Close-up of hands with dry, red, scaly skin caused by psoriasis

How cholesterol-lowering medications and precision medicine improve psoriasis treatment

Ruslan Dorfman, PhD, MBA1 Nov 2026

Psoriasis is a chronic autoimmune condition in which skin cells multiply too quickly, causing red, scaly and often painful patches and inflammation. There is no cure, but many treatments are available. These include creams with corticosteroids, vitamin D analogues, tar or tazarotene (a topical retinoid), light therapy, oral medications such as methotrexate and cyclosporine, and injectable biologics. Some medications can also trigger psoriasis flare-ups, including beta-blockers such as propranolol and metoprolol, lithium and antimalarial drugs. Stopping oral corticosteroids abruptly can also make psoriasis worse.

Psoriasis affects more than the skin. People with psoriasis, especially moderate to severe psoriasis, have a higher risk of heart attack and stroke and are more likely to have unhealthy blood lipids. This is why researchers are studying cholesterol-lowering medications in psoriasis, both to protect the heart and possibly to help the skin.

Is psoriasis linked to cholesterol?

Yes, but not in a simple way. A large UK Biobank study found that low HDL ("good") cholesterol and high triglycerides predicted new cases of psoriasis, especially in women. LDL ("bad") cholesterol and total cholesterol did not. Genetic analyses in the same study supported a causal role for low HDL and high triglycerides.

The European Academy of Dermatology and Venereology (EADV) points out that cardiovascular disease is the leading cause of excess deaths in people with psoriasis, and that the risk rises with psoriasis severity. Its 2023 position statement asks dermatologists to assess heart risk and cholesterol in people with moderate to severe psoriasis, and notes that statins are underused in this group.

Can cholesterol-lowering medications help psoriasis?

Researchers use a method called Mendelian randomization to test this. It looks at people who naturally carry gene variants that mimic the effect of a drug, for example variants that lower the activity of the enzyme targeted by statins. If these people have less psoriasis, the drug may help too.

PCSK9 inhibitors (alirocumab, evolocumab). The strongest and most consistent results are for this pathway. In a 2023 study of more than 12,000 people with psoriasis, gene variants mimicking PCSK9 inhibition were linked to about 30% lower odds of psoriasis, and the result was confirmed in a second population. Later studies found the same.
Statins (HMGCR inhibitors). Results are mixed. The 2023 study found no robust link, while a 2024 study did. Small clinical trials suggest statins may lower psoriasis severity scores modestly after 8 weeks, but not clearly at 12 weeks.
Ezetimibe (NPC1L1 inhibitor). Genetic studies have not found a link with psoriasis risk.

In short, cholesterol-lowering medications are not a treatment for psoriasis on their own. Their main benefit is protecting the heart, and some, particularly PCSK9 inhibitors, may also help the skin. More clinical trials are needed. Statins also have anti-inflammatory effects, and research suggests they may lower the risk of some cancers.

Which cholesterol-lowering medication is right for me?

The choice depends on your cholesterol levels, your overall heart risk and your other medications, as the EADV position statement on statins and psoriasis describes. Talk with your doctor about having your cholesterol and heart risk checked.

Statins are the first choice for most people who need to lower cholesterol. They reduce heart attacks and strokes. Some people develop muscle aches, and your genes affect this risk (see below).
Ezetimibe is often added to a statin when cholesterol needs to come down further, or used when a statin is not tolerated.
PCSK9 inhibitors are injections used for people with very high LDL cholesterol or high heart risk whose cholesterol is not controlled by other medications.

If very high cholesterol runs in your family, you may have familial hypercholesterolemia. It is most often caused by a variant in the LDLR gene, and less often in the APOB or PCSK9 genes. People with this condition usually need a statin and often additional medications, such as ezetimibe or a PCSK9 inhibitor, to lower their heart risk.

How can pharmacogenetics help choose a safe statin?

