Psoriasis Flashcards
Psoriasis is an inflammatory skin disease that usually follows a ___________ course and may have nail or joint involvement
relapsing and remitting
Different forms of psoriasis exist; ______________ psoriasis is the most common, and is characterised by epidermal thickening and scaling, usually affecting extensor surfaces and the scalp
chronic plaque
Different forms of psoriasis exist; chronic plaque psoriasis is the most common, and is characterised by _______________, usually affecting extensor surfaces and the scalp
epidermal thickening and scaling
Different forms of psoriasis exist; chronic plaque psoriasis is the most common, and is characterised by epidermal thickening and scaling, usually affecting _______________ surfaces and the ______________
extensor
scalp
Which drugs may provoke or exacerbate psoriasis? (5)
- Lithium
- Chloroquine and hydroxychloroquine
- Beta blockers
- NSAIDs
- ACEi’s
- Psoriasis may not be seen until the drug has been taken for weeks or months
Offer ____________ treatment first-line to all patients with psoriasis
topical; topical treatment options include emollients, topical corticosteroids, coal tar preparations, and topical vitamin D or vitamin D analogues
What topical treatments are available for psoriasis? (4)
- Emollients
- Topical corticosteroids
- Coal tar preparations
- Topical vit D or vit D analogues
*When choosing topical treatment, consider patient preference, practical aspects of application, extent of psoriasis, and the variety of preparation forms available
_______________ are widely used in psoriasis; they moisturise dry skin, reduce scaling, and relieve itching. They also soften cracked areas and help other topical treatments absorb through the skin to work more effectively.
Emollients
Some cases of mild psoriasis may settle with the use of emollients alone
Continuous long-term use of ______________ may cause psoriasis to become unstable, and lead to irreversible skin atrophy and striae
potent or very potent topical corticosteroids
Continuous long-term use of potent or very potent topical corticosteroids may cause psoriasis to become unstable, and lead to irreversible _____________ and ____________
skin atrophy
striae
Widespread use of topical corticosteroids in the treatment of psoriasis (greater than 10% of body surface area affected) can also lead to _______________
systemic and local side-effects
Widespread use of topical corticosteroids in the treatment of psoriasis (greater than ____% of body surface area affected) can also lead to systemic and local side-effects
10
Patients with psoriasis who have been on intermittent or short courses of potent or very potent topical corticosteroids should be offered a review of treatment at least ___________
annually
Consecutive use of potent topical corticosteroids should not be used for more than ____________ weeks at any one site; _______________ weeks for very potent topical corticosteroids
8
4
*Application may be restarted after a 4-week ‘treatment break’
Consecutive use of potent topical corticosteroids should not be used for more than 8 weeks at any one site; 4 weeks for very potent topical corticosteroids. Application may be restarted after a _____-week ‘treatment break’
4
____________ has anti-inflammatory, antipruritic, and anti-scaling properties and is often combined with other topical treatments for psoriasis. Several ___________ preparations are available including ointments, shampoos, and bath additives
Coal tar
coal tar
- Newer products are preferred to older products containing crude coal tar (coal tar BP), which is malodorous and usually messier to apply
Vit D is available in which forms for the treatment of psoriasis? (4)
- Ointments
- Gels
- Scalp solutions
- Lotions
What is the first line initial treatment of psoriasis of the trunk and limbs?
- Potent topical CS
- Topical Vit D or Vit D analogue
Applied once daily at different times of the day for up to 4 weeks
If satisfactory control of psoriasis is not achieved after 8 weeks of initial therapy, what should be offered?
Offer a topical Vit D or Vit D analogue alone applied twice daily
*If satisfactory control is not achieved after 8–12 weeks of twice-daily topical vitamin D or vitamin D analogue, offer either a potent topical corticosteroid applied twice daily for up to 4 weeks, or a coal tar preparation
If satisfactory control of psoriasis is not achieved after 8–12 weeks of twice-daily topical vitamin D or vitamin D analogue, offer either a _________________ applied twice daily for up to 4 weeks, or a ________________
potent topical corticosteroid
coal tar preparation
*A combination product containing calcipotriol with betamethasone for up to 4 weeks is an alternative in patients unable to use twice-daily potent topical corticosteroids, a coal tar preparation, or in patients where a once-daily application would improve adherence
What can be offered to patients with psoriasis of the trunk and limbs when all other topical treatments have failed?
A very potent topical corticosteroid under specialist supervision for a maximum of 4 weeks
- In patients with treatment-resistant psoriasis of the trunk or limbs, consider treatment with short-contact dithranol
What is the first-line initial management of scalp psoriasis?
Offer a potent topical corticosteroid applied once daily for up to 4 weeks
If satisfactory control is not achieved after 4 weeks of initial treatment for scalp psoriasis, what treatment should be offered?
