Antihypertensive Drugs (АCE- Inhibitors/ Beta- Blockers) and Chronic Infections as Potential Triggers for the Spontaneously Development of Small Plaque Parapsoriasis ?!

Abstract

Background: There are different literature data according to which small plaque parapsoriasis (SPP) and guttate parapsoriasis could be considered as part of the various clinical forms of MF. However, there are no literature data that compare different control groups of patients (receiving/ not taking antihypertensive medication) and the two important possibilities deriving from it, namely: 1) that certain drug forms could be inducers of parapsoriasis and 2) that other drug forms could potentiate the transformation of existing parapsoriasis into T-cell lymphoma. We describe a case of possible infectious and / or drug-induced SPP by discussing an important, albeit currently hypothetical link to the drug mediated cancerogenesis. Case report: We present a 39-year-old man with a disseminated eruptive erythemo-papulo-squamous rash, localized on the skin of the trunk and extremities. According to anamnestic data, skin symptoms date back to about 1 month when the patient was hospitalized in the ENT compartment for severe throat pain. Primary empirical antibiotic therapy with clindamycin 4x 600mg/ daily i.v was performed on a regimen and partial remission was achieved. Immediately afterwards there was a resumption of symptoms and the additional occurrence of skin lesions. From the conducted tests, the presence of acute tonsillopharyngitis, focal infection of dental origin and elevated antistreptolysin titer was found. In parallel, the patient receives antihypertensive therapy (ACE inhibitor and beta blocker) on the occasion of arterial hypertension. There was a suspicion for infectious and / or drug-triggered psoriasis gutata, as the subsequent histological study showed evidence of small plaque parapsoriasis. Conclusion: Although there are a number of literature data on the relationship between antihypertensive drugs and their pro-or anticancerogenic action against various types of tumors, there is currently no data available to compare the existing risk of developing T- cell lymphoma in patients with SPP and concomitant cardiac therapy with ACE inhibitors and beta blockers. We present a patient with triple histologically verified small plaque parapsoriasis and we are discussing a completely new pathogenetic element: triggering in the framework a possible chronic infection and systemic antihypertensive therapy. The selected retrospective or prospective analysis of wider groups of patients with chronic infections / systemic antihypertensive medication as well as proven T cell lymphomas could provide clarity with respect to the shared by us observations in single patients. Keywords: Small plaque parapsoriasis; antihypertensive drugs; chronic infections; triggers; drug mediated cancerogenesis;