Psorias Flashcards
what is psoriasis
Tcell mediated disease resulting in hyperkeratotic skin disorder (increased cell turnover)
what are some factors that caus psorias
- Immune systme changes \
- hereditary (PSOR1)
- Environemntal (trauma, stress and infections)
- drugs (beta blockers, antimalarials, steroids, lithium)
What kind of trauma aids in psoriasis development?
koebner phenomenon - trauams like getting a bug bite, or a tattoe, or a sunburn)
what kind of infections aid in psorias development
strep - guttate psorias
what drugs can aid in psoriases
lithium - exacerbate
beta-blockers - induce new onset psoriases
antimaralirs - exacerbate
steroid - when taken away an exacerbate
indomethacin -can exacerbate
comorbidties of psorias
- itching - hydroxyzine
- arthritis
- psychiatric disorder (depression)
- metabolic syndrome
- other immune disorders (Crohn’s, Ms, etc)
- malignancies
Tyoes of psoriasis and focus of her lecture
- plaque psoroias (focus)
- Guttate psoriasis
- inverse psoriasis
- pustular psoriasis
-erythroderma psoriasis - palmar /planter psoriasis
what types of psoriasis are medical emergencies
-pustular psoriasis
- erythroderma psoriasis
Clinical manifestations
plaque-like lesions, silver- white, loosely adherent plaques
auspitz sign
oil spots
efficacy tests
PASI - severity
DLQI - QofL
mild classification
less than score of 10 on PASI, and DLQI, and BSA
mod- severe classifiaction
score more than 10 on BSA, PASI, and DLQI
two phases for tx
induction
- rapid induction within 16 wks
- slower induction within 24 weeks
maintenance phase
- monitor at 8 week intervals
how to assess if treatment is sufficient
PASI score of less than 50 - mody tx
PASI score between 50-75 - check DLQI if the score is more or less then 5
if less than or equal to 5 then continue with treatment
if more then 5 then modify treatment
if PASI score if 75 or more - continue with treatment
Tc options of therpay
- non-drug
- topical rx
- phototherpay
- systemic rx
non-pharm tx for psoriases
- stress reduction, non-medical moisturizer (fragrances free), avoid irritating chemicals on skin, avoid skin trauma(sunburn), wear loose fitting cotton clothing
tx for mild to mod
topical
topical + phototherpay
topical and systemic agents
- always moisture and step down to the lowest possible regimen while maintaining control
Tx for mod-severe
Systemic +/- topical dna dphototherpay
Biologic (or 2 systemics) +/- topical
biologic +/- other therpaies
- whle time use mositurizer and use less potent agent to maintain control
topical agents
- CS
- Retinoids
- vit D analogues
- crude coal tar or tar distillates
- salicyclate acid
- anthrallin
- immunomodulators
Cs options
HD Valiant Drgaons DiG For Helium D/C
low potency : hydrocortisone, desonide
medium potency : betamethasone valete, batemethasome dipropirate lotion
high potency: betamethsone dipropriate crem/gel, flucinonide, halocinode
super high potency: betmetasone diproprionte ointment, colobetasol propionate
when due I use lowest potency, medium potency, and high potency
lowest - face and skin folds
medium - trunk, arms, legs
high - plams, soles, elbows
what is a pro of ointments
they enhance penetration
what is the purpose of proplyene glycol
increases rx solubility, and hence increased rx availibilty and potency
systemic affects of CS
- cushing
- addiosn crisis
- retarded geowth
- hyerpgkycemia, glaucoma and caratarcts
Toppcal retinoids option
tazotarone and tretinoin
Toppcal retinoids option cons
- drying agent
- tertagenic
vitamin D analogue options
- calciprotol, calciprotreine, calciotriol
what are some steroid sparring options?
tretinoins, and vit D analogues
coal tar charcteristics
- staining
-unpleseant odor - stinging or irrattaing to skin
- may be photosenitizing
anthrlain indication
- for thick skin otherwise highly irritaing
anthralin dose
0.1%-0.4% - applied to thicker skin can use zinc oxide to protect
1-4%
- can only be applied for 20 mins before it should be wipped off
