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7006PHM Prof Pharm II > Psoriasis > Flashcards

Psoriasis Flashcards

1
Q

What causes psoriasis?

A

Exact cause unknown

Genetic factors

Immune factors and inflammatory cytokines

Environmental factors = stress, excessive alcohol, smoking, skin trauma

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2
Q

Summarise the pathophysiology of psoriasis

A

Abnormal maturation of dermis –> over proliferation epidermis –> inflammation and redness, crusting of skin

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3
Q

What are the characteristics of plaque psoriasis?

A

Well demarcated

Pink plaques with silvery scales

May be single or numerous lesions

May be itchy but usually asymptomatic

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4
Q

Where is plaque psoriasis usually found?

A

outside of elbows

knees

sacrum

lower back

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5
Q

What are the characteristics for scalp psoriasis?

A

Thick patches can cover entire scalp, may extend slightly past hairline (facial psoriasis)

Mild hair loss (temporary, my be severe)

May be first or only site, can co-exist with other forms of psoriasis

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6
Q

What are the characteristics of nail psoriasis?

A

pitting, yellow, ridging nails

Onycholysis may be present

one or more nails

May have chronic plaque psoriasis, psoriatic arthritis

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7
Q

Summarise psoriatic arthritis

A

painful, inflammatory condition of joints

Pain and swelling of joints/stiff joints

Severe joint damage

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8
Q

What are the characteristics of guttate psoriasis?

A

Looks like a shower of red, scaly tear drops on body

Lesions are pink, scaling less noticeable

Occurs at any age, good chance of spontaneous resolution

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9
Q

Where is guttate psoriasis usually found?

A

Trunk

Upper arms

thighs

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10
Q

What causes guttate psoriasis?

A

streptococcal throat infections

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11
Q

What are the characteristics of flexural psoriasis?

A

More moisture = different appearance

Smooth, well-defined patches –> may be shiny, little scales

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12
Q

Where is flexural psoriasis usually found?

A

body folds

genitals

e.g.: armpits, groin, under breast, navel, natal cleft, penis, vulva

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13
Q

What is palmoplantar pustulosis?

A

Similar to psoriasis, can be in combination w/ psoriasis

Crops of pustules, red, scaly, thickened skin

localised to palms and soles

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14
Q

What are some differential diagnoses to psoriasis?

A

Dermatitis = less plaque, no silver scale, usually on flexors, more itchy

Tinea = active outer border and clear centre, most common in toe nails

Seborrheic dermatitis = can progress to psoriasis, will respond to antifungals

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15
Q

Summarise the treatment options for psoriasis

A

Emollients

Coal Tar preparations

Topical corticosteroids

Dithranol

Vit D analogous

Calcineurin inhibitors

Phototherapy

Systemic treatments = immunosuppressants, acitretin, apremilast, biotherapies

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16
Q

What is the role of keratolytic in psoriasis?

A

Salicylic acid preparations –> soften scales, allow other meds to penetrate

Weak antifungal and antibacterial activity

17
Q

How often should keratolytics be applied?

A

2-3 times a day

Thin layer, wash hand after use

May cause irritation/stinging to surrounding (broken) skin

18
Q

What is the proposed mechanism of coal tar preparations in psoriasis?

A

reduce epidermal thickness

antipruritic

weakly antiseptic

19
Q

What coal tar preparations are used in psoriasis?

A

Coal tar (crude) or liquid coal tar (LPC)

1% crude coal tar = 5% LPC

Cream, ointment, other formulation

20
Q

What are some topical corticosteroids used in psoriasis?

A

hydrocortisone

betamethasone

mometasone

triamcinolone

21
Q

What is the role of corticosteroids in psoriasis treatment?

A

Anti-inflam = manage/reduce redness and inflammation

Antimitotic = reduce skin cell turnover

Most common treatment for initial control

22
Q

What is dithranol?

A

Compounded ointment or paste (Lazzar’s) = also known as anthralin

Usually applied and washed off depending on strength, stains things (skin, everything)

keep in dark place, if turn brown/purple –> no longer effective

23
Q

What are some available Vitamin D analogues for psoriasis?

A

Calcipotriol = calcipotriene (never alone)

Combinations with betamethasone are also present

24
Q

Outline some guidelines about the application of Vit D analogues in psoriasis? (areas to avoid, freq, things to consider)

A

Avoid skin folds, face

Apply once a day for 4 weeks

large areas, apply less freq

Protect area from sunlight

25
Q

What is phototherapy and what does it do? (psoriasis)

A

Narrowband UVB phototherapy –> inhibits immune and inflammatory pathways in skin

Photochemotherapy = topical or oral methoxsalen w/ UVA light

26
Q

What immunosuppressants are used in psoriasis?

A

Methotrexate (once weakly dose) and ciclosporin (relapse is common)

Methotrexate req folic acid supplementation (not on same day as dose)

27
Q

Summarise the use of acitretin in psoriasis (What is, what do, what combined w/, important fact)

A

Systemic retinoid

Can be combined with phototherapy or topical drugs for inc efficacy

Potent tetratogen –> best with food, need contraception

Can cause drying of skin

28
Q

Summarise the use of apremilast in psoriasis (What is, what do, what combined w/, important fact)

A

Phosphodiesterase 4 (PDE-4) inhibitor

Used in moderate to severe chronic plaque psoriasis

Used in adults when methotrexate has failed, toxic, or C/I

29
Q

List interleukin targeted biological therapies used in psoriasis treatment

A

Ixekizumab

Guselkumab

secukinumab

tildrakizumab

risankizumab

ustekinumab

all injections

30
Q

List tumour necrosis factor (TNF) targeted biological therapies used in psoriasis treatment

A

adalimumab

certolizumab

etanercept

infliximab

31
Q

What comorbid condition is at greater risk of occurring in people with psoriasis?

A

CVD = encourage quitting smoking, manage/discuss CV health

Psoriatic arthritis

32
Q

What lifestyle changes can help psoriasis?

A

Reduce skin trauma

Stop smoking

Avoid excessive alcohol, stress, stressful events

Reduce obesity

reduce sun exposure

33
Q

What medications can trigger/worsen psoriasis?

A

trigger = lithium, hydroxychloroquine, interferon alpha

7006PHM Prof Pharm II (24 decks)

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