Drug-related psoriasis

Psoriasis is a common chronic, systemic immune-mediated, polygenic, and multifactorial skin disorder [1, 2] requiring complex long-term treatment. The onset of psoriasis or relapses of the disease can be caused by various environmental factors including drugs [2] often used to treat comorbidity. Along with classic comorbidities associated with psoriasis such as psoriatic arthritis, inflammatory bowel disease, psychiatric disturbances, and uveitis, there is growing evidence of emerging comorbidities e.g. metabolic syndrome and its components, cardiovascular diseases, non-alcoholic fatty liver disease, chronic kidney disease, etc. [3]. The enlarging spectrum of comorbid disease states in psoriasis patients is associated with the eventual use of a diverse array of medications that may affect the course of psoriatic disease.
Case 1. A 54-year-old male with a 30-year history of psoriasis had typical winter flares of the disease and symptoms of joint pain in the last year. Topical medication consisted of corticosteroids and emollients. Betamethasone sodium phosphate/betamethasone dipropionate IM injection had been administered for his joint complaints before hospitalization. Physical examination revealed indurated scaly plaques, onycholysis, and nail pits. Psoriasis Area Severity Index (PASI) score was 20.4. The patient was overweight (obesity class III) with concomitant arterial hypertension and type 2 diabetes mellitus treated with bisoprolol, lisinopril/amlodipine, aspirin, liraglutide, metformin, gliclazide, and allopurinol. Laboratory data revealed poor glycaemic control with peak blood sugar concentration of 34.4 mmol/l (ref. range 3.75–6.1 mmol/l) and glycosuria. Blood count, creatinine, uric acid and liver function tests were within normal range. Serologic tests for HIV, hepatitis B and C, as well as Quantiferon Gold assay were all negative.
Following consultation with a cardiologist, the b-blocker and angiotensin-converting enzyme (ACE) inhibitor were substituted with verapamil, irbesartan, and indapamide. Treatment of psoriasis included emollients and narrow-band UVB (311 nm). Adalimumab was initiated in a standard dose regimen, and PASI 75 at week 16 was achieved.
Case 2. A 53-year-old female with a 2-year history of psoriasis presented with erythematous indurated scaly plaques covering most of the body surface. PASI score was 32.0. Concomitant idiopathic thrombocytopenic purpura had been continuously treated with varying doses of...


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