The correct answer is: E. Acitretin.

The shown lesion is consistent with psoriasis, and systemic therapy can be associated with immunosuppression leading to infection. However, only acitretin of the options listed is non-immunosuppressive and thus should be the first systemic therapy in patients with concerns for immunosuppression.

The remaining answer choices are less ideal considering that they are immunosuppressive.

References: 

PMID: 30017706 Wong JW, Koo JY. The safety of systemic treatments that can be used for geriatric psoriasis patients: a review. Dermatol Res Pract. 2012;2012:367475. doi:10.1155/2012/367475