Psoriasis Flashcards
What is the recommended initial treatment for significant scalp psoriasis?
A) Daily use of a vitamin D analogue
B) Monthly use of an ultra-high-potency topical corticosteroid
C) Daily use of a moderate- to ultra-high-potency topical corticosteroid
D) Oral corticosteroid therapy
C) Daily use of a moderate- to ultra-high-potency topical corticosteroid
What is the primary mechanism underlying psoriasis?
A) Overproduction of melanin
B) Dysfunction of sebaceous glands
C) Autoimmune process affecting T-cells and TNF dysfunction
D) Excessive keratin production
C) Autoimmune process affecting T-cells and TNF dysfunction
Which of the following environmental factors has been linked to the development of guttate psoriasis?
A) Excessive sun exposure
B) Trauma to the skin
C) Streptococcal infections
D) Exposure to cold weather
C) Streptococcal infections
Which type of psoriasis is the MOST common?
Plaque Psoriasis
Which of the following medications may trigger or worsen psoriasis in susceptible individuals?
A) Antibiotics
B) Antihistamines
C) Lithium
D) Oral contraceptives
c) Lithium
~~
Certain medications, such as lithium, beta-blockers, and antimalarial drugs, have also been implicated in triggering or worsening psoriasis in susceptible individuals.
T/F: Psoriasis is primarily caused by an overproduction of melanin in the skin
FALSE!
Psoriasis is primarily an autoimmune disorder involving the DYSFUNCTION of the Immune System and inflammation in the skin, rather than an overproduction of melanin.
The primary mechanism of psoriasis involves the autoimmune process affecting T-cells and TNF dysfunction.
T/F: Trauma to the skin, such as cuts or burns, can trigger the development of psoriasis plaques at the site of injury.
True!
T/F: Excessive sun exposure is a known trigger for psoriasis flare-ups.
True!!
** While moderate sun exposure may benefit some individuals with psoriasis,
excessive sun exposure can trigger or worsen psoriasis flare-ups in others.
If the response to corticosteroids is Inadequate to treat psoriasis, what should be considered as an additional treatment option?
A) Oral antibiotics
B) Oral antihistamines
C) Addition of a vitamin D analogue
D) Phototherapy
C) Addition of a vitamin D analogue
Which of the following does NOT contain a Vitamin D Analogue that can be used to treat psoriasis?
a) Dovonex (calcipotriol)
b) Diprosalic (betamethasone dipropionate/salicylic acid)
c) Silkis (calitriol)
d) Dovobet Gel, Dovobet Ointment, Enstilar Foam (calcipotriol/betamethasone dipropionate)
b) Diprosalic (betamethasone dipropionate/salicylic acid)
^^ This is classified as a Corticosterioid/Keratolytic Combo agent. It can be used to treat psoriasis in some cases BUT does not possess a Vit D analogue.
Recommended initial treatment for significant scalp psoriasis involves daily use of a ______ [grade] topical corticosteroid for 4-8 weeks.
Examples could include: betamethasone valerate lotion, clobetasol propionate lotion/shampoo, mometasone furoate lotion, etc.,
… Moderate- to ultra-high-potency [topical corticosteroid]
T/F: Monotherapy with topical corticosteroids is a less expensive approach initially for treating scalp psoriasis
True!
Since safety profiles between corticosteroids and vitamin D analogues are said to be similar and the fact that combination products provided only a marginal benefit over corticosteroids alone, monotherapy with topical corticosteroids is a reasonable, less expensive approach initially
Which of the following represents a Keratolytic Agent [drug class] drug that can be used to treat psoriasis?
a) Coal tar
b) Salicylic acid 3-10%
c) Diprosalic (betamethasone dipropionate/salicylic acid)
d) Dovobet or Enstilar Foam (calcipotriol/betamethasone dipropionate)
b) Salicylic acid 3-10%
What is the purpose of scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid in significant scalp psoriasis cases?
A) To increase hair growth
B) To reduce inflammation
C) To improve penetration of topical corticosteroids and/or vitamin D analogues
D) To prevent infection
C) To improve penetration of topical corticosteroids and/or vitamin D analogues
Which combination product is available for scalp psoriasis and contains both corticosteroid and salicylic acid?
A) Shampoo
B) Lotion
C) Foam
D) Gel
E) All of the above
a) Shampoo
T/F: Scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid is recommended to prevent infection in scalp psoriasis cases.
FALSE!
Scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid is NOT recommended to prevent infection in scalp psoriasis cases.
T/F: Vehicles such as lotion, solution, gel, or foam are easier to apply to hair-bearing scalp and may increase patient acceptance and adherence in scalp psoriasis treatment.
True!
