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#1 Psoriasis 2007
Ferris Therapeutics
| Psoriasis | Answer |
|---|---|
| What is plaque psoriasis (a.k.a. psoriasis vulgaris)? | Sharply demcarcated, erythematous lesions accompanied by scaling plaques. 1) Affect extensor more than flexor surfaces 2) 80-90% of the patients |
| What is inverse psoriasis? | Erythematous scaling plaques in flexural sites like: a) axillae b) antecubital fossae c) popliteal fossae d) inguinal creases |
| What is Guttate psoriasis? | A sudden development of numerous small, erythematous, oval lesions accompained by scales on the trunk or extremities 1)Can develop a few days after URI 2)Responsive to phototherapy 3)Mild cases usually disappear 4)Flare-ups occur |
| What is pustular psoriasis? | Localized: Papules or plaques studded with pustules usually found on the palms or soles. Generalized: More widespread than localized. Protective skin functions lost. Life threatening! |
| What is erythrodermic psoriasis? | Exfoliative psoriasis. Severe, intense, generalized erythema and scaling covering the body (up to 100% involvement). Associated with systemic symptoms. Protective skin functions lost. Life threatening! |
| What are two life threatening types of psoriasis? | 1) Pustular 2) Erythrodermic |
| Break down the Psoriasis Area and Severity Index (PASI). | Mild < 2% of coverage (1%= the size of your palm) Moderate 2% - 10% Severe > 10% |
| Two complications of psoriasis. | 1) psoratic arthritis 2) cellulitis |
| Name 3 non-pharmacologic treatments of psoriasis. | 1)balneotherapy/climatotherapy ("salt baths") 2)UVB Phototherapy (wavelength b/w 310 - 315 nm) 3)Excimer Laser: Limited to isolated plaques |
| MOA, AE, and Dosing/application of emollients for psoriasis. | MOA: decreases dryness AE: may cause folliculitis or contact dermatitis Dosing/Application: QID |
| MOA, AE, and dosing/application of keratolytics for psoriasis? | MOA: removes scale, smooths skin, decreases hyperkeratosis AE: may induce salicylism or salicylate poisoning Dosing/Application: Apply 2-3 times per day. Enhances penetration of other topical agents. |
| What is coal tar's MOA for psoriasis? | Stimulates transient epidermal hyperplasia folled by a cytostatic effect causing epidermal thinning. |
| Problems with coal tar? | Time involved, Local irritation Unpleasant odor Staining of skin and clothing Increased sensitivity to UV light |
| What product is activated to form photoadducts with epidermal DNA when used in combination with UVB light? | COAL TAR --may lead to an increase of nonmelanoma skin cancers |
| What is a Goeckerman regimen? | Crude coal tar applied for most to the day and only removed prior to UV therapy. |
| Which topical treatment may lead to an increase of nonmelanoma skin cancers. | Coal tar |
| How is coal tar generally applied? | Apply in the evening and leave on skin throughout the night. |
| For psoriasis, corticosteroids decrease what three things? | 1)erythema 2)scaling 3)puritis |
| What are three high potency corticosteroids? | Clobetasol, halobetasol, and betamethasone |
| What is a low potency corticosteroid used for psoriasis? | Hydrocortisone 1%. |
| What are the three major classes of corticosteroids used for psoriasis? | High potency---Class 1 Intermediate potency---Class 2-6 Low potency---class 7 |
| Which forms of corticosteroids are considered the most effective? | Ointment dosage forms due to their hydrating effect and lipophilicty. |
| What are some adverse effects of topical corticosteroids? | Localized atrophy, skin degeneration, striae, telangiectasis, purpura, acneiform eruptions masking bacterial/fungal infections. |
| What are some systemic "consequences" of topical corticosteroids? | HPA axis suppression, hyperglycemia, development of cushingoid features. |
| Where should corticosteroid ointments not be used for psoriasis? | In the axilla, groin, or other interiginous areas where maceration or folliculitis may develop. |
| Since ointments should not be used in certain areas in psoriasis, what is used? | Creams or emulsified products with an aqueous phase. |
| What is "Long-term therapy" for corticosteriods? | Typically applied 2-4 times daily. |
| What is a Vitamin D Analogue in the treatment of psoriasis? | Calcipotriene (Dovonex) |
| How long does visual improvement take for Vitamin D analogues in psoriasis therapy? | 2-8 weeks |
| What are some adverse effects of Vitamin D Analogues? | Lesional and perilesional irritation and irritant contact dermatitis of the face. |
| Calcipotriene (Dovonex) is applied how often? | 1-2 times per day (no more than 100 grams per week. |
| Name one synthetic retinoid pro-drug. | Tazarotene (Avage, Tazorac) |
