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Importance:Patients with psoriasis are at an increased risk of hypertension, and when present, hypertension is more severe in patients with psoriasis. However, hypertension often goes underdiagnosed and undertreated in this population, which can contribute to increased overall morbidity and mortality.Objective:To review the relationship between psoriasis and hypertension and provide practical screening and treatment recommendations for dermatologists to address hypertension in patients with psoriasis.Evidence Review:PubMed and MEDLINE databases were searched for hypertension and psoriasis. Consensus was reached by the authors based on published work and clinical experience for recommendations on screening, monitoring, diagnosis, and treatment of hypertension in patients with psoriasis.Findings:Hypertension is more prevalent, and often more severe, in the psoriasis population. This review summarizes recommendations for annual hypertension screening in patients with psoriasis, as well as diagnostic cutoffs and initial therapies for dermatologists to consider. Referral to primary care for continued hypertension management and additional referral recommendations based on comorbidities are described.Conclusions and Relevance:Psoriasis is a common dermatologic diagnosis in the United States. Dermatologists should be fully aware of appropriate screening, diagnosis, and initial management of hypertension in this population to help improve morbidity and mortality.

Objectives Systemic allergic reactions to nickel alloys in percutaneous atrial septal defect occlusion devices have a poorly defined natural history. We describe our experience of surgical removal of the offending device in a series of patients with nickel allergy and refractory symptoms. Methods Patients with atrial septal defect device explants for nickel allergy were reviewed. Administered questionnaires focused on symptoms, quality of life, and satisfaction along with the 36-Item Short Form Health Survey to measure physical and mental health postsurgery. Results Atrial septal defect devices were removed for nickel allergy in 58 patients during the past 10 years. The median age was 42 years (range, 24-71 years) and 95% were women. Explantation occurred at a median of 8 years (range, 6 months-18 years) after insertion. Symptoms included fatigue (82%), chest pain (78%), headache (73%), and palpitation (58%). Surveys were available for 45 patients: 58% rated their quality of life as poor and 69% were not at all satisfied with their device. Postexplant, all patients reported improvement in their symptoms, with 18 patients (42%) noting complete resolution. In 12 patients prospectively studied, the preoperative scores in physical and mental health domains were lower than the validation group, indicating significant disability. Similarly, there was marked improvement in each domain postremoval. Conclusions Patients with nickel allergy and severe refractory symptoms after atrial septal defect device implantation experience profound resolution of symptoms and improved quality of life after removal. Nickel allergy should be considered before device insertion, and a low threshold should exist for surgical removal for refractory symptoms.