Vehicles such as lotion, solution, gel, or foam are indeed easier to apply to hair-bearing scalp and may increase patient acceptance and adherence in scalp psoriasis treatment.
T/F: Psoriasis is relatively uncommon on the face in comparison to other affected sites (elbows, knees, scalp, sacral area).
True! While it may be seen on the upper forehead as an extension of scalp psoriasis, if there are suspicions of psoriasis on the face, should consider other diagnostic considerations.
HC 1% Cream or Ointment BID might be adequate to treat for some cases of psoriasis that is located on the face region… If this doesn’t work, what can we add to treatment regiment?
Vitamin D Analogue
Which type of psoriasis is rare and often associated with bacterial infections?
Guttate Psoriasis
Which type of psoriasis may require the use of ultra-high-potency topical corticosteroids due to the increased thickness of the skin?
A) Plaque psoriasis
B) Guttate psoriasis
C) Nail psoriasis
D) Palmoplantar psoriasis
D) Palmoplantar psoriasis
^^^ affects the skin of the palms and soles of the feet.
Which type of vehicle is considered the most effective for topical treatments in palmoplantar psoriasis due to its ability to increase penetration through thickened, scaly skin?
A) Creams
B) Gels
C) Ointments
D) Lotions
E) None of the above
c) Ointments
Ointments are the most effective vehicle at this site as they increase penetration of the drug through the thickened, scaly skin. However, creams are cosmetically more acceptable and may be preferred, especially for morning application.
What is the purpose of using cotton gloves or socks after application of moisturizers and/or medicated topical products to the hands or feet?
A) To prevent sweating
B) To enhance penetration and protect irritated skin
C) To keep the skin cool
D) To increase moisture retention
E) To enhance likelihood of adherence of ointment applications
B) To enhance penetration and protect irritated skin
Dermatologist-guided phototherapy, including psoralens with _____ or ______, may be combined with topical agents such as coal tar, anthralin, vitamin D analogues, topical corticosteroids, or tazarotene.
UVA (or PUVA), or UVB
T/F: Thicker, more occlusive agents such as ointments and creams are less effective in hydrating the skin compared to lotions
False!
Thicker, more occlusive agents such as ointments and creams are MORE effective in hydrating the skin compared to lotions.
T/F: Maintenance application of a topical agent 2–3 times per week is recommended for individuals with recurrent psoriasis.
True!
Once control has been achieved after the initial therapy, maintenance application of a topical agent 2–3 times per week may be helpful in individuals with recurrent psoriasis.
What is the purpose of dermatologist-guided phototherapy (PUVA/UVA and/or UVB) in psoriasis treatment?
A) To reduce hair growth
B) To provide pain relief
C) To induce skin pigmentation
D) To treat more severe cases
D) To treat more severe cases
Once control has been achieved in initial therapy, which topical agent may be useful in maintenance therapy for individuals with recurrent psoriasis?
A) Antibacterial agents
B) Antifungal agents
C) Topical corticosteroids
D) Vitamin D analogues
E) Topical corticosteroids combo with Vit D analogues
C) Topical corticosteroids
Systemic therapy is considered for more advanced palmoplantar psoriasis and may include options such as acitretin, apremilast, biologic agents, cyclosporine, deucravacitinib, and ______
Methotrexate (MTX)
T/F: Dermatologist-guided phototherapy is primarily used to induce skin pigmentation in individuals with psoriasis
False!
Phototherapy is used to treat more severe cases of psoriasis, (not to induce skin pigmentation).
Which area is commonly affected by classic plaque psoriasis?
A) Abdomen
B) Palms of the hands
C) Extensor elbows and forearms
D) Soles of the feet
C) Extensor elbows and forearms
Which condition presents with multiple macules (i.e., area of skin discolouration) that merges together into patches on the upper torso, with a fine scale apparent when scratched?
A) Pityriasis (tinea) versicolor
B) Pityriasis rosea
C) Atopic dermatitis
D) Tinea corporis
A) Pityriasis (tinea) versicolor
- Colour may be reddish-brown, pink or more pale than the background skin tone.
What postinflammatory changes may persist for months after psoriatic plaques have been successfully treated, particularly in darkly pigmented skin?
Post-Inflammatory Hyperpigmentation **
Postinflammatory hyperpigmentation may persist for months after psoriatic plaques have been successfully treated, particularly in darkly pigmented skin.
_______ presents with a “herald” patch followed by an eruption of oval pink (in lightly pigmented skin) or grey/brown/black (in darkly pigmented skin) plaques with a fine collarette of central scale
a) Pityriasis (tinea) vesicolor
b) Pityriasis rosea
c) Hives
d) Tinea corporis
b) Pityriasis Rosea
Pityriasis rosea is a rash that often begins as an oval spot on the face, chest, abdomen or back. This is called a herald patch and may be up to 4 inches (10 centimeters) across. Then you may get smaller spots that sweep out from the middle of the body in a shape that looks like drooping pine-tree branches. The rash can be itchy.
