Psoriasis Flashcards
Psoriasis is defined as a chronic, immune-mediated skin disease with markedly increased _______ cellular turnover
epidermal
What is the most common subtype of psoriasis ?
Plaque psoriasis (about 90% of cases)
- flexural
- nail
- scalp
- palmoplantar
- sebopsoriasis
Most common features of plaque psoriases:
1.
2.
3. sharp borders
- Red plaques
- silver scales
Non-plaque psoriases subtypes:
1.
2. Pustular
3. Erythrodermic
- guttate
Non-drug measures for psoriasis include:
1.
2.
3.
4. occlusive dressings
- avoid triggers
- moisturizer
- humidifier
One of the biggest non-modifiable risk factors for psoriasis is:
Genetics, almost 50% of patients report a family history
Smoking, excessive alcohol
This type of non-plaque psoriasis is characterized by small papules triggered by respiratory infection and appears on trunk, limbs and face
Gutatte
This type of non-plaque psoriasis can cover up to 90% of the BSA and is associated with complications
Erythroderma
First line for MILD plaque psoriasis?
Non-Rx self care
1. Topical steroid mild-medium potency <7 days
adjuncts:
- Petrolatum: to reduce irritation and tachyphylaxis + can allow someone to taper of steroid
- Salicyclic acid: Increases topical steroid penetration
- Lactic acid: 2nd line to SA, safe on large BSA
Common side effects of topical steroids?
1.
2.
- Skin atrophy
- Thinning of skin
Tachyphylaxis, contact dermatitis
Initial options for mild-moderate plaque psoriasis?
1.
2.
- topical steroids
- vitamin D analogues
What is the next option for mild-moderate plaque psoriasis when topical therapy doesn’t work?
Topical + Photo TX
If topical + photo therapy fail for mild-moderate plaque psoriasis, the next step should be?
Topical + systemic agents
First line for moderate to severe psoriasis?
1.
- Systemic agents
+/- topical agent or photo therapy
if those fail, then biologics
Topical retinoid Tazarotene is contraindicated in:
Pregnancy
also avoid on face/folds
This topical drug class is approved for atopic dermatitis but not psoriasis:
Topical calcineurin inhibitors tacrolimus and pimecrolimus
2nd line
This agent used in moderate-severe psoriasis can be useful in psoriatic arthritis:
MTX, also first line of plaque psoriases moderate to severe
Methotrexate is contraindicated in:
1.
2.
Liver Dx
Pregnancy
Contraception for both men and women is required during/3 months post treatment
Cyclosporin is used orally for moderate to severe psoriasis first line for severe pustular or ________
erythrodermic
Cyclosporin for psoriasis should be used for a max of ____ weeks
12
Cyclosporin can cause many side effects:
1.
2.
3. HTN
4. higher risk for squamous and basal cell carcinomas
- Renal Toxicity
- Hypertriglyceridemia
Acitretin (retinoid) is used orally for moderate to severe psoriasis first line for pustular psoriasis or _______
chronic palmoplantar
Acitretinin is contraindicated in:
1.
Pregnancy
In patients of childbearing potential, effective contraception must begin 1 month before beginning therapy with _________ and continue for at least 3 y after discontinuation
acitretinin
Rare side effect with acitretinin:
1.
Pseudotumor cerebri
Others: Arthralgia, myalgia, alopecia, dry lips, hyperlipidemia, hepatotoxicity
Apremilast (PDE-4 inhibitor ) can be used for ___ - ____ plaque psoriasis
moderate to severe
If oral therapy for moderate to severe psoriasis does not work the next step would be?
Biologics
For plaque psoriasis of the NAIL, topical therapy is tried first. However if this does not work, one can try:
Intralesional steroid injections (Triamcinolone) for resistant plaque/nail psoriasis
The three psoriasis treatment options safe in pregnancy are:
1.
2.
3.
- Topical steroids
(FIRST) - UVB
- Cyclosporine (only Severe)
Ethanol increases the risk of conversion of acitretin to etretinate, which is also a major teratogen and can remain in the body for years. Therefore no alcohol _____ / _____ months post treatment
during / 2 months post
This type of phototherapy should be avoided in pregnancy:
PUVA
First line treatment for non-plaque psoriasis: Gutatte =
Photo TX UVB
MEDICATION triggers of psoriasis include:
1.
2. lithium
3. antimalaria drugs
4. oral steroids
5. nsaids
- beta blockers
