Psoriasis / Shingles / Pityriasis / Lupus

Question 1

Skin turnover time with Psoriasis?

Answer 1

3d (vs. 30d normal skin)

Question 2

Most commonly affected areas of the body by Psoriasis?

Answer 2

Knees, Elbows, Trunk, Scalp

Question 3

Psoriasis peak onset ages?

Answer 3

20-30yrs & 50-60yrs

Question 4

What percentage of Psoriasis pt.’s have some degree of scalp involvement with their condition?

Answer 4

50-80%

Question 5

What might help & what might worsen Psoriasis?

Answer 5

Help: Sunlight / UV Therapy

Worsen: Cold Weather, Stress, Trauma

Question 6

Therapeutic Ladder of treatments for Psoriasis?

Answer 6

1) Emollients (prn btw. flare-ups)

2) Keratolytics (ie. SA or Steroid + SA combos)

3) Coal Tar

4) Top Steroids (Mid Potency & remember s/e’s!!!)

5) Calcipotriol / ene or Calcitriol

6) Retinoids

7) Anthralin

8) Photo Therapy

9) Biologics

Question 7

T or F: Healing Phase Psoriasis actually requires a stronger therapeutic agent than Scaling, Acute Psoriasis?

Answer 7

True (!!!)… Normal skin has more barrier properties in place than damaged skin in the scaling phases of Psoriasis (so it thus needs stronger agent).

Question 8

What is Calcipotriol / ene?

Answer 8

Vit. D analogue that decreases skin turnover rates

Question 9

How do Calcipotriol products Dovonex & Dovobet differ?

Answer 9

Dovonex: Pure Vit. D

Dovobet: Also has Betamethasone in it.

Question 10

Weekly use guidelines for Calcipotriol products?

Answer 10

100g cream
60mL scalp lotion

Question 11

What do we want to avoid when using Calcipotriol products?

Answer 11

NOT USE PREVENTATIVELY!!! Do not want to use continually once skin normalizes.

Question 12

Calcitriol daily intake values (vs. Calcipotriol)?

Answer 12

Calcitriol: 30g / day
Calcipotriol: 100g / wk

Question 13

Why would concurrent usage of a steroid be wise with those on Retinoids for Psoriasis treatments?

Answer 13

To decrease irritation brought about by the Tazarotene

Question 14

When should the following topical Psoriasis therapies start to work?

Calcipotriol / BM
Vit. D Analogue Mono
Retinoid Mono

Answer 14

Cal / BM: 1wk
Vit. D Mono: 2wks
Retinoid Mono: 1-4wks

Question 15

Biologics are reserved for what severity of Psoriasis?

Answer 15

Severe Cases

Question 16

What other Psoriatic agents can be used for those who experience Psoriatic Arthritis?

Answer 16

-Methotrexate
-Cyclosporine
-TNF-Alpha Blockers

Question 17

Shingles is the reactivation of what virus?

Answer 17

Varicella Virus

Question 18

~How many yrs after Chicken Pox does one typically get Shingles?

Answer 18

50yrs

Question 19

What is one common symptom demonstrated by Shingles patients?

Answer 19

-Excruciating Abdominal Pain
-Unilateral (but can present bilaterally)

Question 20

The course of Shingles lasts about how long?

Answer 20

3-4wks

Question 21

The Varicella Virus responsible for Shingles lies dormant in what?

Answer 21

Nerve Fibers (most common sites lie between T1 & L2)

Question 22

Name of Shingles presentation when a rash isn’t present?

Answer 22

Zoster Sine Herpete (ZSH)

Question 23

How does ZSH present?

Answer 23

-Deep & painful burning sensations

-Pain radiating from spine

-Sensitivity to touch

-Achiness & Itchiness

-Unilateral

Question 24

What can we give for Acute Phase Shingles?

Answer 24

-AV’s (within 72hrs)
-Analgesics
-Cool Compress & Calamine (For Itch)

Question 25

What AV’s can we give within 72hrs of Acute Phase Shingles onset?

Answer 25

1) Acyclovir 800mg 5x daily

2) Famciclovir 500mg TID

3) Valacyclovir 1000mg TID

Three therapies are all used for 7d!!!

Question 26

What rule is sometimes used for determining who can get prescribed AV’s in Acute Phase Shingles?

Answer 26

50-50-50

-Within 50hrs of rash appearance, for > 50yrs, those who have > 50 lesions.

Question 27

What NSAID’s do we avoid giving kids with Chicken Pox?

Answer 27

1) ASA (Reye’s Syndrome from Fever treatment)

2) Ibu (Life-Threatening Bacterial Infections can occur)

Question 28

What complication can arise from Shingles re-infection?

Answer 28

Post-Herpetic Neuralgia (no rash & persistent nerve pains)

Question 29

What is the most common 1st line choice for treating Post-Herpetic Neuralgia brought about by Shingles infection?

Answer 29

TCA’s

Question 30

Are Oral NSAID’s effective treatments for Post-Herpetic Neuralgia (ie. Chronic Shingles)?

Answer 30

NOOOOOOOOOOOO (good for acute rash, but shit for PHN treatment)

Question 31

Can you get Chicken Pox from Shingles infections? Shingles from Shingles infections?

Answer 31

-Yes to Chicken Pox ; No to Shingles.

Question 32

How is Capsaicin believed to treat Shingles?

Answer 32

Depletes Substance P in nerve fibers (which serves as a pain neurotransmitter).

Question 33

How does Pityriasis initially begin?

Answer 33

As one lg. pinkish-red scaly blotch (& becomes more blotches within a few weeks).

Question 34

Who does Pityriasis typically manifest in?

Answer 34

Young Adults

Question 35

Pityriasis is also commonly referred to as what?

Answer 35

Christmas Tree Rash

Question 36

How long does Pityriasis last? Is it contagious? What do we use to treat?

Answer 36

6 to 8wk length ; Not Contagious ; Generally nothing to treat (resolves on its own).

Question 37

How do we distinguish Tinea, Eczema, Psoriasis & Hives from a traditional Pityriasis case?

Answer 37

Tinea: Spreads slower.

Eczema: Multiple locations, itchier, possible blistering at start.

Psoriasis: Shiny plaques.

Hives: Move faster, itchier, no scaling.

Question 38

Systemic Lupus Erythematosus is also referred to as what type of rash?

Answer 38

Butterfly Rash

Question 39

Lupus is more common in what pt. demographic?

Answer 39

Women (15-45yrs)