T/F: Classic plaque psoriasis commonly presents with well-demarcated, inflamed plaques with overlying scale on the palms of the hands.
False!
Classic plaque psoriasis commonly presents with well-demarcated, inflamed plaques with overlying scale on the extensor elbows and forearms, not on the palms of the hands.
- Psoriasis on the palms of the hand = Palmoplantar psoriasis
T/F: Atopic dermatitis is characterized by very itchy, lichenified, and excoriated skin lesions
True!
Which phototherapy modality is associated with an increased risk of skin malignancies?
A) Narrow-band UVB (NBUVB)
B) UVA therapy
C) PUVA
D) Topical corticosteroids
C) PUVA
The “P” in PUVA refers to psoralens, a photosensitizing agent. Photosensitizing agents like these are associated with an increased risk of skin malignancies.
Phototherapy may be combined with which other types of therapies?
A) Surgical procedures
B) Oral antibiotics
C) Topical or systemic therapies
D) Physical therapy exercises
C) Topical or systemic therapies
Phototherapy may be combined with topical or systemic therapies to enhance treatment effectiveness.
Why is NBUVB used more often than PUVA in phototherapy?
A) Due to a higher efficacy in treating psoriasis
B) Due to convenience and a more favourable safety profile
C) Due to lower cost
D) Due to a shorter treatment duration
B) Due to convenience and a more favourable safety profile
NBUVB (Narrowband UVB) is used more often than PUVA in phototherapy due to its convenience (no need for a photosensitizing agent) and a more favourable safety profile.
In skin folds (e.g., armpits, under breasts, groin), the diagnosis of psoriasis can be more challenging, as psoriasis often lacks the characteristic ______. However, specific clinical findings can be helpful in differentiating psoriasis from other possible intertriginous skin diseases
Silvery scale
Potassium hydroxide (KOH) stain is a diagnostic test for what kind of skin diseases?
a) Psoriasis
b) Atopic dermatitis (eczema)
c) Fungal infections
d) Bacteria infections
e) Viral infections
c) Fungal infections
If KOH tests come back positive, it could be indication of things like tinea or candidiasis, for example. Whereas things like psoriasis and eczema will come back with negative-KOH.
List 3 Nonpharmacologic considerations that can be helpful to reduce irritation and maceration and prevent worsening of psoriasis due to skin trauma.
- Reduce friction and reduce any obstruction of the affected areas or skin folds.
- Wear loose-fitting clothes
- Use moisture-wicking fabrics
HC 1% Cream is often the standard choice of initial treatment of psoriasis in the skin folds areas. What is the frequency in usage/dosing per day for HC 1% in this case?
AAA BID
It is possible for secondary candidiasis to occur in complicated cases of psoriasis affecting the skin folds. In such cases, what are two common anti-fungal agents that can be used in combination of HC 1% cream (if the site is has sofened lesions or has a foul odour)?
Clotrimazole or ketoconazole
Which of the following topical drug classes have a favourable safety profile for long-term use intertriginous psoriasis?
a) Phosphodiesterase-4 Inhibitors
b) Systemic non-biologic therapies
c) Corticosteroids
d) Vitamin D analogues
e) Biologic therapies
d) Vitamin D analogues
T/F: Psoriasis often improves during pregnancy.
True!
Some studies have observed that a significant number of pregnant women reported improved or no changes in their psoriasis during their pregnancy.
HOWEVER, Pregnant patients with psoriasis may be at increased risk of adverse pregnancy outcomes due to comorbidities associated with psoriasis such as diabetes and obesity.
_______ _________ therapy options for psoriasis include methotrexate, acitretin, apremilast, cyclosporine and deucravacitinib
Systemic, Non-Biologic
When a patient is on methotrexate, which demographics have contraindications?
- Pregnant women (should stop 3 months before conceiving, if possible)
- Individuals at-risk of: liver disease, Hep B, Hep C, Tb
- CKD
According to the RX Schematic of Psoriasis Treatment Ladder [Slide 21 of Psoriasis section of Winter semester], which Treatment kind has “lesser” effectiveness?
a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar)
b) Systemic (biologics, ciclosporins, MTX, retinoids)
c) Phototherapy (PUVA and UVB)
d) Antifungals (Clotrimazole, ketoconazole)
e) None of the above have “lesser” effectiveness, they are all relatively similar to each other.
a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar)
According to the RX Schematic of Psoriasis Treatment Ladder [Slide 21 of Psoriasis section of Winter semester], which Treatment kind has “greater” effectiveness?
a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar)
b) Systemic (biologics, ciclosporins, MTX, retinoids)
c) Phototherapy (PUVA and UVB)
d) Antifungals (Clotrimazole, ketoconazole)
e) None of the above have “lesser” effectiveness, they are all relatively similar to each other.
b) Systemic (biologics, ciclosporins, MTX, retinoids)
Emollients/Moisturizing products to treat psoriasis includes _______
- They are to be used PRN between flares
- Often a “trial and error” period until the person finds the “best” moisturizing product that works for them.