| Two precautions for Tazarotene. | 1)Avoid application to eczematous skin. 2) Avoid application to >20% of the body (excessive systemic absorption). |
| What medication for psoriasis is often used with corticosteroids to decrease adverse effects and increase efficacy? | Tazarotene (Avage, Tazorac) |
| What is the MOA of Tazarotene? | Modulates keratinocyte proliferation and differentiation. |
| What are some adverse effects of Tazarotene (Avage, Tazorac)? | Mild to moderate puritis, burning, stinging, or erythema. |
| What drug is used for chronic plaque-type and guttate psoriasis in combination with UV light? | Anthralin |
| What are some therapy limiting effects of Anthralin? | Inflammation, irritation, and staining of skin and clothing. |
| How is Anthralin usually applied? | Usually applied at night and remains in contact with skin throughout the night. |
| Problems with Anthralin? | Excessive irritation and staining (disappears withing 1-2 weeks of discontinuation) |
| What are two calcineurin inhibitors? | Tacrolimus (Protopic Ointment) and Percrolimus (Elidel Cream) |
| What is the FDA approved use of Calcineurin inhibitors (Protopic and Elidel)? | Only for the treatment of atopic dermatitis (eczema). |
| What is the off-label use of calcineurin inhibitors? | Psoriasis--generally well-tolerated |
| What would you use in patients with moderate to severe incapacitating psoriasis unresponsive to conventional topical and systemic therapies? | UVA + methoxsalen (photosensitizer). |
| What are some adverse effects of methoxsalen? | Nausea, dizziness, headache. |
| Patients that receive >250 sessions of Methoxsalen treatment have a greater chance of ...? | Skin cancers (malignant melanoma) |
| How would you counsel a patient to take their methoxsalen? | Orally administeredd with milk or food to minimize risk of nausea and GI upset. |
| What ar esome PUVA Long-term adverse effects? | Actinic skin damage, solar elastosis, dry and wrinkled skin, hyperpigmentation, and hypopigmentation, and of course cancer. |
| Which medication may be delivered topically via bath water? | Methoxsalen. This will reduce systemic effects and result in an overall reduction of UVA dose to 1/4 of the usual dose. |
| How often is photochemotherapy given to patients on methoxsalen? | 2-3 times per week. |
| Name an oral retinoid. | Acitretin (Soriatane) |
| Indicated for the treatment of severe psoriasis. More useful as an adjunct in the treatment of plaque psoriasis. | Acitretin (Soriatane) |
| MOA: acts on retinoid receptors in the keratinocyte mucleus correcting abnormal cell differentiation. | Acitretin (Soriatane) |
| Acitretin (Soriatane) is pregnancy category ____. | X---Contraindicated with females who plan to get pregnant within THREE years of discontinuing the drug. |
| Acitretin can be used in combination with... | PUVA, UVB, cyclosporine, and methotrexate. |
| The brand name of Acitretin is... | Generic of Soriatane is... |
| Some adverse effects of Acitretin (Soriatane) | Dose dependant adverse effects: hypervitaminosis, hepatotoxicity, skeletal changes, hypercholesterolema, hypertriglyceridemia, hair loss, cheilitis, nail thinning. |
| Three brand names of cyclosporine? | Gengraf, Neoral, Sandimune. |
| When is cyclosporine used? | Used in both cutaneous and arthritic manifestations of severe psoriasis; short-term use. |
| What are some adverse effects of cyclosporine? | Nephrotoxic with prolonged use and use for >2 years may increase the risk of malignancy. |
| What is the MOA of Cyclosporine? | Inhibits first phase of T-cell activation and the release of inflammatory mediators from mast cells, basophils, and polymorphonuclear cells. |
| A medicine that inhibits T-cell activation and is an alternative treatment in severe psoriasis. | Tacrolimus. |
| Methotrexate should be avoided in patients with... | active infections. |
| What may be administered with methotrexate to decrease anemia and nausea? | Folic acid |
| What are some long-term adverse effects of Methotrexate? | hepatotoxicity/hepatic fibrosis (relationship with malignant lymphomas) |
| What are some short term adverse effects of Methotrexate? | Nausea, vomiting, mucosal ulceration, stomatitis, malaise, HA, macrocytic anemia, and pulmonary toxicity. |
| Methotrexate has been used for decades to treat... | moderate to severe psoriasis. |
| This psoriasis medication inhibits replication and function of T and B cells. | Methotrexate. |
| This psoriasis medication supresses cytokine secretion and epidermal cell division. | Methotrexate. |
| This psoriasis medication may be beneficial in patients with psoriatic arthritis, refractory to UV/topical therapy. | Methotrexate. |
Created by:
Oldschool1
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