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Guttate psoriasis — SCE Dermatology MCQ

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HardGeneral dermatology & dermatology in primary health careGuttate psoriasisSCE Dermatology

A patient develops anti-Ro-positive annular papulosquamous plaques on sun-exposed sites eight weeks after omeprazole was started. There are no systemic lupus features. What is the most appropriate first disease-modifying step?

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Correct answer: A — Withdraw omeprazole and reinforce photoprotection during specialist reassessment

Explanation lettering: E = shown as A · A = shown as B · D = shown as C · B = shown as D · C = shown as E

E is correct. Proton-pump inhibitors are recognized triggers of drug-induced subacute cutaneous lupus, which is commonly anti-Ro positive and photo-distributed. Removing the likely culprit is central; improvement may take weeks after withdrawal, and topical anti-inflammatory treatment or hydroxychloroquine may be required according to severity. Terbinafine is itself a recognized trigger, not a treatment for this morphology. ANA need not become negative before action. Therapeutic ultraviolet exposure is inappropriate for a photosensitive lupus eruption. Systemic features and alternative diagnoses should still be assessed.

Reference: BAD guideline for cutaneous lupus erythematosus: https://doi.org/10.1111/bjd.20503