This patient's presentation is consistent with a diagnosis of psoriasis. Medications that may exacerbate psoriasis include beta blockers (such as propranolol), NSAIDs, ACE-inhibtors, anti-malarial drugs, and lithium.
Psoriasis is an idiopathic inflammatory dermatosis characterized by silver scales overlying erythematous patches, occurring most commonly on the extensor surfaces. It occurs in approximately 2-4% of individuals and often first manifests in adolescence or young adulthood. In addition to the medications listed above, other potential triggers of a psoriasis flare include stress, skin site-specific trauma, and infections.
Weigle et al. review the management of psoriasis. Mild to moderate plaque psoriasis may be effectively treated with topical steroids, vitamin-D analogs, or tazarotene. Severe psoriasis may require phototherapy, systemic steroids, and biologic medications (anti-TNF-alpha agents). Ultimately, the optimal management of psoriasis is individualized and requires a combination of different types of medications.
Basavaraj et al. discuss the role of medications in the induction or exacerbation of psoriasis. Ingestion of trigger medications may either exacerbate pre-existing psoriasis, induce psoriasis lesions on previously uninvolved skin in those with a history psoriasis, or lead to the development of the disease in patients with or without family history of psoriasis. In addition to the medications listed previously, the authors classify tetracyclines as a class of medications that may aggravate psoriasis.
Figure A shows the characteristic rash of psoriasis; note the silvery scales overlying an erythematous base. Illustration A depicts a schematic of how many different psoriasis triggers may interact with the immune system to lead to skin lesions. Illustration B lists a treatment ladder for increasing severity of psoriasis.
Answer 1: Oxycodone is a narcotic analgesic. It is not known to affect the severity or course of psoriasis.
Answer 2: Procainamide is an antiarrhythmic medication and it does not have an effect on psoriasis. Quinidine, however, has been implicated in worsening some cases of psoriasis.
Answer 3: Losartan is an angiotension 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 the condition.
Answer 4: Inflixamab is a TNF-alpha inhibitor indicated for the treatment of chronic severe plaque psoriasis.
Weigle N, McBane S. Psoriasis. Am Fam Physician. 2013 May 1;87(9):626-33.
PMID:23668525 (Link to Abstract)
Basavaraj KH, Ashok NM, Rashmi R, Praveen TK. The role of drugs in the induction and/or exacerbation of psoriasis. Int J Dermatol. 2010 Dec;49(12):1351-61.
PMID:21091671 (Link to Abstract)