7 - Derm - Psoriasis - MGMT of psoriasis

Question 1

6 principles of first line mgmt

Answer 1

emollients
topical steroids
topical vit D analogues
coal tar
dithranol
salicyclic acid

Question 2

potency of top steroids?

Answer 2

mild-mod - v potent if affecting feet/palms

Question 3

top vit D analogues - 2 examples, inhibit what? risk of 2 things?

Answer 3

calcipotriol, calcitriol
inhibit DNA synthesis and cell proliferation
risk of irritation, hypercalcaemia

Question 4

coal tar - anti-what? 3 downfalls?

Answer 4

anti-mitotic

but messy, irritation, folliculitis

Question 5

dithranol - inhibits what? 2 downfalls?

Answer 5

inhibits keratinocyte proliferation

but irritation , skin staining

Question 6

salicyclic acid - mechanisms? downfall?

Answer 6

keratolytic

but irritation

Question 7

specific recommendations for

• thick plaques
• face
• guttate?

Answer 7

thick - salicyclic acid or dithranol
face - mild to mod topical steroids
guttate - coal tar

Question 8

specific recommendations for

• flexures
• flexural

Answer 8

flexures - mild to mod topical steroids or calcitriol

flexural - consider trimovate (antifungal, antibiotic, steroid)

Question 9

second line Tx options ??

Answer 9

phototherapy

• PUVA - risk of erythema, pruritis, nausea, skin cancer
• UVB - TLO1 - fewer SE’s

Question 10

3 3rd line systemic Tx

Answer 10

methotrexate
ciclosporin
retinoids

Question 11

methotrexate - mechanism?

Answer 11

folic acid antagonist - inhibits amino acid synthesis

inhibits fast growing of cells

Question 12

methotrexate risks

Answer 12

teratogenic
bone marrow suppression
hepatotoxicity

Question 13

ciclosporin - suppresses what? risks?

Answer 13

suppression of T-cells

risks- nephrotoxic, htn, cancer

Question 14

Retinoids - example? what are they and mechanism?

Answer 14

acitretin

vit A derivatives, suppress DNA synthesis and cell differentiation

Question 15

retinoids risks

Answer 15

teratogenic, hepatotoxic, hyperlipidaemia