Psoriasis Flashcards
What are complications of psoriasis that pts need to be assessed for?
Psoriatic arthritis (Rheum referral if required)
CVS disease (treat modifiable RF)
Basis of Psoriasis treatment?
Emollients to reduce scale
Topical treatments for acute flare-ups
Topical treatment examples for psoriasis ?
Vit D analogues and steroids (Dovobet or Enstilar foam) for chronic plaque psoriasis for 8-12 weeks
Face/Flexural/Genitalia psoriasis: Mild moderate potent steroid e.g. Eumvate for 1-2 weeks
Examples of Vit d analogues?
Calcipotriol
Tacalcitol
Calcitriol
How do Vit D analogues work?
Help regulate the immune system, slow the overgrowth of skin psoriasis
What are the benefits of Vit D analogues?
Safe, effective and popular
Don’t stain the skin, no strong odour and can be used long term
What are side effects of Vit D analogues?
Can irritate sensitive areas
Can cause hypercalcaemia so do not exceed weekly limit
When are Vit D analogues contraindicated?
Pregnancy and breast feeding
What combinations can you prescribe Vit D analogues with?
Steroid in a gel/ointment for short term use (risk of skin atrophy)
When do you refer to dermatology?
For 2nd line treatments:
Phototherapy
Acitretin
Methotrexate
Ciclosporin
PD4 inhibitor apremilast
Dimethyl fumarate
How does phototherapy help in psoriasis?
Using UVA and UVB wavelengths to reduce inflammation
What is the treatment regime for phototherapy for psoriasis
2x a week usually 15-30 treatments
What are the types of phototherapy?
Narrow band UVB: severe psoriasis and eczema
PUVA: psoralen + UVA- Psoriasis (if UVB not effective), vitiligo, cutaneous T-cell lymphoma
UVB is more common
What is psoralen?
A chemical that increases the effect of UVA on the skin
Available as a tablet or solution/lotion/gel
Side effects of phototherapy?
Short term:
Redness and discomfort
Dry and itchy skin
Folliculitis
Polymorphic light eruption
Cold sores
worsening of skin disease
Psoralen: nausea
Long Term:
Premature skin ageing, skin cancer
What is Apremilast?
Oral medication, inhibits an enzyme
(Phosphodiesterase Inhibitor, PDE4); responsible for
controlling the inflammatory process in the skin
What are the contraindications of Apremilast?
Avoid live vaccines/getting pregnant whilst on it
Efficacy reduced by cytochrome P450 inducers
Side effects of Apremilast
Gl upset (diarrhea,
nausea, reduced appetite)
Headache
Depression(rare)
Weight loss(rare)
Insomnia
Tiredness
Muscle pain
Respiratory infections
When are biologic treatments used?
Both methotrexate and cyclosporin have failed/unable to be used
Psoriasis has a large impact on physical, psychological or social functioning
Psiriais is extensive or severely localised with functional impairment
What do you need to do before prescribing biologics?
Screen for TB, Hep B and C, IV and ZV
Names of first line biologics for Psoriasis?
Ustekinumab
Adalimumab
Secukinumab
How to treat scalp psoriasis
1.Potent corticosteroid once daily scalp application up to
4 weeks (e.g. Betacap® scalp application)
2. Descaling prior to corticosteroid application with
Diprosalic® scalp application ( steroid and salicylic acid it softens and lifts scale allowing steroid to exert effect underneath )
3.Potent corticosteroid with calcipotriol up to 4
weeks e.g. Dovobet® gel - applicator
4.Very potent corticosteroid once daily up to 4 weeks
(Etrivex® shampoo) or coal tar applied OD/BD
(Sebco® scalp ointment)
Pathophysiology of psoriasis
Genetic: associated HLA-B13, -B17, and -Cw6.
Immnunological: Th mediating keratinocyte proliferation
Environmental: may be worsened with stress/ skin trauma, triggered by strep infection or improved by sunlight
Subtypes of psoriasis?
Plaque psoriasis
Flexural psoriasis
Guttate psoriasis
Pustular psoriasis
Features of plaque psoriasis?
Most common subtype
Well-demarcated red, scaly patched affecting extensor surfaces, sacrum and scalp
Features of Guttate psoriasis?
Transient psoriatic rash, frequently triggered by strep infection
Large numbers of red small plaques < 1cm appear on trunk and limbs. Often in young post acute strep infection.
Features of pustular psoriasis?
Commonly occurs on the palms and soles
Clinical features of psoriasis?
Itching
Irritation
Burning
Stinging
Nail changes: pitting and onycholysis
Psoriatic arthritis
Complications of psoriasis?
psoriatic arthropathy (around 10%)
increased incidence of metabolic syndrome
increased incidence of cardiovascular disease
increased incidence of venous thromboembolism
psychological distress
Coeliacs disease (an association)
Investigations for psoriasis?
None, clinical diagnosis
