Cynthia Trickett, MPAS, PA-C, discusses highlights from her lecture on Complicated Psoriasis Cases at the 2021 Elevate-Derm Conference.
In this video
Trickett walks through a mnemonic she uses to remember medications that can trigger or destabilize psoriasis: beta blockers, lithium, antimalarials, certain biologics, other blood pressure agents (calcium channel blockers, ACE inhibitors), interferon, NSAIDs like naproxen and indomethacin, gold salts, and — most importantly — steroids, especially Medrol dose packs and rapid tapers that can "unmask" and seriously destabilize disease.
She also flags patient behaviors that flare psoriasis, from unintentional scratching and picking (a reason scalp psoriasis is notoriously hard to treat) to trauma from footwear or uniforms, and above all nicotine — smoking, vaping, or gum — which she calls one of the most important things to help patients quit. Having trained for about 12 years with Dr. Alan Menter, "one of the godfathers of psoriasis," she describes today's therapies as transformative and a chance to "be a hero" for patients who no longer have to live with psoriasis the way they used to.
- Remember drug triggers with a mnemonic: beta blockers, lithium, antimalarials, biologics, blood pressure meds, interferon, NSAIDs, gold salts, and steroids.
- Steroids are the most important trigger — Medrol dose packs and rapid tapers can unmask and destabilize psoriasis.
- Watch for behavioral triggers like scratching and picking, and trauma from footwear or uniform wear.
- Getting patients to quit nicotine in any form — cigarettes, vaping, or gum — is one of the highest-yield interventions.
- With today's therapies, patients don't have to live with psoriasis the way they used to — the results can be transformative.
