Psoriasis Flashcards
Diagnosis and management
Subtypes of psoriasis, name 3
Plaque psoriasis
Pustular psoriasis
Nail psoriasis
Subtypes of plaque psoriasis
Inverse psoriasis
Guttate psoriasis
Erythrodermic psoriasis
Nail psoriasis, clinical findings. Name 6.
- Often many nails affected.
- Nail pitting
- Onycholysis
- “Oil drop sign”.
- Subungual hyperkeratosis
- Splinter hemorrhages
Clues to onychomycosis, name 5.
- Isolated to 1 or 2 nails
- Uncommon on hands
- Nail plate thickening
- Yellow discoloration
- Signs of tinea pedis
Differential diagnosis of psoriasis, name 5
- Nummular dermatitis
- Lichen simplex chronicus
- Subacute cutaneous lupus
- Lichen planus
- Mycosis fungoides
Psoriasis, associated conditions. Name 4
- Psoriatic arthritis
- Cardiovascular disease
- Depression
- Smoking
Prevalence of psoriatic arthritis
Up to 30%
Screening tool for psoriatic arthritis
PEST
Classes of topical agents to treat psoriasis, name 5
- Topical steroids
- Calcineurin inhibitors
- PDE 4 inhibitors
- Vitamin D analogues
- Combination product
Name 4 topical steroids commonly used
- BMV 0.1% ungt
- Clobetasol propionate 0.05%n ungt
- Clobetasol propionate 0.05% solution
- Fluocinolone acetonide 0.01% oil (Derma-Smoothe)
Name 1 calcineurin inhibitor used in psoriasis
Tacrolimus 0.1% ungt (Protopic)
Name 1 PDE 4 inhibitor used in psoriasis
Roflumilast 0.3% cream (Zoryve)
Name 2 vitamin D analogs used in psoriasis
- Calcipotriol 50 mcg/g ungt (Dovonex)
- Calcitriol 3 mcg/g ungt (Silkis)
Name 4 combination products used in psoriasis
- Calcipotriol/BMD 0.05% gel (Dovobet)
- Calcipotriol/BMD 0.05% ungt (Dovobet)
- Calcipotriol/BMD 0.05% foam (Enstilar)
- Halobetasol propionate 0.01/tazarotene 0.045% lotion (Duobrii)
Phototherapy for psoriasis: What frequency of light is used?
Narrowband UVB (administered in office or at home)
Phototherapy for psoriasis: What is the frequency of application
2-3 times weekly for 3 months minimum
Systemic agents used for treatment of psoriasis. Name 5 classes
- Methotrexate
- Cyclosporine
- Apremilast
- Acitretin
- Biologics and small molecules
Criteria for biological agents: Pharmacare criteria. Name 4.
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
Baseline labs for systemic agents, name 7
CBC and differential
Creatinine
Liver enzymes
Potassium and magnesium
Lipid profile
Hepatitis B and C
HIV serology
Pregnancy test if appropriate
Administration of methotrexate for psoriasis: Dosage
20 mg orally weekly (15 mg if >65 years old)
Switch to subcutaneous if GI upset
Administration of methotrexate for psoriasis: What medication should be administered concurrently?
Folic acid 5 mg daily
Administration of methotrexate for psoriasis: Lab monitoring. Which labs?
CBC and differential
Creatinine
Liver enzymes
Administration of methotrexate for psoriasis: Lab monitoring frequency.
Every 2 weeks twice,
Monthly 3 times,
And every 3 months.
Administration of methotrexate for psoriasis: Onset of action.
Slow, approximately 2 to 3 months.
Administration of methotrexate for psoriasis: Common side effects. Name 2.
GI upset,
tiredness.
Administration of methotrexate for psoriasis: Rare but serious adverse effects. Name 4.
- Stomatitis
- Cytopenia
- Liver toxicity
- Infection
Name 5 classes of biologics/ small molecules used for the treatment of psoriatic arthritis
TNF inhibitors
IL-17 inhibitors
IL-23 inhibitors
IL12/23 inhibitors
TYK2 inhibitor
Name 4 biologics/ small molecules/ TNF inhibitors used to treat Psoriasis/ psoriatic arthropathy.
Adalimumab. Humira. Targets Cytokine TNF alpha
Etanercept. Enbrel.
Infliximab. Remicade. Targets Cytokine TNF alpha
Certolizumab. Cimzia
Class specific side effects of TNF inhibitors
Autoimmune like reactions.
Paradoxical psoriasis
Demyelinating disease - rare
Malignancy- lymphoma - rare
Which TNF inhibitor is approved in pregnancy
Certolizumab
