Rosacea + Psoriasis Flashcards
types of rosacea
-telangiectatic
-papulopustular
-phytmatous
-ocular
Rosacea
-inflammatory dermatosis
-vascular instability
-central part of face
-flushing/blushing
-erythema, papules, pustules
-telangiectasia
-fair complexioned women
telangiectatic rosacea
-visibly dilated blood cells
-very red skinp
papulopustular rosacea
-resembles acne
-“adult acne”
Phytmatous rosacea
-enlarged sebaceous glands esp in nose
-more common in men
Ocular rosacea
-watery, bloodshot eyes
Rosacea triggers
-TEMP
-food
-med conditions
-emotions
-exertion
-skin products
-drugs
Drugs that cause rosacea
-vasodilators
-TCS
-nicotinic acid
-ACE inhibitors
-Ca channel blockers
-statins
Nonpharma tx of rosacea
-avoid triggers and sun
-use mild soap
-adhere to topical meds
-allow 5-10 min penetration before applying makeup
mild rosacea tx
-avoid triggers
-topical abx
-retinoids
mod rosacea tx
-oral abx
-retinoids
severe rosacea tx
-oral isotrentinoin
-laser tx
Topical abx for rosacea
-Metreonidazole 1% cream, gel, lotion
-apply BID
-Clindamycin
-Sulfacetamide and sulfur
Topical retinoids for rosacea
-azelaic acid 15% gel
-antibac, comedolytic, anti inflam
-less acidic = better absorbed
New tx for rosacea
-Brimodine
Brimonidine (mirvasco)
-0.33% gel
-a-2 agonist
-tx persistent erythema
-opthalmic drops for ocular rosacea
Oral abx for rosacea
-doxy or minocycline 50-100 mg qd or BID
-mod to severe
-alone or combo
Laser therapy for rosacea
-remove blood vessels
-reduce redness
-minimum 3 treatments
-SEVERE tx
Psoriasis
-chronic autoimmune inflammatory skin disorder
-T-lymphocyte mediated disease
-keratinocyte proliferation
-thick, red patches covered by silver scales
-7x faster skin growth
-onset around age 40
-series of exacerbations/remissions
Psoriasis common sites
-scalp
-face
-pit
-elbows and knees
-butt
-trunk
-groin
Types of psoriasis
-plaque
-scalp
-psoriatic
Psoriasis classification
-limited <5% BSA
-mod 5-10% BSA
-severe >10% BSA
Psoriasis triggers
-stress
-cold
-injury/infection
-smoking
-drugs (nsaids, ace, lithium)
-diet
Goals of psoriasis tx
-dec symptoms
-dec BSA
-improve QOL
-reduce inflammation
-clear lesions
-prolong periods between exacerbations
Psoriasis non pharma tx
-sun
-baths
-emollients
-keratolytics (salicylic acid 2%)
Approach to psoriasis tx
- topical
- UV
- Systemic
- Biologic
Topical tx of psoriasis
-most effective for <20% BSA
-most pt succeed
Topical options for psoriasis
-emmolients (use for all pt)
-TCS
-Calipotreine/Calcitriol
-TCS + Vit D
-TCS + Tazarotene
-calcineurin inhibitor
TCS for psoriasis
-sec scaling, redness, itching
-economical
-shampoo version for scalp
-high potency ointment better for scaly lesions
-risk of tachyphylaxis
Tachyphylaxis
-tolerance to anti-inflammatory activity of TCS w repeated use
-may alternate w other topical meds to avoid
Occlusion of TCS
-enhances pentration
-plastic wrap + t-shirt
-leave on 6 hours
-10x penetration
High/Very-high potency TCS for psoriasis
-SEVERE lesions and thick skin where max penetration is needed
-do NOT use on face
-dont use more than 2 weeks
-no more than 50g/week
-switch to mid-potency after control
Phototherapy for psoriasis
-mild-mod that failed topical tx
-combo w systemic/biologics for SEVERE tx
-role in maintenance tx
phototherapy mech
-immunomodulatory effect
-UVA penetrates better (thick lesions)
-NB-UVB is tx of choice (thinner lesions)
NB-UVB
-first line
-thinner lesions
-20-25 txs 2-3x a week
-cost effective but inconvenient
Phototherapy risks
-UVA more than UVB
-skin aging and cancer
-PUVA?
-Methoxsalen to prevent risks
SEVERE psoriasis tx
- biologic therapy
- Systemic therapy
Methoxsalen
-photosensitizer
-0.6-0.8mg/kg PO 2 hours before UVA tx
-2-3 tx/week
Biologic tx for severe psoriasis
-tumor necrosis factor inhibitors
-T-cell activation inhibitors
Systemic tx for severe psoriasis
-try biologics first
-oral retinoids
-cyclosporine
-methotrexate
Cyclosporine
-calcineurin inhibitor
-qd
-monitor renal, BP, drug concentration, preg cat C
-HTN, nephrotoxicityy, tremors, HA, risk of infections
Methotrexate
-immunosuppressant
-monitor CBC, LFTs, renal function, preg category X
-liver bx after 3.5-4g total dose
-inc risk of infections
-once weekly
-most cost effective
-nauea, anorexia, fatigue, stomatitis, BM suppression, hepatotoxicity, photosensitivity, pneumonitis
Key aspects of biologics tx
-v expensive
-prior authorization
-for pt that failed other therapies
-well tolerated
-injection site discomfort
-monitor infections/bleeding
-supp w topical
-do NOT admin live virus vax
After controlling psoriasis w systemic therapy
-use emollients
-go back to topical
-some use continuous tx
