ACE-inhibitors and psoriasis
The Netherlands Pharmacovigilance Centre Lareb received 25 reports of aggravation of psoriasis or new-onset psoriasis in association with Angiotensin Converting Enzym (ACE) inhibitors. ACE-inhibitors are used for the treatment of hypertension and heart failure.
Psoriasis is a common disease, affecting 2-3 % of the population in northern Europe. Beside a genetic susceptibility, possible risk factors of psoriasis are stress, bacterial and viral infections, smoking, obesity and alcohol and drug use. Although it is not easy to establish an evident drug-relationship in a fluctuating disease like psoriasis, in 9 of 25 reports, patients recovered after discontinuation of the involved ACE-inhibitor. The postulated mechanism is related to blockade of bradykinin inactivation, leading to elevated concentrations of inflammatory mediators.
It is of importance to acknowledge the possible role of ACE-inhibitors in (exacerbation of) this disease.