Psoriasis and Acne

Question 1

Psoriasis is a 1) disorder which involves 2) cell populations stimulated by undefined antigens via APCs. The T cells which then in turn release 3) such as 4) that induce 5) and 6) proliferation.

Answer 1

1. inflammatory skin
2. T cells
3. pro-inflammatory cytokines
4. TNF and IFN
5. keratinocytes
6. endothelial cell

Question 2

Three drugs that target TNF alpha are 1), 2), and 3). They are 4) or a receptor 5) that bind up either free or cell surface TNF alpha and prevents the inflammatory process, which include TGF beta, IL-10 secretion by 6), 7) and 8) by T cells, and 9) and 10) by macrophages

Answer 2

1. Infliximab
2. Etanercept
3. Adalimumab
4. monoclonal antibodies
5. fusion protein
6. Treg
7. IL-6, IFN gamma
8. IL-1, TNF-alpha

Question 3

Adalimumab is a 1) (structure) which has 2) (component), binding to 3). Etanercept is a 4) with components of 5). Infliximab is a 6) with 7) region of mouse monoclonal antibody on 8). Adalimumab and Etanercept are administered 9) while Infliximab is 10).

Answer 3

1. