not always quickly. It can take weeks or even months for the inflammation to calm down. In the meantime, treatment follows standard psoriasis protocols:

• Topical steroids to reduce redness and itching
• Vitamin D analogues like calcipotriene to slow skin cell growth
• Phototherapy (UV light treatment) for moderate to severe cases
• Systemic drugs like methotrexate or biologics for widespread or stubborn flares

Many patients find relief with just topical treatments once the trigger is removed. But if the flare was severe, you might need stronger options. The goal is to get your skin under control while keeping your heart safe.

Why This Matters for Millions of Americans

About 8.1 million Americans have psoriasis. And roughly 63 million beta-blocker prescriptions are filled every year in the U.S. alone-most of them for metoprolol. That means a huge number of people are taking these drugs, and some of them are unknowingly worsening their skin condition.

A 2023 MedicalNewsToday survey of 187 psoriasis patients found that 37% of those on beta-blockers reported worsening skin symptoms, compared to just 12% of those on other blood pressure meds. That’s a big difference. And while the sample size was small, it lines up with what dermatologists see in clinics every day.

The American Heart Association still lists beta-blockers as a second-line option for hypertension. But they now say dermatological side effects should be considered-especially in patients with a history of skin disease.

What’s Next? Better Options on the Horizon

Researchers are working on new drugs that target only the heart’s beta-receptors and leave the skin’s receptors alone. These so-called “cardioselective” beta-blockers could be safer for people with psoriasis. Some pharmaceutical companies are already testing them in early trials.

There’s also interest in topical beta-blockers with minimal absorption-like eye drops that don’t leak into the bloodstream. If that works, it could make glaucoma treatment safer for psoriasis patients.

Long-term, personalized medicine might be the answer. If we can identify who’s genetically at risk before they even start a beta-blocker, we can avoid the problem entirely. That’s the future.

Bottom Line: Know the Signs, Speak Up

If you have psoriasis and your doctor prescribes a beta-blocker, don’t assume it’s harmless. Ask: “Could this make my skin worse?” If you’re already on one and your skin has changed recently, write down when the flare started and what else changed around that time. Bring it up at your next appointment.

It’s not about avoiding necessary heart meds. It’s about finding the right balance. You don’t have to choose between your heart and your skin. With the right conversation and the right alternatives, you can protect both.