Drug-Induced Psoriasis Exploration Through Pharmacovigilance Lens

Psoriasis, a chronic inflammatory skin condition affecting approximately 2-3% of the global population, presents as itchy, scaly rashes primarily on the knees, elbows, trunk, and scalp. This prevalent ailment lacks a definitive cure and often leads to discomfort, sleep disturbances, and difficulty concentrating. It typically follows a pattern of recurring flare-ups lasting weeks or months, followed by temporary relief. Common triggers for individuals genetically predisposed to psoriasis include infections, injuries, and certain medications. Given its widespread impact and multifaceted causes, this article explores drug-induced psoriasis, a specific type induced by certain medications. Additionally, we’ll examine the latest insights gleaned from the DrugCard platform in medical literature to enhance our understanding of this condition.

Common Triggers and Effects of Drug-Induced Psoriasis

In drug-induced psoriasis, ceasing the medication responsible for triggering it often resolves psoriasis symptoms. This type of psoriasis can occur in individuals with no prior condition history. On the other hand, drug-aggravated psoriasis persists even after discontinuing the offending drug, typically affecting patients who have a personal or family history of psoriasis.

Common medications known to induce or exacerbate psoriasis include:

• Beta-blockers, such as propranolol, metoprolol, and bisoprolol, can induce psoriasis in approximately 20% of patients.

• Around 50% of psoriasis patients associate lithium with aggravation, along with other mood-improving medications, albeit less frequently.

• Antimalarial drugs like hydroxychloroquine, chloroquine, and quinacrine.

• Antibiotics, including amoxicillin, although sometimes the underlying infection for which the antibiotic is prescribed, might be the actual cause.

• Non-steroidal anti-inflammatory drugs (NSAIDs) like indomethacin and aspirin.

• Angiotensin-converting enzyme (ACE) inhibitors and tumor necrosis factor-alpha (TNF-α) inhibitors.

Drug-Induced Psoriasis: Insights from the DrugCard Platform

Innovative oncologic treatments, like immune checkpoint inhibitors (ICIs), have significantly enhanced cancer patient survival rates. However, these therapies often introduce immune-related adverse effects (irAEs), impacting patients’ quality of life and potentially restricting treatment options. Among these effects are psoriasis and psoriatic arthritis, which may emerge or worsen during ICI therapy. As ICIs are relatively new, their associations with various adverse effects are still emerging. Recent findings by the DrugCard platform reveal instances of psoriasiform adverse events linked to ICIs in the medical literature. Three cases of ICI-induced new-onset psoriasis and two cases of ICI-induced psoriasis worsening requiring systemic treatment were reported. This underscores the importance of recognizing and promptly addressing psoriasis exacerbation or onset during immunotherapy. Heightened awareness and timely skin-directed therapies are vital to prevent worsening and avoid interfering with ICIs’ efficacy or necessitating treatment discontinuation.

Exploring Paradoxical Psoriasis Risk: Clinical Observations with Ustekinumab Therapy

Ustekinumab (UST), a biologic medication targeting interleukin-12 and interleukin-23, is commonly used to manage psoriasis and Crohn’s disease. Despite its effectiveness, some patients undergoing UST therapy have experienced paradoxical induction or worsening of psoriasis symptoms. Intriguingly, this phenomenon can manifest even in individuals without prior psoriasis history, suggesting that pre-existing psoriasis isn’t a prerequisite. A recent article identified by the DrugCard platform underscores this finding. It describes a 39-year-old woman with long-standing Crohn’s disease who developed a psoriasiform rash during UST treatment, confirmed via biopsy. In summary, while UST effectively treats psoriasis and Crohn’s disease, clinicians must recognize the potential for paradoxical drug-induced psoriasis. Most cases resolve upon discontinuing UST and switching to alternative biologic agents, although some may benefit from continued UST treatment with adjunctive topical corticosteroids or intensified therapy.

The Significance of Pharmacovigilance in Psoriasis Treatment

Additionally, pharmacovigilance is vital for monitoring the safety and effectiveness of psoriasis treatments. With the emergence of new therapies and advancements in existing ones, it’s crucial to evaluate their impact on patient well-being continuously. Pharmacovigilance in psoriasis care involves systematic monitoring of adverse drug reactions, treatment effectiveness, and long-term outcomes associated with various medications. For instance, experts in pharmacovigilance from DrugCards uncovered an unexpected adverse effect of secukinumab in psoriasis treatment through medical literature analysis. Secukinumab, approved by the U.S. FDA and the European Medicines Agency for moderate-to-severe plaque psoriasis and psoriatic arthritis, is known to have documented adverse effects. However, a case report highlighted the development of Prurigo nodularis (PN) during programmed secukinumab dosing. The patient experienced lesions and itching, gradually improving upon discontinuing secukinumab and initiating combined treatment with antihistamines and 0.1% triamcinolone acetonide cream.

Conclusion

Pharmacovigilance and continuous monitoring of medical literature play pivotal roles in enhancing the safety and efficacy of treatments for psoriasis, including drug-induced psoriasis. As a chronic inflammatory skin condition affecting millions worldwide, psoriasis poses significant challenges to patients’ quality of life. Pharmacovigilance professionals can promptly identify and address potential risks by systematically monitoring adverse drug reactions, treatment efficacy, and emerging complications. Recent insights from the DrugCard platform underscore the importance of remaining vigilant and responsive to emerging risks and opportunities in psoriasis care. Therefore, medical literature monitoring is a linchpin in pharmacovigilance, offering critical insights into drug safety and efficacy.