
==== Front
Psoriasis (Auckl)
Psoriasis (Auckl)
ptt
Psoriasis: Targets and Therapy
2230-326X
Dove

492761
10.2147/PTT.S492761
Letter
NSAIDs: Unveiling Their Role in Drug-Induced Psoriasis [Letter]
Shaikh
Shaikh
http://orcid.org/0000-0002-9943-9907
Shaikh Somina 1
1 Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
Correspondence: Somina Shaikh, Dow Medical College, Karachi, Pakistan, Email somina.sh16@gmail.com
13 9 2024
2024
14 101102
03 9 2024
11 9 2024
© 2024 Shaikh.
2024
Shaikh.
https://creativecommons.org/licenses/by-nc/3.0/ This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php).
==== Body
pmcDear editor

I would like to commend the authors for their insightful review of “Drug-induced psoriasis: clinical perspectives”.1 I appreciate the authors for their thorough examination of the various drugs implicated in the onset of psoriasis, a topic of significant clinical importance. However, I would like to highlight the importance of non-steroidal anti-inflammatory drugs (NSAIDs) as potential inducers of psoriasis. NSAIDs are widely prescribed for their analgesic and anti-inflammatory properties, and a substantial body of evidence suggesting their role in exacerbating or inducing psoriatic lesions.

NSAIDs are a class of medications used to treat pain and arthritis. NSAIDs are frequently used in patients with psoriasis and psoriatic arthritis. NSAIDs are available by prescription and over-the-counter. NSAIDs block the cyclooxygenase (COX) pathway, which inhibits arachidonic acid metabolism. This leads to the build-up of leukotrienes, which have been suggested to exacerbate psoriasis. One study found that the most frequent causes of psoriasis induction and aggravation was NSAIDs, both systemic and topical NSAIDs. One study found that both topical and systemic NSAIDs were the leading factors in worsening existing psoriasis and triggering new cases.2 In another study, 1% indomethacin cream applied topically exacerbated psoriasis 14 out of 20 patients.3 Among the NSAIDs, naproxen was the most common culprit.4

The use of NSAIDs has been linked to the worsening of psoriasis and onset of generalized pustular psoriasis.5

Given that patients with psoriasis may experience associated arthropathies, it is crucial for clinicians to be aware that NSAIDs can potentially worsen psoriasis symptoms. Owing to the widespread use of NSAIDs and the potential risk they pose to patients predisposed to psoriasis, it is crucial that they are included in discussions of drug-induced psoriasis. I believe that acknowledging this class of drugs in future reviews will provide a more comprehensive understanding of the factors contributing to psoriasis.

Disclosure

In this correspondence, the author declares that there are no conflicts of interest.
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References

1. Balak D, Hajdarbegovic E. Drug-induced psoriasis: Clinical perspectives. Psoriasis. 2017;7 :87–94. doi:10.2147/PTT.S126727 29387611
2. Fry L, Baker BS. Triggering psoriasis: The role of infections and medications. Clin Dermatol. 2007;25 (6 ):606–615. doi:10.1016/J.CLINDERMATOL.2007.08.015 18021899
3. Cohen AD, Bonneh DY, Reuveni H, Vardy DA, Naggan L, Halevy S. Drug exposure and psoriasis vulgaris: Case-control and case-crossover studies. Acta Derm Venereol. 2005;85 (4 ):299–303. doi:10.1080/00015550510032823 16191849
4. Grau R. Drug-induced psoriasis-A retrospective chart. Availabe from: https://scholar.google.com/scholar_lookup?journal=J+Am+Acad+Dermatol.&title=Drug-induced+psoriasis%E2%80%94A+retrospective+chart+review+performed+at+the+University+of+Oklahoma+Department+of+Dermatology&author=R+Grau&volume=59&publication_year=2008&pages=P2647&. Accessed September 3, 2024.
5. Milavec-Puretić V, Mance M, Čeović R, Lipozenčić J. Drug-induced psoriasis. Recognition and management. Am J Clin Dermatol. 2000;1 (3 ):39–42. doi:10.2165/00128071-200001030-00003
