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PHAM01 - term 2 > Wk 30 - Dermatology OTC (Psoriasis) > Flashcards

Wk 30 - Dermatology OTC (Psoriasis) Flashcards

1
Q

How does psoriasis occur?

A
  • Stimulation of cutaneous vasculature -> new blood vessel formation in psoriatic plaques
  • Dec epidermal turnover time (4 days)
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2
Q

What are the clinical features of psoriasis?

A
  • Red, scaly, sharply demarcated plaque
  • Common sites: extensor surfaces of elbows, knees, sacrum + scalp
  • Scales scrape off revealing tiny bleeding points
  • Pruritus (itching)
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3
Q

What are precipitating factors of psoriasis?

A
  • Trauma
  • Infection
  • Hormones
  • Sunlight
  • Smoking + alcohol
  • Bblockers, lithium + antimalarials
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4
Q

What is chronic plaque psoriasis?

A
  • Flexural psoriasis = little/no scale bc friction against other skin
  • Symmetrical + crack + bleed
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5
Q

What is guttate psoriasis?

A
  • Affects children + young adults
  • Occur 1st presentation or exacerbation of chronic plaque
  • Follows strep throat
  • Small, red macules, scaly then clear after few months
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6
Q

What are the medical emergency psoriasis?

A
  • Erythrodermic: all skin surface, precipitated by infection, tar, drugs or w/drawal of corticosteroids
  • Pustular: w/ fever + toxicity, genitals, fingers + flexures
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7
Q

What is psoriatic arthritis?

A
  • Affects hands + feet
  • Swollen, inflamed, painful joints
  • Refer to rheumatologist
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8
Q

What is nail psoriasis?

A

Pitting of nails, discolouration, hyperproliferation of nail bed, oncholysis

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9
Q

How is psoriasis assessed?

A
  • Psoriasis area severity index: from 0-4, redness, thickness + scaliness
  • Physician global assessment: Clear, almost clear, mild, moderate, severe, lesion erythema, induration + scale
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10
Q

What is the first line treatment for psoriasis?

A
  • Emollient: soften blacks + improves abs
  • Topical corticosteroids
  • Vit D analogues
  • Dithranol
  • Tar
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11
Q

What is the second line treatment for psoriasis?

A
  • Phototherapies
  • MXT, ciclosporin, acitretin
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12
Q

What is the third line treatment for psoriasis?

A

Biologics:

  • Adalimumab
  • Etanercept
  • Infliximab
  • Ustekinumab
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13
Q

What are the BAD guidelines for management of psoriasis w/ topical steroids?

A
  • Don’t use more than 4 wks w/o review
  • Don’t use potent steroids >7 days
  • Review 3 months
  • No more than 100g mod/high potency per month
  • Rotate topical steroids w/ alt
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14
Q

Which vitamin D analogues are used?

A
  • Calcipotriol
  • Tacalcitol
  • Calcitriol
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15
Q

What is the MOA of vitamin D analogues?

A
  • Inhibit keratinocyte differentiation + proliferation
  • Used in mild/mod chronic plaque psoriasis
  • Clears in 6-8 wks
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16
Q

What are the counselling points of Vitamin D analogues?

A
  • Skin irritation = inc redness/dryness + stinging
  • Calcipotriol: not for face/flexures
  • Calcitriol: face/flexures
  • Finger tip unit, apply thickly
  • Max dose to avoid hypercalcaemia: calcip 100g, calcit 210g, taca 70g
17
Q

What is tazarotene?

A
  • Activated retinoids

-Normalises keratinocyte differentiation, anti-proliferation

-teratogenic

18
Q

What is the problem w/ coal tar?

A

Smells unpleasant + stains clothing

19
Q

What is dithranol?

A
  • Irritant to skin
  • Temp staining
  • Response w/in 3 wks
  • Not for: multiple small plaques or flexural psoriasis
20
Q

What is phototherapy?

A
  • Modulate expression of cellular adhesion molecules + induce T-cell apoptosis
  • 3x/wk
  • CI: photosensitising med/photosensitive disease
21
Q

What is phototherapy - PUVA?

A
  • Combine 8-MOP + UVA
  • MOP tab: 1-2 hrs before radiation
  • Photosensitive til psoralen cleared tf resunscreen
  • 2x/wk for 10 wks
  • Cause nausea, inc risk of skin cancer + photoaging
22
Q

How does cyclosporine work in psoriasis?

A
  • Blocks intracellular component of T-cell activation
  • Inhibit calcineurin phosphatase, inhibits nuclear factor of activated T-cells
  • Clear in 6-8 wks
23
Q

How does oral retinoid work in psoriasis?

A
  • Bind to nuclear receptor + regulate gene transcription
  • Induce keratinocyte differentiation + red epidermal hyperplasia
24
Q

What are things to be aware of when giving oral retinoid?

A
  • LFTs + lipid start of therapy + every 2-4 wks for 2 months then 3 months
  • CI: MXT, Tetracycline, children, child bearing women (teratogenic)
  • Cause: dryness of mucous membrane, skin + conjunctiva
  • Px female in PPP valid 7 days + 30 day treatment
25
Q

What are the counselling points for psoriasis?

A
  • Can’t be cured
  • Not infectious
  • Doesn’t develop into skin cancer
  • Can’t spread to other areas

PHAM01 - term 2 (21 decks)

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