Rosacea + Psoriasis Flashcards by Brooke Thornburg

types of rosacea

-telangiectatic
-papulopustular
-phytmatous
-ocular

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Rosacea

-inflammatory dermatosis
-vascular instability
-central part of face
-flushing/blushing
-erythema, papules, pustules
-telangiectasia
-fair complexioned women

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telangiectatic rosacea

-visibly dilated blood cells
-very red skinp

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papulopustular rosacea

-resembles acne
-“adult acne”

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Phytmatous rosacea

-enlarged sebaceous glands esp in nose
-more common in men

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Ocular rosacea

-watery, bloodshot eyes

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Rosacea triggers

-TEMP
-food
-med conditions
-emotions
-exertion
-skin products
-drugs

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Drugs that cause rosacea

-vasodilators
-TCS
-nicotinic acid
-ACE inhibitors
-Ca channel blockers
-statins

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Nonpharma tx of rosacea

-avoid triggers and sun
-use mild soap
-adhere to topical meds
-allow 5-10 min penetration before applying makeup

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mild rosacea tx

-avoid triggers
-topical abx
-retinoids

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mod rosacea tx

-oral abx
-retinoids

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severe rosacea tx

-oral isotrentinoin
-laser tx

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Topical abx for rosacea

-Metreonidazole 1% cream, gel, lotion
-apply BID
-Clindamycin
-Sulfacetamide and sulfur

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Topical retinoids for rosacea

-azelaic acid 15% gel
-antibac, comedolytic, anti inflam
-less acidic = better absorbed

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New tx for rosacea

-Brimodine

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Brimonidine (mirvasco)

-0.33% gel
-a-2 agonist
-tx persistent erythema
-opthalmic drops for ocular rosacea

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Oral abx for rosacea

-doxy or minocycline 50-100 mg qd or BID
-mod to severe
-alone or combo

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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

1. topical 2. UV 3. Systemic 4. 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

1. biologic therapy 2. 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