mx of psoriasis

Question 1

What 4 topical treatments may be prescribed?

Answer 1

1. emolients
2. vitamin D3 analogue
3. coal tar
4. Dithranol

Question 2

Explain the use of calcitriol?

Answer 2

1. vitamin d3 analogue - mechanism is not understood

2. limited by amount you can use

Question 3

what is the adverse effect of calcitriol?

Answer 3

too much vit d3 analogue causes hypercalcaemia

Question 4

Name 2 preperations of calcitriol?

Answer 4

1. ‘Dovonex - calcitriol on its own

2. Dovobet - calcipitrol and betamethosome

Question 5

what are the problems associated with using coal tar?

Answer 5

1. smelly and stains the skin

2. cause skin irritation

Question 6

Name 2 preperations of coal tar>

Answer 6

1. Sebco - use on scalp

2. Exonex - use on body

Question 7

Explain the use of ‘Dithranol’ cream?

Answer 7

1. Common treatment for inpatient use only
2. stains and causes skin irritation
3. only sutible for large plaques as can burn skin

Question 8

Explain the use of light treatments?

Answer 8

1. UVA light/PUVA - uses psolarens to photosensitise the skin to make light therapy more effective
2. good for Guattate psoriasis
3. Increases the risk of skin cancer

Question 9

how often does light therapy need to be administered?

Answer 9

2-5 x a week for 6-8 weeks

Question 10

what is light therapy primary used to treat?

Answer 10

Guttate psoriasis

Question 11

Explain the of immunosupression agents to treat Psoriasis?

Answer 11

1. helps to control as psoriasis is due to increased t cell activation and inflammation
2. increases risk of infections
3. increases risk of cancer

Question 12

Name 3 drugs used as immunosupression agents in psoriasis?

Answer 12

1. Cyclosporin
2. Methotrexate
3. Acitretin

Question 13

immunosupression agent - Cyclosporin

Answer 13

1. monitor renal function and blood pressure

2. should not be given longer than 1 year

Question 14

immunosupression agent - Methotrexate

Answer 14

1. hepatotoxic

2. nausea

Question 15

immunisupression agwnr - Acitretin

Answer 15

1. retinoid agent
2. dry eyes and dry lips
3. monitor triglyceride levels
4. avoid pregnancy for minimum 3 years after

Question 16

What is the final line of treatment and what is the criteria for administering it?

Answer 16

1. anti TNF given in injection form
2. Infliximab, Etanercept etc
3. Criteria of > 10 on DIQI/PASA score
4. must have failed on two systemic treatments (methotrexate/ciclosporin)

Question 17

what needs to be considered before starting anti TNF?

Answer 17

must screen for TB as it can cause reactivation