What is the cause of this woman’s lesions?
This 69-year-old woman presented for evaluation of a rash on both lower extremities after having started a regimen of metoprolol and rivaroxaban for atrial fibrillation.
What is the cause of this woman’s lesions?
- Adverse drug reaction to metoprolol
- Adverse drug reaction to rivaroxaban
- Stasis dermatitis due to decreased cardiac function
- Stasis dermatitis due to fluid retention from the β-blocker
- Granuloma annulare
Answer on next page
Answer: Stasis dermatitis due to fluid retention from the β-blocker
A biopsy of the patient’s lesion confirmed the diagnosis of psoriasis, which had been exacerbated by the addition of metoprolol, a β-blocker on the list of medications that can exacerbate psoriasis.
This woman’s psoriasis was cleared by adding methotrexate to her regimen after she did not respond to topical therapy. Her cardiologist was reluctant to discontinue her β-blocker. Other drugs such as lithium also have been implicated in exacerbations of psoriasis, and β-blockers have been reported to exacerbate psoriatic arthritis (Macfarlane DG, Settas L. Acute psoriatric arthropathy precipitated by oxprenolol. Ann Rheum Dis. 1984;43[1]:102-104).