Psoriasis: The Daily PANCE Blueprint
A 42-year-old male with a history of hypertension, hyperlipidemia, major depressive disorder, and psoriasis presents to your clinic for further blood pressure management. On physical exam, you notice well-defined erythematous lesions with silvery plaques on the extensor surfaces of his bilateral elbows. Which of the following medications is the LEAST appropriate for this patient as it can worsen his psoriasis?
A. Calcium channel blockers
B. Non-selective alpha-2 agonists
C. Angiotensin II receptor blockers
D. Beta blockers
E. Nitroglycerin
Answer and topic summary
The answer is D. Beta blockers
Psoriasis is characterized by chronic skin inflammation. It is common and occurs in people with some sort of genetic predisposition. There can be “triggers” including certain infections (especially group A strep), medications (like lithium or beta-blockers), and physical irritation. Classically you will see well-defined, erythematous lesions with silvery plaques that mainly occur on the extensor surfaces of the elbows and knees (any site can be involved though). Patients may also have nail pitting, brittle nails, pruritus, and Auspitz sign (pinpoint bleeding when the scales are scraped off). Treatment depends on the severity but may include topical emollients, topical steroids, topical vitamin D analogs, phototherapy, systemic medications (e.g., biologics like infliximab, cyclosporine, methotrexate, acitretin, apremilast), etc. Psoriasis can have many negative psychosocial effects and these should be managed as well.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
Also covered as part of the Family Medicine EOR topic lists
