Psoriasis Flashcards
Which HCPs are the most involved in psoriasis care?
MD
What is psoriasis?
skin disease that causes red, itchy, scaly patches
scales are silvery
long-term disease
tends to go through cycles
no cure
What are the most common spots for psoriasis?
knees
elbows
trunk
scalp
Which form of psoriasis accounts for 90% of cases?
plaque psoriasis
-scales, silvery, above plane of skin
Which form of psoriasis is tougher to treat?
scalp psoriasis
-epithelium on scalp is thicker
What do the nails of psoriasis patients tend to look like?
they have tiny pits
Which forms of psoriasis are less common and well beyond our scope of practice?
guttate
pustular
palmo-plantar
erythrodermic
True or false: sunlight worsens psoriasis
false
UV light therapy is helpful
What can worsen psoriasis?
cold weather
stress
trauma
How bad is the scarring that results after lesions resolve?
there is no scarring as the lesions resolve
What is the etiology of psoriasis?
autoimmune (T-cell and TNF dysfunction)
genetic + environmental factors
12x the normal rate of skin cell production
What are the impacts of psoriasis?
can be physically debilitating
social aspects (especially if on scalp)
risk factor for many other diseases
1 million Canadians impacted
What is central to the skin care routine of psoriasis patients?
emollients/standard dry skin products (eczema-grade)
How are emollients used for psoriasis?
PRN between flares
What is the main use of keratolytics for psoriasis?
salicylic acid can loosen scales thus enhancing steroid penetration (combo Rx product)
-Diprosalic and Nerisalic
-keratolytics are very mild agents on their own
What are the properties of tar in treatment of psoriasis?
anti-proliferative (decrease skin turnover)
OTC shampoos for mild cases are common
What are the side effects of tar shampoos?
irritating
smell (hospital)
folliculitis
What are the directions for use of T Gel?
leave on for several minutes
use at least 2x/week
What is the mainstay of therapy for psoriasis?
topical steroids
-can have 2 agents if patient can afford it
USED IN COMBO WITH OTHERR AGENTS
What is used to decreased steroid use in psoriasis?
dry skin lotions
-steroid sparing
-separate application by 1 hour
What strength of steroid is needed for psoriasis?
mid-potency (except for face and skin folds)
-scalp is tougher to treat, may need stronger steroid
Why should you not stop topical steroid treatment suddenly in psoriasis?
rebound flare-up
-use every 2 or 3 days for one week
What are the side effects of topical steroids?
skin atrophy
telangiectasia
striae
rebound flare-ups on sudden d/c (psoriasis specific)
Which phase of psoriasis needs a lighter steroid? Which stage needs a heavier steroid?
lighter: acute phase (skin is easier to penetrate)
heavier: healing phase (tougher barrier)
What is calcipotriol?
vitamin D analogue that is very popular for psoriasis
decreases skin turnover
used in mild-moderate cases
How long does it take for calcipotriol to show results?
2 weeks
-slower than a steroid
What are some precautions to take with calcipotriol?
not recommended for face
max weekly guidelines: 100g cream, 60ml scalp lotion
reports say to avoid vitamin D
What is the difference between Dovonex and Dovobet?
Dovonex: calcipotriene
Dovobet: calcipotriol + betamethasone
What is the treatment for scalp psoriasis?
topicals regardless of severity
-potent steroid>D analogue alone
-D analogue COMBO>steroid alone
What are the side effects of vitamin D analogue combos for treatment of scalp psoriasis?
very low to placebo-like side effects
Are psoriasis agents used when skin is normalized?
psoriasis agents typically arent used preventatively
-usually playing catch up
What is calcitriol and when is it used?
vitamin D analogue for psoriasis
cases with up to 35% of affected body area
max 30g/day
What is the action of retinoids for psoriasis?
utilizes retinoid receptor–> decrease cell proliferation
indicated for face
Which retinoid is used for psoriasis?
tazarotene (mild to moderate cases)
-concurrent use with steroid to decrease irritation
How long does it take for improvement for the following: calcipotriol/betamethasone, steroid monotherapy, vitamin D analogue monotherapy, retinoid monotherapy.
calc/betamethasone: 1 week
steroid: varies
vit D analogue: 2 weeks
retinoid: 1-4 weeks
What is anthralin?
anti-mitotic agent that is not commonly used in Canada for psoriasis
-vit D analogues and steroids are better
How does phototherapy help treat psoriasis?
UVB and PUVA rapidly decrease cell proliferation
Describe narrow band UVB treatment for psoriasis.
2-3 a week
more common than UVA (less se)
can be done at home
Describe PUVA treatment for psoriasis.
go to clinic for treatment
UVA needs photoactive agent (psoralen)
treatment can be very itchy and need to avoid sunlight for a day after
Describe biologic agent treatment for psoriasis.
TNF-a/IL-23 antagonists
severe cases
injection and expensive
worries about serious se, safety record is growing
What is the treatment for psoriatic arthritis?
cyclosporine
methotrexate
TNF-a blockers
What percentage of psoriasis sufferers have scalp involvement?
50-80%
Which area of the body do psoriasis lesions linger longer?
scalp
Which patients are typically candidates for phototherapy or systemic therapy?
> 5% BSA
-one hand is approximately 1% of BSA
