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Clopidogrel: a possible exacerbating factor for psoriasis

Vikram K Mahajan1, Gayatri Khatri1, Neel Prabha1

  • 1Department of Dermatology, Venereology & Leprosy, Dr. R. P. Govt. Medical College, Kangra (Tanda) - 176001, Himachal Pradesh, India.

Indian Journal of Pharmacology
|February 20, 2014
PubMed

Insights

A patient developed palmoplantar pustular psoriasis linked to cardiovascular medications. Stopping these drugs resolved the psoriasis, but re-challenge with clopidogrel triggered it again, suggesting a drug-induced condition.

Area of Science:

  • Dermatology
  • Cardiology
  • Pharmacology

Background:

  • Coronary artery disease (CAD) management often involves multiple medications.
  • Palmoplantar pustular psoriasis is a chronic inflammatory skin condition.
  • Drug-induced dermatoses are a recognized clinical phenomenon.

Observation:

  • A 64-year-old male with suspected CAD was treated with diltiazem, atenolol, aspirin, and atorvastatin.
  • He subsequently developed palmoplantar pustulosis, progressing to palmoplantar pustular psoriasis.
  • Initial treatment adjustments, including stopping atenolol and switching aspirin to clopidogrel, provided no relief.

Findings:

  • Discontinuation of all cardiovascular medications led to the resolution of both psoriasis and CAD symptoms.
  • Re-administration of oral clopidogrel precipitated the recurrence of skin lesions.
  • This suggests a causal link between clopidogrel and the patient's palmoplantar pustular psoriasis.

Implications:

  • This case highlights a potential drug-induced psoriasis, specifically linked to clopidogrel.
  • It suggests caution when prescribing antiplatelet agents like clopidogrel or ticlopidine to patients with psoriasis and cardiovascular comorbidities.
  • Alternative antiplatelet strategies or careful monitoring may be necessary in such cases.

Keywords:
Adverse drug reactionsantiplatelet therapyclopidogrelpsoriasis triggerspustular psoriasis

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