Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
A 64-year-old Caucasian man comes to see you in the office for the evaluation of a rash. The rash is mildly pruritic and initially appeared over his elbows, but it has progressed to involve his back and the front of his knees in the past week. He was seen by his primary care provider (PCP) a month ago for uncontrolled hypertension. His PCP started him on a new pill for hypertension at that time, but he cannot recall the name of the new medication. On physical examination, the rash over his knees and elbows is an erythematous, well-defined plaque with silver scales. You suspect that he is suffering from psoriasis.
. Which of the following antihypertensive medication is known to exacerbate psoriasis?
Options
1. Hydrochlorothiazide
2. Metoprolol
3. Amlodipine
4. Doxazosin
5. Hydralazine
Posts: 3,675,934
Threads: 734,342
Joined:
Sep 2021
Reputation:
5
The Correct Answer is 2.
Psoriasis is a common inflammatory skin disorder characterized by erythematous, well-defined plaques covered by thick, silvery scales. These lesions are typically seen over the scalp, knees, elbows, back, and nail plates. Patients are often asymptomatic, but some may complain of mild pruritus. Once diagnosed, most patients tend to have the disease for life. Spontaneous remissions and marked variations in the severity of symptoms are observed throughout the course of the disease.
Psoriasis results from hyperproliferation and abnormal differentiation of the epidermal layer of the skin. Although the exact pathophysiology of these changes is not understood, immunologic and genetic factors are both thought to play significant roles.
Physicians should be wary when prescribing medications to patients with psoriasis because several drugs may exacerbate psoriatic lesions. The most common of these drugs are beta-blockers, antimalarial drugs, nonsteroidal antiinflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors, and lithium. Bacterial and viral infections, especially HIV infection, have also been associated with worsening of psoriasis.
(Choices A, C, D, and E) Hydrochlorothiazide, amlodipine, doxazosin, and hydralazine are not associated with worsening of psoriasis.
