Psoriasis and Diabetes — SCE Dermatology MCQ

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ModerateDermatopharmacologyPsoriasis and DiabetesSCE Dermatology

A 55-year-old man has chronic plaque psoriasis and type 2 diabetes. His dermatologist wants to start systemic therapy. Which conventional systemic should be used cautiously in diabetes due to interactions with hypoglycaemic agents?

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Correct answer: D — Ciclosporin (can cause hyperglycaemia and interact with diabetes medications)

Ciclosporin can cause hyperglycaemia (impaired glucose tolerance/new-onset diabetes) through direct pancreatic beta-cell toxicity and insulin resistance. It also interacts with some diabetes medications — Ciclosporin levels may be affected by agents metabolised through CYP3A4. Careful glucose monitoring is needed. Methotrexate has no significant hyperglycaemic effect. Acitretin can cause lipid disturbances but less glucose impact. Hydroxychloroquine paradoxically has hypoglycaemic properties (potentially beneficial in diabetes). The choice of systemic therapy in psoriasis patients with diabetes should account for these metabolic effects — biologic therapies may be preferable if conventional systemics pose metabolic risks.

Reference: BAD 2020 Psoriasis Comorbidities; BNF