A review of antibiotics and psoriasis: induction, exacerbation, and amelioration

ABSTRACT

Introduction: Psoriasis is affected by many environmental factors, including infections and antibiotics. However, the relationship between antibiotics and psoriasis is inadequately studied. Some antibiotics were listed as triggering factors; others showed benefit for psoriasis control. The aim of this article is to review current evidence that may help identify appropriate antibiotics for patients with psoriasis.

Areas covered: The PubMed, Embase, Clinicalkey databases, and google scholar were searched for relevant articles published up to May 2019. Literature regarding antibiotics and psoriasis were included. Six randomized controlled trials and four controlled or cohort studies were identified in 13 kinds of antibiotics.

Expert opinion: Macrolides and rifampin showed decrease of psoriasis area and severity index score in plaque-type psoriasis, while penicillin revealed no statistically significant improvement in guttate psoriasis. Previously tetracyclines were considered as triggering factors, but data were found only in cases or retrospective studies. Mechanisms were thought to be related to immunomodulation rather than bacteria inhibition. Research gap in the influence of genetic susceptibility, the impact on microbiota, and the mode of actions remain to be investigated.

KEYWORDS:

• Antibiotic
• amoxicillin
• fusidic acid
• isoniazid
• macrolide
• microbiota
• penicillin
• psoriasis
• rifampin
• streptococcus

Article highlights

• Use of penicillin revealed no statistically significant improvement in randomized controlled trials in guttate psoriasis.

• Use of macrolides and rifampin improved psoriasis area and severity index (PASI) in plaque-type psoriasis.

• It took weeks to months to show the benefit of antibiotics for psoriasis. Therefore, a too limited period of antibiotic exposure might influence the results.

• Case reports exist for aggravation of generalized pustular psoriasis after amoxicillin, and plaque-type psoriasis following tetracyclines. But more convincing data is still needed to prove the causality.

• Combination of penicillin and rifampin could not show better improvement of PASI response.

Declaration of interest

TF Tsai has conducted clinical trials or received honoraria for serving as a consultant for AbbVie, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, GSK-Stiefel, Janssen-Cilag, Leo-Pharma, Merck, Novartis, Pfizer, and Serono International SA (now Merck Serono International). YC Tsai has delivered speeches held by Pfizer, Janssen-Cilag Pharmaceuticals, Novartis, and Eli Lilly. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.