Psoriasis

Question 1

Main mediators in psoriasis? How do they cause psoriasis?

Answer 1

IL-17, TH-17 -> increased keratinocyte proliferation

Question 2

Nonpharm options for psoriasis?

Answer 2

• reduce stress
• moisturisers
• oatmeal baths
• sunscreen
• phototherapy (PUVA, UVB)

Question 3

What are the scores used for psoriasis diagnosis?

Answer 3

Scores
- psoriasis area & severity index (PASI)
- dermatology life quality index (DLQI)

Question 4

Topical pharm options for psoriasis?

Answer 4

• topical corticosteroid
• vitamin D3 analogs
• retinoids (tazarotene)
• coal tar
• salicylic acid
• emollients
• calcineurin inhibitors

Question 5

What are examples of vitamin D3 analogs?

Answer 5

• calcipotriol
• calcitriol
• tacalcitol

Question 6

How to vitamin D3 analogs work?

Answer 6

• bind to vitamin D receptors -> inhibit keratinocyte proliferation & differentiation
• inhibit T lymphocyte activity

Question 7

How do coal tar & salicylic acid work?

Answer 7

keratolytic

Question 8

Systemic pharm options for psoriasis?

Answer 8

• oral retinoid (acitretin)
• methotrexate (+ folic acid)
• TNF-alpha inhibitors (infliximab, adalimumab)
• JAK inhibitors (tofacitinib)

Question 9

What is the difference between Daivobet and Daivonex and when to use which one?

Answer 9

Diavobet: betamethasone + calcipotriol
Diavonex: calcipotriol only

Use Diavobet for 4 weeks (control flare first), then switch to Diavonex

Question 10

How does methotrexate work?

Answer 10

folic acid analog
- anti-proliferative effect on T cells, inhibit macrophages, downregulate pro-inflammatory cytokines
- decrease production of DNA, RNA & certain AA -> disrupt growth & proliferation of rapidly-dividing cells (e.g. bone marrow, hair follicles, GIT walls) -> SE