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PHAR154 > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

Which HCPs are the most involved in psoriasis care?

A

MD

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2
Q

What is psoriasis?

A

skin disease that causes red, itchy, scaly patches
scales are silvery
long-term disease
tends to go through cycles
no cure

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3
Q

What are the most common spots for psoriasis?

A

knees
elbows
trunk
scalp

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4
Q

Which form of psoriasis accounts for 90% of cases?

A

plaque psoriasis
-scales, silvery, above plane of skin

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5
Q

Which form of psoriasis is tougher to treat?

A

scalp psoriasis
-epithelium on scalp is thicker

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6
Q

What do the nails of psoriasis patients tend to look like?

A

they have tiny pits

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7
Q

Which forms of psoriasis are less common and well beyond our scope of practice?

A

guttate
pustular
palmo-plantar
erythrodermic

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8
Q

True or false: sunlight worsens psoriasis

A

false
UV light therapy is helpful

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9
Q

What can worsen psoriasis?

A

cold weather
stress
trauma

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10
Q

How bad is the scarring that results after lesions resolve?

A

there is no scarring as the lesions resolve

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11
Q

What is the etiology of psoriasis?

A

autoimmune (T-cell and TNF dysfunction)
genetic + environmental factors
12x the normal rate of skin cell production

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12
Q

What are the impacts of psoriasis?

A

can be physically debilitating
social aspects (especially if on scalp)
risk factor for many other diseases
1 million Canadians impacted

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13
Q

What is central to the skin care routine of psoriasis patients?

A

emollients/standard dry skin products (eczema-grade)

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14
Q

How are emollients used for psoriasis?

A

PRN between flares

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15
Q

What is the main use of keratolytics for psoriasis?

A

salicylic acid can loosen scales thus enhancing steroid penetration (combo Rx product)
-Diprosalic and Nerisalic
-keratolytics are very mild agents on their own

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16
Q

What are the properties of tar in treatment of psoriasis?

A

anti-proliferative (decrease skin turnover)
OTC shampoos for mild cases are common

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17
Q

What are the side effects of tar shampoos?

A

irritating
smell (hospital)
folliculitis

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18
Q

What are the directions for use of T Gel?

A

leave on for several minutes
use at least 2x/week

19
Q

What is the mainstay of therapy for psoriasis?

A

topical steroids
-can have 2 agents if patient can afford it
USED IN COMBO WITH OTHERR AGENTS

20
Q

What is used to decreased steroid use in psoriasis?

A

dry skin lotions
-steroid sparing
-separate application by 1 hour

21
Q

What strength of steroid is needed for psoriasis?

A

mid-potency (except for face and skin folds)
-scalp is tougher to treat, may need stronger steroid

22
Q

Why should you not stop topical steroid treatment suddenly in psoriasis?

A

rebound flare-up
-use every 2 or 3 days for one week

23
Q

What are the side effects of topical steroids?

A

skin atrophy
telangiectasia
striae
rebound flare-ups on sudden d/c (psoriasis specific)

24
Q

Which phase of psoriasis needs a lighter steroid? Which stage needs a heavier steroid?

A

lighter: acute phase (skin is easier to penetrate)
heavier: healing phase (tougher barrier)

25
Q

What is calcipotriol?

A

vitamin D analogue that is very popular for psoriasis
decreases skin turnover
used in mild-moderate cases

26
Q

How long does it take for calcipotriol to show results?

A

2 weeks
-slower than a steroid

27
Q

What are some precautions to take with calcipotriol?

A

not recommended for face
max weekly guidelines: 100g cream, 60ml scalp lotion
reports say to avoid vitamin D

28
Q

What is the difference between Dovonex and Dovobet?

A

Dovonex: calcipotriene
Dovobet: calcipotriol + betamethasone

29
Q

What is the treatment for scalp psoriasis?

A

topicals regardless of severity
-potent steroid>D analogue alone
-D analogue COMBO>steroid alone

30
Q

What are the side effects of vitamin D analogue combos for treatment of scalp psoriasis?

A

very low to placebo-like side effects

31
Q

Are psoriasis agents used when skin is normalized?

A

psoriasis agents typically arent used preventatively
-usually playing catch up

32
Q

What is calcitriol and when is it used?

A

vitamin D analogue for psoriasis
cases with up to 35% of affected body area
max 30g/day

33
Q

What is the action of retinoids for psoriasis?

A

utilizes retinoid receptor–> decrease cell proliferation
indicated for face

34
Q

Which retinoid is used for psoriasis?

A

tazarotene (mild to moderate cases)
-concurrent use with steroid to decrease irritation

35
Q

How long does it take for improvement for the following: calcipotriol/betamethasone, steroid monotherapy, vitamin D analogue monotherapy, retinoid monotherapy.

A

calc/betamethasone: 1 week
steroid: varies
vit D analogue: 2 weeks
retinoid: 1-4 weeks

36
Q

What is anthralin?

A

anti-mitotic agent that is not commonly used in Canada for psoriasis
-vit D analogues and steroids are better

37
Q

How does phototherapy help treat psoriasis?

A

UVB and PUVA rapidly decrease cell proliferation

38
Q

Describe narrow band UVB treatment for psoriasis.

A

2-3 a week
more common than UVA (less se)
can be done at home

39
Q

Describe PUVA treatment for psoriasis.

A

go to clinic for treatment
UVA needs photoactive agent (psoralen)
treatment can be very itchy and need to avoid sunlight for a day after

40
Q

Describe biologic agent treatment for psoriasis.

A

TNF-a/IL-23 antagonists
severe cases
injection and expensive
worries about serious se, safety record is growing

41
Q

What is the treatment for psoriatic arthritis?

A

cyclosporine
methotrexate
TNF-a blockers

42
Q

What percentage of psoriasis sufferers have scalp involvement?

A

50-80%

43
Q

Which area of the body do psoriasis lesions linger longer?

A

scalp

44
Q

Which patients are typically candidates for phototherapy or systemic therapy?

A

> 5% BSA
-one hand is approximately 1% of BSA

PHAR154 (18 decks)

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