A report describes a case of a 61-year-old woman with a medical history of coronary artery disease (CAD) who complained of the recent onset of an erythematous and scaly rash over her hands and feet, which had progressed to the trunk. She revealed a history of a recent diagnosis of stable angina and was prescribed bisoprolol as the only medication at the initial dosage of 2.5 mg that she tolerated well. Subsequently, her medication was adjusted to 10 mg twice daily, which she continued to take without any complaints at her 4-week follow-up. However, after 5 weeks of consuming 10 mg bisoprolol twice daily, she noticed the appearance of an erythematous scaly rash. She denied any history of skin lesions of this nature, atopy or seasonal allergies in her as well as her family. 

Skin examination revealed erythematous and scaly lesions, particularly on the dorsal surface of her hands and feet, sparing her face. Her nails, hair and mucosal surfaces appeared normal, the systemic examination was unremarkable, and her vitals were stable. She showed no evidence of dehydration. 

Her lab results were unremarkable, which excluded any atopic or autoimmune condition. A dermatologist consultation revealed the lesions as beta-blocker-induced erythrodermic psoriasis (EP) and recommended a biopsy to confirm the diagnosis. Over 4 days, her beta-blocker was gradually tapered off and replaced with a calcium channel blocker. She received topical medications, oatmeal baths and supportive care, along with an oral dose of methotrexate 15 mg weekly. 

Biopsy revealed psoriasiform dermatitis with parakeratosis, the absence of the granular layer, elongated rete ridges, suprapapillary thinning of the epidermis, focal lymphocytic infiltrates, and marked dilation and coiling of vessels within the papillary dermis, indicating drug-induced EP.

She experienced an improvement in lesions following the discontinuation of beta blockers which resolved completely within 2 months. She never experienced a recurrence of these lesions during her 6 months follow-up and denied a retest of the beta-blocker. Her biopsy results, along with a rating of 6 on the Naranjo scale, directed a conclusive diagnosis of beta-blocker-induced EP.

Source: Voloshyna D, Ehsan Ullah S, Jahan N, et al. Beta-blocker-induced erythrodermic psoriasis: a case report. Cureus. 2022;14(10):e29809.