NSAIDs: Unveiling Their Role in Drug-Induced Psoriasis [Letter]

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. 2In another study, 1% indomethacin cream applied topically exacerbated psoriasis 14 out of 20 patients. 3Among 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.