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Dermatology review April 2024 > Psoriasis > Flashcards

Psoriasis Flashcards

Diagnosis and management

1
Q

Subtypes of psoriasis, name 3

A

Plaque psoriasis
Pustular psoriasis
Nail psoriasis

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2
Q

Subtypes of plaque psoriasis

A

Inverse psoriasis
Guttate psoriasis
Erythrodermic psoriasis

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3
Q

Nail psoriasis, clinical findings. Name 6.

A
  1. Often many nails affected.
  2. Nail pitting
  3. Onycholysis
  4. “Oil drop sign”.
  5. Subungual hyperkeratosis
  6. Splinter hemorrhages
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4
Q

Clues to onychomycosis, name 5.

A
  1. Isolated to 1 or 2 nails
  2. Uncommon on hands
  3. Nail plate thickening
  4. Yellow discoloration
  5. Signs of tinea pedis
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5
Q

Differential diagnosis of psoriasis, name 5

A
  1. Nummular dermatitis
  2. Lichen simplex chronicus
  3. Subacute cutaneous lupus
  4. Lichen planus
  5. Mycosis fungoides
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6
Q

Psoriasis, associated conditions. Name 4

A
  1. Psoriatic arthritis
  2. Cardiovascular disease
  3. Depression
  4. Smoking
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7
Q

Prevalence of psoriatic arthritis

A

Up to 30%

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8
Q

Screening tool for psoriatic arthritis

A

PEST

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9
Q

Classes of topical agents to treat psoriasis, name 5

A
  1. Topical steroids
  2. Calcineurin inhibitors
  3. PDE 4 inhibitors
  4. Vitamin D analogues
  5. Combination product
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10
Q

Name 4 topical steroids commonly used

A
  1. BMV 0.1% ungt
  2. Clobetasol propionate 0.05%n ungt
  3. Clobetasol propionate 0.05% solution
  4. Fluocinolone acetonide 0.01% oil (Derma-Smoothe)
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11
Q

Name 1 calcineurin inhibitor used in psoriasis

A

Tacrolimus 0.1% ungt (Protopic)

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12
Q

Name 1 PDE 4 inhibitor used in psoriasis

A

Roflumilast 0.3% cream (Zoryve)

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13
Q

Name 2 vitamin D analogs used in psoriasis

A
  1. Calcipotriol 50 mcg/g ungt (Dovonex)
  2. Calcitriol 3 mcg/g ungt (Silkis)
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14
Q

Name 4 combination products used in psoriasis

A
  1. Calcipotriol/BMD 0.05% gel (Dovobet)
  2. Calcipotriol/BMD 0.05% ungt (Dovobet)
  3. Calcipotriol/BMD 0.05% foam (Enstilar)
  4. Halobetasol propionate 0.01/tazarotene 0.045% lotion (Duobrii)
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15
Q

Phototherapy for psoriasis: What frequency of light is used?

A

Narrowband UVB (administered in office or at home)

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16
Q

Phototherapy for psoriasis: What is the frequency of application

A

2-3 times weekly for 3 months minimum

17
Q

Systemic agents used for treatment of psoriasis. Name 5 classes

A
  1. Methotrexate
  2. Cyclosporine
  3. Apremilast
  4. Acitretin
  5. Biologics and small molecules
18
Q

Criteria for biological agents: Pharmacare criteria. Name 4.

A

Psoriasis area and severity index (PAS I) greater than 12
BSA greater than 10%
Failed or no access to phototherapy
Tried and failed 3 months of:
Methotrexate 20 mg/week (15 mg/week if greater than 65 years old)
Cyclosporine 4 mg/kg/day
Or contraindications to above agents

19
Q

Baseline labs for systemic agents, name 7

A

CBC and differential
Creatinine
Liver enzymes
Potassium and magnesium
Lipid profile
Hepatitis B and C
HIV serology
Pregnancy test if appropriate

20
Q

Administration of methotrexate for psoriasis: Dosage

A

20 mg orally weekly (15 mg if >65 years old)
Switch to subcutaneous if GI upset

21
Q

Administration of methotrexate for psoriasis: What medication should be administered concurrently?

A

Folic acid 5 mg daily

22
Q

Administration of methotrexate for psoriasis: Lab monitoring. Which labs?

A

CBC and differential
Creatinine
Liver enzymes

23
Q

Administration of methotrexate for psoriasis: Lab monitoring frequency.

A

Every 2 weeks twice,
Monthly 3 times,
And every 3 months.

24
Q

Administration of methotrexate for psoriasis: Onset of action.

A

Slow, approximately 2 to 3 months.

25
Q

Administration of methotrexate for psoriasis: Common side effects. Name 2.

A

GI upset,
tiredness.

26
Q

Administration of methotrexate for psoriasis: Rare but serious adverse effects. Name 4.

A
  1. Stomatitis
  2. Cytopenia
  3. Liver toxicity
  4. Infection
27
Q

Name 5 classes of biologics/ small molecules used for the treatment of psoriatic arthritis

A

TNF inhibitors
IL-17 inhibitors
IL-23 inhibitors
IL12/23 inhibitors
TYK2 inhibitor

28
Q

Name 4 biologics/ small molecules/ TNF inhibitors used to treat Psoriasis/ psoriatic arthropathy.

A

Adalimumab. Humira. Targets Cytokine TNF alpha
Etanercept. Enbrel.
Infliximab. Remicade. Targets Cytokine TNF alpha
Certolizumab. Cimzia

29
Q

Class specific side effects of TNF inhibitors

A

Autoimmune like reactions.
Paradoxical psoriasis
Demyelinating disease - rare
Malignancy- lymphoma - rare

30
Q

Which TNF inhibitor is approved in pregnancy

A

Certolizumab

Dermatology review April 2024 (3 decks)

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