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

Rupioid skin lesions usually develop on a background of immunosuppression and are grossly hyperkeratotic cone-shaped plaques with thick, dark, adherent, and lamellate crusts resembling limpet shells.1 Relatively few etiologies, mainly infectious, are relevant to the differential diagnosis of rupioid presentations, including syphilis, HIV, scabies, histoplasmosis, rupioid psoriasis (RupP), or reactive arthritis.1 RupP is an uncommon condition resulting from a pronounced inflammatory response, leading to abnormal keratinized scale mixing with copious sero-exudate.2 The lesions exhibit classic histopathologic findings of psoriasis.1 Drug-provoked psoriasis (either drug-aggravated or drug-induced) is similarly infrequent, with lithium, beta-blockers, and antimalarials being the most common causative agents.3 Drug-induced RupP is extremely rare, with only a few reports in the literature (Table I). Table I Summary of drug-provoked rupioid psoriasis (RupP) cases identified in PubMed