Psoriasis Flashcards
casues/Risk factors of Psoriasis
1) Enviromental –> cold weather, trauma, infectio, alcohol and certain drugs (e.g,Steroid withdrawel)
2) Genetic –> Human leukocyte antigen Cw6 (HLA-Cw6) gene, IL-23R and IL-12.
3) Immnulogic –> High levels of dermal and circulating TNF- α
- increased activity of T cells in the underlying skin
clinical presentation of Psoriasis
1) skin rash
2) itching
3) fine scaling
4) pain
5) Generalized erythema
Non-pharmacological management of Psoriasis
- Stress reduction.
- Reduce alcohol and smoking.
- Climatotherapy, sun exposure, emollients
Pharmacogical management of Psoriasis
1) Topical medication
2) Phototherapy and psoralens
3) Topical Corticosteroids
4) Ophthalamic Corticosteroids
indication of Topical Corticosteroids
mild to moderate plaque psoriasis
MoA of Topical Corticosteroids
reduce plaque formation
Adverse effects of Topical Corticosteroids
- Skin atrophy, striae, allergic dermatitis.
- Slow withdrawal to avoid sudden flares.
Exmaples and Topical Steroids and their indication
1) Hydrocortisone topical –> mild potency – for face.
2) Betamethasone topical –> strong potency – truncal area
Indication of Betamethasone topical
Strong potency- truncal area
Indication of Hydrocotisone Topical
Mild potency- for face
indication of Ophthalmaic Corticosteroids
- Treat conjunctival and corneal inflammation.
- Control infiltration and delay vascularization.
Opthalmaic corticosteroids
1) Prednisolone ophthalmic.
2) Betamethasone ophthalmic.
AE of Systemic Corticosteroids
–> IM corticosteroids are not recommended
for the management of psoriasis.
– >High risk of flare upon withdrawal
Indication of Vitamine D analogues
mild to moderate plaque
psoriasis in combination with steroids
–> Used in patients with lesions on the faceor
exposed areas
Category of Calcipotriol Topical
vitamin D Analog
MoA of Calcipotriol topical
–> Inhibits epidermal proliferation.
* Less irritating in sensitive areas of skin
indication of Calcipotriol tropical
mild to moderate plaque psoriasis in combination with steroids
–> on the FACE
Category of Methotrexate
Cytotoxic/Immunosuppressive drugs
Indication of Methotrexate
symptomatic control of severe,
refractory, disabling psoriasis
PK/PD of Methotrexate
Can be used for as long as it remains effective and well-tolerated.
Adverse effetcs of Methotrexate
1) Monitor patients closely for bone marrow, liver,
lung and kidney toxicities
2) Teratogenic – contraindicated in pregnancy
Category of Apremilast
PED4 inhibitor
*PED4 : Phosphodiesterase-4 inhibitor
MoA of Apremilast
increase in cAMP which causes an increased gene expression of anti-inflammatory mediators
Indication of Apremilast
moderate-to-severe plaque psoriasis in
candidates for phototherapy or systemic therapy and
for patients with active psoriatic arthritis
Adverse effects of Apremilast
1) Nausea,
2) headache
Category of Infliximab, etanercept, adalimumab
TNF-α inhibitors
MoA of Infliximab, etanercept, adalimumab
neutralize the effects of TNF-α.
Indication of Infliximab, etanercept, adalimumab (TNF-α inhibitors)
1) chronic, severe plaque psoriasis in candidates for systemic therapy and when
other systemic therapies are medically less appropriate
2) reducing signs and symptoms in patients
with active psoriatic arthritis
Adverse effects of Infliximab, etanercept, adalimumab
1) infections,
2) infusion reactions
Category of Ustekinumab
Interleukin Inhibitor
MoA of Ustekinumab
monoclonal antibody directed against
interleukin-12 and interleukin-23 → interferes with T-cell differentiation and activation
Indication of Ustekinumab
moderate-to-severe plaque psoriasis who are candidates for phototherapy or systemic therapy and also for patients with active psoriatic arthritis
Adverse effects of Ustekinumab
1) infections,
2) back pain
Category of Acitretin
Retinoids
Administration of Acitretin
Orally
Indication of Acitretin
1) severe extensive plaque psoriasis resistant to other forms of therapy and also for
2) first-line treatment of pustular psoriasis
MoA of Retinoids
vitamin A analogue
*MoA of oral retinoids same as of topical retinoids (e.g.
tazarotene topical).
Precautions followed during the use of Retinoids
1) Category X medication - teratogenic
2) Contraindicated in pregnancy and hyperlipidaemia
3) Use of sunscreens during treatment and avoid exposure to sunlight.
4) Avoid use of alcohol.
Adverse effects of Acitretin (oral)
1) hepatotoxicity,
2) cheilitis (inflammation of the lips)
3) alopecia,
4) skin peeling.
Adverse effects of Tazarotene (Topical Retinoid)
1) desquamation,
2) pruritus,
3) erythema,
4) burning.
the 2 types of Phototherapy treatments of Psorisis
1) UVB- ultraviolet B light
2) PUVA- Psoralen and ultraviolet A
MoA of UVB
UVB penetrates the skin and slows the growth of affected skin cells.
MoA of PUVA
UVA is relatively ineffective unless used w/ a light-sensitive meciation called psoralen (topically or orally)
Indication of UVB and PUVA
1) extensive and widespread disease or
2) resistance to topical treatment in combination with other pharmacological treatment
Adverse effects of PUVA treatment
higher risk of skin cancer
