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

If you’re taking a beta-blocker for high blood pressure or heart issues and your psoriasis suddenly got worse, you’re not alone. Thousands of people report their skin flared up after starting meds like metoprolol, propranolol, or atenolol. It’s not a coincidence - it’s a known, documented reaction. And if you’ve been told your psoriasis is just "stress-related" or "getting worse with age," you might be missing a key trigger hiding in your medicine cabinet.

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

Psoriasis isn’t just dry, itchy patches. It’s an autoimmune condition where your immune system attacks your own skin cells, making them grow too fast and pile up in thick, red, scaly plaques. Beta-blockers, on the other hand, slow your heart rate and lower blood pressure by blocking adrenaline. Sounds harmless, right? But here’s the catch: those same adrenaline receptors are also found in your skin. When beta-blockers interfere with them, they mess with the balance of inflammation and cell growth in your skin.

Research shows beta-blockers can drop levels of cAMP - a molecule that helps keep skin cells in check. When cAMP falls, skin cells multiply faster, and immune cells in the skin go into overdrive. The result? A flare. This isn’t just theory. A 2022 update from DermNet NZ found that about 20% of people with existing psoriasis see their condition worsen after starting a beta-blocker. And for some, it’s not just a flare - it’s a full transformation. There are documented cases where plaque psoriasis turned into pustular psoriasis or even life-threatening erythroderma after taking drugs like pindolol or topical timolol eye drops.

Which Beta-Blockers Are the Worst Offenders?

Not all beta-blockers are created equal when it comes to skin risk. Some are far more likely to trigger flares than others. Based on clinical reports and patient data, the biggest culprits include:

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

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 are on a drug with a known, documented risk of worsening psoriasis. And here’s the kicker: if one beta-blocker triggers your skin to flare, chances are high another one will too. Banner Health’s 2023 guidance says doctors typically won’t recommend switching to a different beta-blocker - because the risk is class-wide.

It’s Not Always Immediate - That’s Why People Miss the Link

One of the biggest reasons this connection gets missed is timing. You don’t wake up with a rash the day after starting metoprolol. The delay can be anywhere from one month to 18 months. A 2023 survey on MyPsoriasisTeam showed patients often didn’t connect their worsening skin to their new heart medication until months later - if at all.

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 rare. In fact, a 2010 study in the Journal of the American Academy of Dermatology found beta-blockers were a “major factor” in triggering or worsening psoriasis in hospitalized patients. But because the timeline is so long, many doctors never make the connection. Patients get told to use more steroid cream, not to consider stopping the med.

What Does the Science Really Say? Contradictions and Confusion

You might have heard conflicting info. A 2010 study (PMC2921739) claimed beta-blocker exposure wasn’t a “substantial risk factor” for new psoriasis. That’s true - but it’s also misleading. That study looked at whether beta-blockers cause psoriasis in people who never had it. The answer? Maybe, but it’s rare. The real issue is what happens to people who already have psoriasis. For them, the risk of flare is real and significant.

GoodRx’s 2023 analysis puts it plainly: beta-blockers can worsen existing psoriasis - but they don’t reliably cause new cases. Meanwhile, a 2023 MedicalNewsToday survey found that 37% of psoriasis patients on beta-blockers reported worsening symptoms, compared to just 12% on other blood pressure meds. That’s a big gap. And when patients stop the drug? Many see improvement. In fact, clinical guidelines say improvement after stopping the drug is one of the strongest signs it was the trigger.

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

If you’re on a beta-blocker and your psoriasis has gotten worse, don’t panic - but don’t ignore it either. Here’s what to do:

1. Track your symptoms. Note when the flare started and how it changed over time.
2. Don’t stop your med on your own. Beta-blockers are often critical for heart health. Stopping suddenly can cause dangerous spikes in blood pressure or heart rate.
3. Talk to both your dermatologist and cardiologist. This isn’t a one-doctor problem. You need both specialties involved.
4. Ask about alternatives. Calcium channel blockers like amlodipine or ARBs like losartan are often safer for psoriasis patients. ACE inhibitors can also trigger flares, so they’re not always the answer.
5. Consider genetic testing. A 2024 study at Johns Hopkins and Mayo Clinic is looking into whether people with the HLA-C*06:02 gene are more likely to react to beta-blockers. If you have this gene, your risk may be higher.

What Happens If You Switch Medications?

Switching from a beta-blocker isn’t always easy - especially if you have heart disease. But it’s often necessary. Many patients report noticeable improvement in their skin within 4 to 12 weeks after switching. One patient on MyPsoriasisTeam said, “Switched from metoprolol to amlodipine. My plaques started fading in 3 weeks. I didn’t think it was possible.”

The good news? There are plenty of effective alternatives. A 2023 American Heart Association guideline still recommends beta-blockers for certain heart conditions, but it now says doctors should consider skin health when choosing meds. For many, calcium channel blockers or ARBs work just as well for blood pressure without the skin risk.

How Is Beta-Blocker-Induced Psoriasis Treated?

Even after switching meds, your skin may still need treatment. The approach is the same as for regular psoriasis, but now you’re removing the trigger - which makes treatment more effective.

• Topical steroids - reduce inflammation and scaling
• Vitamin D analogues (calcipotriene) - slow skin cell growth
• Phototherapy - UV light therapy helps calm immune activity in the skin
• Systemic drugs (like methotrexate or biologics) - used only for severe, widespread cases

The key difference? When the drug trigger is removed, these treatments work better and faster. Many patients find they need less aggressive therapy after switching meds.

What About Eye Drops? Yes, Even Those Can Trigger Flares

You might not think of glaucoma eye drops as a risk - but timolol, a common beta-blocker eye drop, can be absorbed into your bloodstream through the tear ducts. There are documented cases where patients developed severe psoriasis or even erythroderma from timolol drops. If you’re using eye drops and notice a flare, tell your dermatologist. They may recommend switching to a non-beta-blocker alternative like brimonidine or latanoprost.

Why This Matters More Than You Think

Psoriasis affects over 8 million Americans. Beta-blockers are prescribed over 150 million times a year in the U.S. That’s a massive overlap. If 20% of psoriasis patients on beta-blockers have flares, that’s hundreds of thousands of people unnecessarily suffering because the connection isn’t being made.

The European Academy of Dermatology and Venereology now recommends that dermatologists ask every patient with new or worsening psoriasis: “Are you on any beta-blockers?” That’s not a question most doctors ask - but it should be.

What’s Next? Better Drugs on the Horizon

Researchers are working on next-generation beta-blockers that target heart receptors without affecting skin ones. Early animal studies show promise. In the meantime, personalized medicine is gaining ground. If you have psoriasis and need a beta-blocker, genetic testing might one day tell you which ones are safest for you.

For now, the message is simple: if your skin is flaring and you’re on a beta-blocker, don’t assume it’s just your psoriasis acting up. Ask the question. Get the right help. Your skin - and your heart - will thank you.