Review Question - QID 102794

This patient is presenting with silver scales on a salmon base with nail pitting which is suggestive of a diagnosis of psoriasis. Beta-blockers (such as propranolol) can exacerbate psoriasis.

Psoriasis is an idiopathic inflammatory dermatosis characterized by silver scales overlying erythematous patches which occur most commonly on the extensor surfaces. It often first manifests in adolescence or young adulthood. Potential triggers of a psoriasis flare include stress, skin site-specific trauma, and infections. Medications that can exacerbate psoriasis include beta-blockers (such as propranolol), NSAIDs, ACE-inhibitors, anti-malarial drugs, and lithium.

Figure A shows the characteristic rash of psoriasis with the silvery scales overlying an erythematous base.

Incorrect Answers:
Answer 1: Infliximab is a TNF-alpha inhibitor indicated for the treatment of chronic and severe psoriasis. When given for other medical conditions in patients who do not have psoriasis, it can occasionally cause psoriasis-like lesions to appear.

Answer 2: Losartan is an angiotensin receptor blocker (ARB) used for the treatment of hypertension. It is not known to worsen psoriasis. ACE-inhibitors, however, do have an association with worsening psoriasis.

Answer 3: Oxycodone is a narcotic analgesic. It is not known to affect the severity or course of psoriasis.

Answer 4: Procainamide is an anti-arrhythmic medication and does not have an effect on psoriasis. Quinidine, however, has been implicated in worsening some cases of psoriasis.

Bullet Summary:
Medications that can exacerbate psoriasis include beta blockers, NSAIDs, ACE-inhibitors, anti-malarial drugs, and lithium.