Term
| What causes medication induced psoriasis? |
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Definition
NAILS:
- N - NSAIDs
- A - Antimalarials, ACE inhibitors
- I - Inderal ( beta blockers)
- L - Lithium
- S - Steroid withdrawal |
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Term
| What is the pathophysiology of psoriasis? |
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Definition
- T cells induce hyperplasia - large turnover and slow healing = plaques
- Cytokines + growth factors = hyperproliferation of keratinocytes
- Genetic AND environmental
**HIGH cell turnover |
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Term
| What comorbidities are associated with psoriasis? |
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Definition
- Psoriatic arthritis
- Metabolic syndrome
- Crohn's disease/UC
- MS
- psychological illness
**Leads to increased mortality --> leads to coronary artery disease |
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Term
| How is psoriasis assessed? |
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Definition
- Mild - - Moderate - >/ 8%
- Severe - 10% by any scale |
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Term
| What is plaque psoriasis? |
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Definition
90% of cases - well defined plaques on elbow, knees, scalp, genitals, nails.
Auspitz' signs - scratch off a plaque, it bleeds. |
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Term
| What is inverse psoriasis? |
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Definition
| - Very red smooth plaques in the skin folds, not much scaling |
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Term
| What is guttate psoriasis? |
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Definition
| Small, fine red scales triggered by bacterial infection (strep throat) |
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Term
| What is pustular psoriasis? |
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Definition
| Localized pustules usually on palms and soles |
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Term
| What is erythrodermic psoriasis? |
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Definition
| Widespread large red inflamed patches. Covers most of BSA |
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Term
| What is psoriatic onychodystrophy? |
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Definition
| Can occur in all subtypes - nail changes, difficult to treat. 90% accompanyment with arthritis. |
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Term
| What is nonpharmacologic tx for psoriasis? |
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Definition
- Stress reduction
- Moisturizers - lotion/cream
- Oatmeal bath
- Skin protectants - SPF 30+
- Eliminate irritants
- Climate therapy - warm saline
- Emollient - retain moisture. Aloe, petroleum, baby oil |
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Term
| What type of therapy is important to use with psoriasis? |
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Definition
Step down therapy
- Topical - mild to moderate
- Phototherapy - Moderate to severe
- Systemic - Extensive, moderate to severe |
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Term
| How is coal tar used for psoriasis? |
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Definition
- Keratolytic, pregnancy category C
- Inexpensive, can combine with UV, apply QD-BID
- Can irritate, cause photosensitivity |
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Term
| How is salicylic acid used for psoriasis? |
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Definition
- Keratolytic - decr binding and pH. Pregnancy category C, avoid in kids
- Do NOT use in UV therapy, >20% BSA, renal impairment
- Irritates, not good as monotherapy |
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Term
| What is the dosing limit of very potent topical steroids? |
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Definition
less than or equal to 50 grams per week
Ointments are the most potent preparation as they are occlusive |
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Term
| How are topical steroids used for psoriasis? |
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Definition
- Ointments are most potent, pregnancy category C
- Effective, the gold standard
- Lack trials for long term. Tachyphylaxis, ADR |
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Term
| How are Vit D3 analogues used for psoriasis? |
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Definition
- Bind to Vit D receptors, inhibiting keratinocyte proliferation. Inhibits T-lymphcyte activity
- Calcipotriene/Dovonex - <100g/week in adults
- Taclonex - Calcipotriene + betamethasone.
- Do not use with UV light! Pregnancy category C
- Very effective and well tolerated. Can cause hypercalcemia and PTH suppression in high doses. Slow onset |
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Term
| How are retinoids used for psoriasis? |
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Definition
- stops abnormal keratinocyte differentiation, decr hyperproliferation
- Tazarotene/Tazorac - Pregnancy Category X. Only for ppl over 12!
- Steroid sparing, very effective!
- PHOTOSENSITIVITY! slower onset |
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Term
| How is anthralin used for psoriasis? |
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Definition
- Prevents T lymphocyte activation
- Dritho-Creme, Dritho-Scalp, Zithranol
- Short Contact Anthralin therapy (SCAT) - apply for 2 hours then wipe off
- Ingram regimen - tar bath and UV light regimen. For inpatients. Pregnancy category C
- For refractory plaques if nothing else works. Stains the skin, lower efficacy |
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Term
| How do calcineuring inhibitors work for psoriasis? |
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Definition
- Block synthesis of inflammatory cytokines
- Off label for facial/inverse type
- Pimecrolimus/Elidel and Tacrolimus/Protopic. Pregnancy category C, safe in children over 2
- Well tolerated, not for plaque psoriasis. Black box warning for malignancy |
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Term
| How is Ultraviolet therapy used for psoriasis? |
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Definition
- UV-B - dect proliferation of keratinocytes
- UV-A - Additional effects on
- PUVA photochemotherapy - addition of psoralen/methoxsalen/
- RE-PUVA - addition of retinoids. has greatest efficacy. But use UVB due to toxicity
- Excimer laser - very effective, safe in pregnancy, for mild-severe |
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Term
| What are non-biologic systemic agents for psoriasis? |
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Definition
- Acitretin/Soriatane - oral retinoid. Dry eyes, brittle nails. Pregnancy category X
- Methotrexate - for severe. 10-25 mg QW. Incr LFTs, pregnancy category X
- Cyclosporine - severe. 5 mg/kg/day. Hypertension limits drug use |
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Term
| What biologics are used for psoriasis? |
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Definition
- Alefacept/Amevive - binds to CD2 inhibiting activation. 15 mg QW
- Ustekinumab/Stelara - inhibits IL12/23. Inject at 0, 4, 12 weeks
- Adalimumab/Humira - TNF inhibitor
- Etanercept/Enbrel - humanized TNF inhibitor
- Infliximab/Remicade - chimeric TNF inhibitor,more susc. to inj site rxns
**Second line, increase risk of infection, expensive |
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