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 might not be random. It could be the medication. While beta-blockers save lives by lowering heart rate and blood pressure, they’re also one of the most common drug triggers for psoriasis flares - especially in people who already have the condition. Around 20% of psoriasis patients report worsening symptoms after starting these drugs, according to DermNet NZ’s 2022 clinical review. And for some, it’s not just a flare - it’s a full-blown transformation of their skin disease.

Which Beta-Blockers Are Most Likely to Cause Problems?

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

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

Metoprolol is the most prescribed beta-blocker in the U.S., with over 63 million prescriptions filled in 2023 alone. That means thousands of people with psoriasis are taking it - and many don’t realize their skin is reacting to the drug. Even topical timolol eye drops can cause problems. How? Because some of the medication gets absorbed into the bloodstream through the eye, triggering a systemic response.

How Do Beta-Blockers Trigger Psoriasis?

The exact mechanism isn’t fully understood, but researchers have a solid theory. Beta-blockers interfere with the body’s natural stress-response system by blocking beta-adrenergic receptors. This disruption lowers levels of cyclic AMP (cAMP), a molecule that helps regulate skin cell growth and immune activity. When cAMP drops, skin cells (keratinocytes) start multiplying too fast - one of the hallmarks of psoriasis. At the same time, immune cells called granulocytes become overactive, causing inflammation and scaling.

This isn’t just about surface irritation. In rare cases, beta-blockers like pindolol have turned mild plaque psoriasis into pustular psoriasis - a more severe form with pus-filled bumps. Atenolol has been linked to psoriasiform pustulosis, and timolol has even triggered erythroderma, where the entire skin surface turns red and inflamed.

When Do Flares Happen After Starting the Drug?

There’s no set timeline. Some people notice changes within weeks. Others don’t see a flare until 18 months after starting the medication. That delay is why so many patients - and even some doctors - miss the connection. You might think your flare is stress-related, seasonal, or caused by a new skincare product. But if you started a beta-blocker around the same time, it’s worth considering.

One Reddit user, u/PsoriasisWarrior2024, shared: “After 6 months on metoprolol, my psoriasis went from manageable to covering 30% of my body.” That’s not an isolated story. On MyPsoriasisTeam, dozens of users report similar experiences. A 2023 survey by MedicalNewsToday found that 37% of psoriasis patients on beta-blockers said their skin got worse - compared to just 12% of those on other blood pressure meds.

Can Beta-Blockers Cause Psoriasis in People Who Never Had It?

The evidence here is mixed. Some studies say yes - especially with older drugs like practolol, which was pulled from the market in the 1980s because of severe skin reactions. Others say new-onset psoriasis from beta-blockers is rare. The American Academy of Dermatology says it’s possible, but less common than worsening existing psoriasis. Banner Health’s 2023 guidance puts it simply: “Some drugs can trigger psoriasis in people who didn’t have it - but they’re far more likely to make it worse if you already have it.”

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

Don’t stop your beta-blocker on your own. These drugs are often critical for heart health. Stopping suddenly can cause dangerous spikes in blood pressure or even heart attacks.

Instead, talk to both your dermatologist and cardiologist together. Bring your medication list. Ask: “Could this be causing my skin flare?” If your doctor suspects a link, they’ll likely suggest switching to a different type of blood pressure medication.

Good alternatives include:

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

But be careful - ACE inhibitors (like lisinopril) can also trigger psoriasis in some people. Your doctors will weigh your heart risks against your skin health to pick the safest option.

How Is Beta-Blocker-Induced Psoriasis Treated?

Once the trigger is removed, many patients see improvement within weeks. But until then, treatment focuses on managing symptoms:

• Topical steroids to reduce inflammation
• Vitamin D analogues like calcipotriene to slow skin cell growth
• Phototherapy (UV light treatments)
• For severe cases: systemic drugs like methotrexate or biologics

Some patients find relief with moisturizers, oatmeal baths, and avoiding known triggers like alcohol or stress - but none of that will help if the root cause (the beta-blocker) stays in place.

Is It Safe to Try Another Beta-Blocker?

Probably not. Banner Health’s 2023 guidance says: “If one beta-blocker triggers a flare, it’s likely another one will too.” That’s because they all work the same way - blocking beta receptors. Even switching from metoprolol to bisoprolol won’t solve the problem if your body reacts to the class as a whole.

There’s one exception: some newer beta-blockers are being designed to target only the heart (beta-1 receptors) and leave skin receptors alone. But these are still in research. For now, if you’ve had a flare, avoid the whole class.

What’s New in Research?

Scientists are now looking for genetic markers that predict who’s at risk. A 2024 study at Johns Hopkins and Mayo Clinic is testing whether people with the HLA-C*06:02 gene - already linked to psoriasis susceptibility - are more likely to have drug-induced flares. Early results suggest they are.

The European Academy of Dermatology now recommends that dermatologists ask every patient with new or worsening psoriasis: “Are you on any beta-blockers?” That simple question could prevent months of unnecessary suffering.

Bottom Line: Don’t Ignore the Connection

If you have psoriasis and take a beta-blocker, your skin flare isn’t just bad luck. It’s a known, documented reaction - and it’s fixable. You don’t have to choose between heart health and skin health. With the right team and the right switch in medication, you can manage both.

Keep a symptom diary. Note when your flare started, what meds you began, and how your skin changed. Bring it to your next appointment. You might be the one who helps your doctor make the connection - and finally get you the relief you’ve been waiting for.