Psoriasis Management (all types)

Question 1

3 main types of psoriasis to know management for?

Answer 1

Chronic plaque psoriasis
Scalp psoriasis
Face, flexural, genital psoriasis (thinner/more sensitive skin)

Question 2

1st line for chronic plaque psoriasis?

Answer 2

Potent topical corticosteroid OD + Vit D analogue OD
For 4 weeks initially

Question 3

2nd line for chronic plaque psoriasis?

Answer 3

No improvement after 8 weeks on 1st line = Vitamin D analogue BD

Question 4

3rd line for chronic plaque psoriasis?

Answer 4

No improvement after 8-12 weeks on 2nd line = potent corticosteroid BD for 4 weeks max OR coal tar prep OD/BD OR short-acting dithranol

Question 5

Secondary care management of chronic plaque psoriasis?

Answer 5

Phototherapy - UVB or photo chemotherapy (PUVA)
Systemic therapy - methotrexate (esp if joint disease)

Question 6

Scalp psoriasis management?

Answer 6

1st - potent corticosteroid OD for 4 weeks max
2nd - change formulation of steroid + topical agent to remove scale to allow steroid to work (agent with salicylic acid, emollient, oils) (apply steroid after this)

Question 7

Face/flexural/genital psoriasis management?

Answer 7

MILD/MODERATE topical corticosteroid OD/BD for 2 weeks max

Question 8

Topical corticosteroid side effects?

Answer 8

Skin atrophy
Striae
Rebound symptoms
Systemic symptoms when used on >10% body surface area

Question 9

Rules around topical corticosteroid use?

Answer 9

4-week break in between courses
Don’t use potent for more than 8 weeks at a time, don’t use very potent for more than 4 weeks at a time

Question 10

Examples of Vit D analogues? (may be called these in answers in the exams)

Answer 10

Calcipotriol (Dovonex), calcitriol, tacalcitol

Question 11

Main clinical aspects of Vit D analogues?

Answer 11

Can be used long-term
Reduce scale/thickness but not erythema of lesions
Avoid in pregnancy
Max weekly 100g
Work by decreasing cell division/differentiation = decreased epidermal proliferation

Question 12

MoA of dithranol?

Answer 12

Inhibits DNA synthesis

Question 13

Dithranol use advice?

Answer 13

Wash off after 30 mins
Can cause burning and staining

Question 14

Overall management of psoriasis (all types)?

Answer 14

CPP
- 1st - potent corticosteroid OD (4 weeks) + Vit D analogue OD
- 2nd - (after 8 weeks) Vit D analogue BD
- 3rd - (after 8-12 weeks) potent corticosteroid BD (4 weeks) OR coal-tar prep OD/BD OR dithranol
- 4th - refer to secondary care for phototherapy (UVB/PUVA) or systemic therapy (methotrexate, etc)

Scalp Psoriasis
- 1st - potent corticosteroid OD (4 weeks)
- 2nd - (after 4 weeks) change formulation and continue steroid but use after scale remover (salicylic acid + emollient + oils)

FFGP
- 2 weeks mild/moderate corticosteroid OD/BD

Question 14

Overall management of psoriasis (all types)?

Answer 14

CPP
- 1st - potent corticosteroid OD (4 weeks) + Vit D analogue OD
- 2nd - (after 8 weeks) Vit D analogue BD
- 3rd - (after 8-12 weeks) potent corticosteroid BD (4 weeks) OR coal-tar prep OD/BD OR dithranol
- 4th - refer to secondary care for phototherapy (UVB/PUVA) or systemic therapy (methotrexate, etc)

Scalp Psoriasis
- 1st - potent corticosteroid OD (4 weeks)
- 2nd - (after 4 weeks) change formulation and continue steroid but use after scale remover (salicylic acid + emollient + oils)

FFGP
- 2 weeks mild/moderate corticosteroid OD/BD