Psoriasis and Beta-Blockers: Can Your Blood Pressure Med Make Skin Flares Worse?

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 your medication.

What’s Really Going On Between Your Skin and Your Heart Med?

Psoriasis isn’t just a rash. It’s an autoimmune condition where your immune system attacks healthy skin cells, causing thick, scaly patches that itch, burn, or crack. About 8.1 million Americans live with it, and for many, triggers are unpredictable - stress, infections, weather changes. But one trigger that’s often missed? Beta-blockers.

These drugs - like metoprolol, propranolol, and atenolol - are among the most common heart medications in the U.S., with over 63 million prescriptions filled last year alone. They work by slowing your heart rate and lowering blood pressure by blocking adrenaline. Simple, effective, life-saving for many. But for about 1 in 5 people with existing psoriasis, they also make skin symptoms worse.

The connection isn’t new. Doctors have seen it since the 1970s, when a beta-blocker called practolol was pulled off the market because so many patients developed severe skin reactions. Today, even the newer versions - the ones still widely prescribed - carry the same risk.

Which Beta-Blockers Are Most Likely to Trigger Flares?

Not all beta-blockers are created equal when it comes to skin effects. Some are far more likely to cause trouble:

• Metoprolol (Lopressor, Toprol-XL) - the most prescribed beta-blocker in the U.S., and one of the top offenders for psoriasis flares.
• Propranolol (Inderal) - known to trigger both new-onset psoriasis and make existing cases much worse.
• Atenolol (Tenormin) - linked to pustular psoriasis, a more severe form with pus-filled bumps.
• Pindolol (Visken) - rare now, but has been tied to pustular psoriasis in case reports.
• Timolol (eye drops for glaucoma) - yes, even eye drops. The medication can be absorbed through the eye and trigger full-body psoriasis flare-ups.

The timing? That’s where it gets tricky. You might start a beta-blocker and see no change for months - or even up to 18 months. Then, out of nowhere, your plaques spread, itchier than ever, or new pustules appear. By then, most people don’t connect it to their heart pill.

How Do Beta-Blockers Even Affect Your Skin?

It’s not just coincidence. The science points to real biological changes.

Beta-blockers reduce levels of a signaling molecule called cAMP inside skin cells. Lower cAMP means keratinocytes - the cells that make up your skin’s outer layer - start multiplying too fast. At the same time, immune cells in the skin get more active and inflamed. It’s like flipping two switches at once: one that speeds up skin cell production, and another that turns up the immune system’s heat.

In people with psoriasis, this pushes an already overactive system into overdrive. Even worse, some beta-blockers may cause receptors in the skin to become less responsive over time, leading to a rebound effect that worsens inflammation.

Studies show that patients who develop psoriasis after starting beta-blockers often see improvement - sometimes dramatic - after stopping the drug. That’s a key clue: if your skin gets better when you stop the medication, it’s likely the culprit.

Is It Causing Psoriasis - Or Just Making It Worse?

There’s debate here. Some studies say beta-blockers mainly worsen existing psoriasis. Others report cases where someone had no skin issues before - then started metoprolol for high blood pressure, and six months later, got full-blown plaque psoriasis.

The American Academy of Dermatology says both can happen. But the stronger evidence points to worsening rather than causing outright. Still, if you’re genetically predisposed to psoriasis - say, you have a family history or carry the HLA-C*06:02 gene - your skin may be more vulnerable.

A 2024 study at Johns Hopkins and Mayo Clinic is now looking at whether this gene can predict who’s at highest risk. Early results suggest carriers are far more likely to have a flare after starting a beta-blocker. That could one day mean genetic testing before prescribing.

What Should You Do If You Suspect Your Med Is the Problem?

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

Instead, do this:

1. Track your symptoms. When did the flare start? Did it get worse after starting the med? Did it improve after a dose change?
2. Talk to both your dermatologist and cardiologist. They need to work together. Your skin doctor should ask, “Are you on any beta-blockers?” - and your heart doctor should know your psoriasis history.
3. Consider alternatives. Calcium channel blockers like amlodipine or ARBs like losartan are often safer for psoriasis patients. ACE inhibitors (like lisinopril) can also trigger flares, so they’re not always a better choice.
4. Try switching beta-blockers. If one triggers a flare, chances are others will too. Most doctors won’t recommend trying a different one.

What Happens If You Stop the Beta-Blocker?

Many patients see improvement within weeks to months after stopping the drug. One patient on Reddit reported his psoriasis went from covering 30% of his body to nearly gone after switching from metoprolol to a calcium channel blocker. Another said his flares cleared up after switching from propranolol to valsartan.

But again - don’t quit cold turkey. Work with your doctors. They may slowly taper you off while introducing a new medication.

How Do You Manage the Flare in the Meantime?

While you’re adjusting meds, your dermatologist may recommend:

• Topical corticosteroids to calm inflammation
• Vitamin D analogs like calcipotriene to slow skin cell growth
• Phototherapy (UV light treatment) for moderate to severe cases
• Systemic drugs like methotrexate or biologics if the flare is severe

These treatments won’t fix the root cause - the beta-blocker - but they can help you feel better while you sort out your meds.

Why This Matters More Than You Think

With 150 million beta-blocker prescriptions filled in the U.S. every year - and over 8 million people living with psoriasis - the overlap is huge. That means tens of thousands of people are likely being treated with heart meds that are making their skin condition worse.

Most patients never connect the two. They see their dermatologist for the rash, their cardiologist for their blood pressure - and no one asks the right question: “Are you on any beta-blockers?”

The European Academy of Dermatology now recommends that dermatologists ask this question during every new psoriasis evaluation. It’s a simple step - but it could prevent years of unnecessary suffering.

Bottom Line: It’s Not All in Your Head - It’s in Your Meds

If you have psoriasis and are on a beta-blocker, your flare isn’t just bad luck. It’s a known, documented reaction. And while not everyone will be affected, the risk is real - especially if you’re on metoprolol, propranolol, or atenolol.

The good news? You don’t have to choose between heart health and skin health. With the right team and the right alternatives, you can manage both. Talk to your doctors. Track your symptoms. Ask the question. Your skin might thank you.