Consider a different formulation of the potent topical CS eg shampoo or mousse and/or topical agents to soften or remove adherent scales (eg agents containing salicylic acid, emollients, oils); these agents should be used prior to applying the potent CS to allow effective penetration
If response of scalp psoriasis to potent topical corticosteroid treatment remains unsatisfactory after a further 4 weeks of treatment, offer a combination product containing __________________ for up to 4 weeks
calcipotriol with betamethasone
In patients with mild to moderate scalp psoriasis who cannot use topical corticosteroids, offer treatment with a ______________ or _______________ only
topical vitamin D
vitamin D analogue
*If treatment with a vitamin D or vitamin D analogue for up to 8 weeks does not give a satisfactory response, either offer a coal tar preparation or refer the patient to a specialist.
Can coal tar preparations be used alone for the treatment of scalp psoriasis?
Nope
What is the first line treatment of facial, flexural, and genital psoriasis?
Mild to moderate potency topical corticosteroid
The face, flexures, and genitals are particularly vulnerable to ______________ therefore topical corticosteroids should only be used short-term (e.g. 1–2 weeks per month)
steroid atrophy
The face, flexures, and genitals are particularly vulnerable to steroid atrophy therefore topical corticosteroids should only be used short-term (e.g. _____________ per month)
1–2 weeks
*If response to a moderate potency topical corticosteroid is inadequate, or there is serious risk of side-effects from continuous use, offer a topical calcineurin inhibitor, such as pimecrolimus or tacrolimus [unlicensed indications], for up to 4 weeks (initiated under specialist supervision)
Widespread unstable psoriasis of erythrodermic or generalised pustular types requires urgent same-day specialist assessment and should be managed as a _________________
medical emergency
Widespread unstable psoriasis of erythrodermic or generalised pustular types requires _________________ and should be managed as a medical emergency
urgent same-day specialist assessment
Widespread _____________ psoriasis of _____________ or generalised ____________ types requires urgent same-day specialist assessment and should be managed as a medical emergency
unstable
erythrodermic
pustular
Narrowband _____________ phototherapy can be offered to patients with plaque or guttate psoriasis in whom topical treatment has failed to achieve control.
ultraviolet B (UVB)
Narrowband ultraviolet B (UVB) phototherapy can be offered to patients with ____________ or ____________ psoriasis in whom topical treatment has failed to achieve control.
plaque
guttate
Photochemotherapy combining ___________ with _____________ is available in specialist centres, given under the supervision of an appropriately trained healthcare professional in the treatment of psoriasis.
psoralen
ultraviolet A (PUVA)
- Psoralen enhances the effects of UVA and is administered either by mouth or topically
PUVA irradiation can be considered for the treatment of ____________ and ___________-type psoriasis
localised palmoplantar pustulosis
plaque
Cumulative doses of PUVA increase the risk of ______________ and ____________ skin lesions, especially ______________
dysplastic
neoplastic
squamous cell
What systemic treatment is available for psoriasis? (5)
- MTX
- Ciclosporin
- Acitretin
- Apremilast
- Biologics
Under the supervision of a specialist, systemic non-biological treatment with _____________ or _____________ may be offered to some patients with psoriasis that cannot be controlled with topical treatment and if the psoriasis has a significant impact on physical, psychological or social well-being
methotrexate
ciclosporin
- In addition, the psoriasis would have to be extensive, or localised with significant distress or functional impairment, or have failed phototherapy treatment
____________ can be considered first-line in patients who need rapid or short-term disease control, have palmoplantar pustulosis, or who are considering conception (both men and women).
Ciclosporin
Only consider ____________ in patients where methotrexate and ciclosporin are not appropriate or have failed, or in patients with pustular forms of psoriasis
acitretin
_____________ is licensed for the treatment of moderate to severe chronic plaque psoriasis in patients who failed to respond to other systemic treatments including ciclosporin, methotrexate, or PUVA, or in those who have contra-indications to or intolerance to these treatments
Apremilast
What are the contraindications to using coal tar? (7)
- Broken or inflamed skin
- Avoid eye area
- Avoid genital area
- Avoid mucosal areas
- Avoid rectal areas
- Infection
- Sore, acute, or pustular psoriasis
Can coal tar be used to treat pustular psoriasis?
Nope
In general, coal tar should be used with caution when applied to the ___________ and in ____________
Face
Children under 12 yo
What are the side effects of coal tar? (2)
- Photosensitivity
2. Skin reactions
What advice should be given to patients and carers regarding coal tar?
May stain skin, hair, and fabric
What are the contraindications to using combined calcipotriol/betamethasone preparations in the treatment of psoriasis? (2)
- Erythrodermic psoriasis
2. Pustular psoriasis
