Hassan is a 48-year-old accountant of South Asian descent with a history of well-controlled plaque psoriasis. 

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<p>Hassan is a 48-year-old accountant of South Asian descent with a history of well-controlled plaque psoriasis.</p><p>He presents with sudden appearance of erythematous scaly plaques across his trunk and extremities (pictured) — far more severe than his previous psoriatic episodes.</p><p>Prior to this, his psoriasis had been stable for years, managed with topical therapies.</p><p>Hassan’s past medical history is significant for metabolic syndrome, gastro-oesophageal reflux disease and osteoarthritis, with a strong family history of ischaemic heart disease and diabetes.</p><p>Over the past two months, Hassan has been commenced sequentially on metformin and ramipril as a preceding 12-month trial of lifestyle measures had no effect on his cardiometabolic parameters.</p><p>He also takes regular paracetamol and daily esomeprazole.</p><p>His GP suspects drug-aggravated psoriasis might be the cause for the recent flare-up.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.