- Should be CENTRAL to their routine skin care
- Will also be using other agents
[…] Standard dry skin products.
Which type of therapy should be used as needed between flares and is considered an essential part of routine skin care for individuals with psoriasis?
A) Keratolytics
B) Tar products
C) Emollients/Moisturizing therapy
D) Topical steroids
E) Both c and d
C) Emollients/Moisturizing therapy
Emollients/Moisturizing therapy should be used as needed between flares and should be a standard part of routine skin care for individuals with psoriasis.
Use of dry skin products can also help reduce the use of steroids, for instance.
What is the primary benefit of using combination prescription products like Diprosalic, which contain both corticosteroid + salicylic acid?
A) Enhanced anti-inflammatory effect
B) Enhanced penetration of salicylic acid
C) Enhanced penetration of corticosteroid
D) Enhanced moisturization
E) All of the above
C) Enhanced penetration of corticosteroid
Using combination prescription product Diprosalic (corticosteroid + SA) will be beneficial as using SA with the steroid helps enhance the steroid penetration but note that the steroid is the main benefit for the treatment.
Psoriasin, an over-the-counter product (OTC) containing only coal tar as a medicinal ingredient, is unlikely to provide significant therapeutic benefits because:
A) It lacks the anti-inflammatory properties of corticosteroids
B) Coal tar is not effective in treating psoriasis
C) It is not applied frequently enough
D) Coal tar alone is considered a very mild agent with little therapy benefits for psoriasis
D) Coal tar alone is considered a very mild agent with little therapy benefits for psoriasis
Using single entity OTC agents that only have SA or Coal Tar as a medicinal ingredient is unlikely to provide significant therapeutic benefits because:
A) It lacks the anti-inflammatory properties of corticosteroids
B) Neither are not effective in treating psoriasis
C) It is not applied frequently enough
D) Using each alone is considered a very mild agent with little therapy benefits for psoriasis
D) Using each alone is considered a very mild agent with little therapy benefits for psoriasis
T/F: Emollients/Moisturizing therapy should only be used during psoriasis flares to provide relief from symptoms
FALSE!
Emollients/Moisturizing therapy should be used as needed BETWEEN flares and should be a standard part of routine skin care for individuals with psoriasis.
T/F: The primary benefit of using keratolytics like salicylic acid in psoriasis treatment is their anti-inflammatory effect.
FALSE!
The primary benefit of using Keratolytics like salicylic acid is to enhance the penetration of other active ingredients, such as corticosteroids.
T/F: Psoriasin, an OTC product containing only salicylic acid, is likely to provide significant therapeutic benefits for psoriasis.
FALSE.
- It contains coal tar
- Has little to no effect in treating psoriasis.
Keratolytics such as salicylic acid __-___% is considered to be small, low-level therapy with very little benefit on its own…
3-10%
Diprosalic (betamethasone dipropionate/salicylic acid) is a combination topical agent to treat certain kinds of psoriasis.
What drug class is this agent?
Corticosteroid/Keratolytic Combination
What is the active ingredient in T-Gel?
Coal Tar 1%
What is T-Gel therapeutic shampoo? What properties does this have? Treats what? Side effects?
- Coal Tar 1%
- Anti-proliferative properties
- Available in Canada as an OTC shampoo to treat mild cases of scalp psoriasis
- Side Effects: Odour, Folliculitis and Irritation.
Dovonex vs Dovobet?
- Contents
- Frequency of use per day
- Duration of approved use (safety)
Dovonex (calcipotriol): Only contains Vit D analogue… BID… Takes 2 weeks to see any changes but can take up to 8 weeks to see considerable improvements BUT safety profile for longer term use is not known.
Dovobet (calcipotriol/betamethasone dipropionate): Vit D analogue + corticosteroid… OD/QD use… Usually can expect to see changes within a week of use. Can take up to 8 weeks to see considerable improvements BUT longer term use is safe.
What is the primary mechanism of action of topical retinoids like Tazorac (Tazarotene) in the treatment of psoriasis?
A) Suppressing the immune response
B) Decreasing skin cell proliferation rate
C) Increasing skin cell turnover rate
D) Reducing inflammation
B) Decreasing skin cell proliferation rate (via utilization of the retinoid receptor)