The Clinical Pharmacogenetics Implementation Consortium (CPIC) has published a guideline on genes and statins. Three genes affect how much statin stays in your blood and your risk of muscle aches:

SLCO1B1 controls how statins enter the liver. Reduced function raises statin levels in the blood. The guideline recommends a different statin or a lower dose for some statins, especially simvastatin.
ABCG2 affects rosuvastatin levels. People with reduced function may need a lower starting dose.
CYP2C9 breaks down fluvastatin. Poor metabolizers may need a lower dose or a different statin.

A Pillcheck test reports all three genes, so your doctor can choose a statin and dose that suit you from the start.

How can pharmacogenetics guide other psoriasis treatments?

Taking several medications increases the risk of side effects and drug interactions. A pharmacist medication review that looks at your genes and all your medications together can make psoriasis treatment safer.

Methotrexate is an effective treatment for moderate to severe psoriasis. There is no pharmacogenetic guideline for low-dose methotrexate, but drug interactions matter. For example, the antibiotic trimethoprim-sulfamethoxazole can greatly increase methotrexate toxicity, and some pain relievers (NSAIDs) can raise methotrexate levels. A pharmacist review flags these combinations.

Cyclosporine is used for severe psoriasis. It is broken down by the CYP3A4 and CYP3A5 enzymes, and many medications change its levels, so doctors monitor its blood levels. Cyclosporine also raises the blood levels of statins: simvastatin must not be taken with cyclosporine, and other statins need dose limits or a careful choice. This is important if you need both cholesterol and psoriasis treatment.

Azathioprine and thioguanine are sometimes used off-label for psoriasis when other treatments are not suitable. Variants in the TPMT and NUDT15 genes greatly increase the risk of serious bone marrow toxicity from these medications. CPIC guidelines recommend adjusting the starting dose, or choosing another medication, based on TPMT and NUDT15 results. NUDT15 variants are more common in people of East Asian and Hispanic ancestry. Pillcheck reports both genes.

Light therapy is a common and effective treatment. Long-term PUVA therapy (psoralen plus UVA light) increases the risk of skin cancer, including melanoma, so the number of treatments is limited. Narrowband UVB is now used more often and has not shown a clear increase in skin cancer risk.

Biologic therapies block specific inflammatory signals and work very well for many people. There are currently no validated genetic tests to predict which biologic will work for you. Biologics have few drug interactions, so they can usually be taken together with statins or other cholesterol-lowering medications when needed.

Pillcheck testing is performed in CAP- and COLA-accredited clinical genetic laboratories located in Canada. Pillcheck reports on 24 genes, increasing coverage with new guidelines and drug labels (see the genes tab), and covers 355 medications, which account for over 70% of dispensed prescriptions. The Pillcheck test panel ensures high accuracy for people of non-European and admixed ancestries. Your results last a lifetime, and report updates are free of charge.

Summary

Psoriasis, especially moderate to severe psoriasis, raises the risk of heart disease and is linked to low HDL cholesterol and high triglycerides.
Genetic studies most consistently link PCSK9 inhibition with lower psoriasis risk. Evidence for statins is mixed, and none has been found for ezetimibe. These medications mainly protect the heart and are not a stand-alone psoriasis treatment.
SLCO1B1, ABCG2 and CYP2C9 test results help your doctor choose a safe statin and dose.
TPMT and NUDT15 results guide azathioprine and thioguanine dosing, and a pharmacist review flags interactions with methotrexate and cyclosporine.
Pharmacogenetic testing is covered by many workplace insurance plans as part of extended health benefits.

Frequently asked questions

Can statins treat psoriasis?

Not on their own. Small trials suggest a modest short-term improvement, but the main reason to take a statin is to lower cholesterol and heart risk, which is higher in people with psoriasis. Keep using the psoriasis treatment your doctor prescribed.

Should I be checked for heart risk if I have psoriasis?

Yes. European dermatology experts recommend that people with moderate to severe psoriasis have their cholesterol and heart risk assessed. Ask your doctor about it.

Can I take a statin with my psoriasis medication?

Usually, yes, but some combinations need care. Cyclosporine raises statin levels, and simvastatin must not be taken with it. A pharmacist medication review checks your combination.