Antimalarial therapy in psoriatic arthritis was felt to be contraindicated traditionally due to frequent exacerbation of psoriatic skin disease. Interest in hydroxychloroquine treatment of psoriatic arthritis has been revived because of recent series found no exacerbation of psoriatic skin lesions in 50 psoriatic arthropathy patients treated with hydroxychloroquine. A psoriatic arthropathy patient whose skin lesions were markedly exacerbated by hydroxychloroquine is reported. The literature on antimalarial effects on psoriatic skin lesions is briefly discussed.