Drugs, infections and their interference with psoriasis

Certain drugs are known to aggravate psoriasis; these include the antimalarial drug chloroquine, the antidepressant lithium, and anti-arrhythmic drugs and beta-blockers, usually used to treat heart disease or high blood pressure. If you are taking any of these drugs, it may be that you cannot discontinue them, and you should certainly not do so without consulting your doctor. It is, however, worth discussing this with your doctor as there may be alternatives that do not have a triggering effect. The problem with chloroquine is worth remembering, especially if you are planning a holiday to improve your psoriasis: it would be a shame to make it worse by taking chloroquine. Although you must not ignore the need to take antimalarial drugs if you are holidaying in an area where malaria is present, there are alternative antimalarial drugs that will not make psoriasis worse.

A throat infection, especially a ‘strep’ sore throat (caused by the Streptococcus bacterium) can trigger guttate psoriasis.

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Damaging the skin (e.g. a cut from falling over or from surgery) can trigger psoriasis at the point of the injury. This is known as the Koebner phenomenon

The skin does not have to be broken for this to occur. Many of you will be familiar with the fact that psoriasis develops where your clothes rub (e.g. round the belt line); this too is the Koebner phenomenon, caused by the constant rubbing of material against the skin. Scratching itchy patches of psoriasis may also aggravate the psoriasis because scratching can damage the skin. For most people, sunshine is very helpful in improving the psoriasis, but for about 10% of people with psoriasis, sunlight actually makes the condition worse.

Having a fungal infection – athlete’s foot or ringworm – does not cause psoriasis, but some types of fungus may infect nails damaged by psoriasis. Some of the nail changes in psoriasis and fungal infection can look very similar, so it is worth checking this out, especially if only a few nails are affected. Your GP should be able to arrange for nail clippings to be examined for evidence of fungal infection. Some fungal infections on the skin can look very like small patches of psoriasis with redness and scale.