A case of generalized ostraceous psoriasis mimicking dermatitis neglecta

Abstract

Lithium has been implicated in the exacerbation of pre-existing psoriasis, in the induction of psoriasis on previously uninvolved skin of psoriasis patients, and in the triggering of psoriasis for the first time in patients without a personal or family history. Lithium-induced psoriasis (and its resistance to treatment) is one of the major reasons for noncompliance in patients treated with lithium. We describe a male patient who developed generalized ostraceous psoriasis whose clinical appearance mimicked dermatitis neglecta, 10 months after starting therapy with lithium.

Onset of rupioid psoriasis after vasodilatory regimen initiation in a patient with pulmonary arterial hypertension

“…3 Reported drug-provoked RupP cases implicate pharmacologically unrelated drugs, suggesting that there are multiple molecular pathogenic mechanisms leading to development of rupioid lesions ( Table I ). While inflammation can be potentiated by lithium-mediated modulation of adenylyl cyclase and inositol monophosphatase pathways 13 and immune check-point inhibition with pembrolizumab, 14 our patient's presentation was more complex. We hypothesize that the immunopathogenic, hyperproliferative, and vasodilatory properties of our patient's recently initiated PAH drug regimen synergistically contributed toward her presentation.…”

“… ∗ Some authors consider RupP and ostraceous psoriasis synonyms and use the terms interchangeably to describe the same hyperkeratotic psoriasis variant. 13 † Time to RupP onset since drug initiation. …”

“…Agg, Aggravation of pre-existing lesion; d/c, discontinued; Diss, disseminated; DNI, de-novo induction; F, female; INLS, induction of non-lesional skin in patient with psoriasis history; M, male; MTX, methotrexate; NS, not specified; O, ostraceous; R, rupioid; SA, salicylic acid. *Some authors consider RupP and ostraceous psoriasis synonyms and use the terms interchangeably to describe the same hyperkeratotic psoriasis variant 13. y Time to RupP onset since drug initiation.…”

Psoriasis

“…• Definition: Rupioid, elephantine, and ostraceous psoriasis are rare forms which are characterized by hyperkeratotic lesions and are considered a type of chronic plaque psoriasis. Some authors use the terms rupioid, elephantine, and ostraceous as synonyms (Koley et al 2015;Nascimento et al 2015). • Clinical feature: Rupioid form is characterized by welldemarcated, circular, and limpet-like cone-shaped plaques (Bonciani et al 2015;Koley et al 2015;Chung et al 2014) (Fig.…”

“…It usually affects the limbs, dorsal area, and buttocks (Ahmad and Hassan 2016). Ostraceous form presents horny plaques with concave surface, formed by thick and adherent scales, resembling an oyster shell (Ahmad and Hassan 2016;Nascimento et al 2015) (Fig. 19).…”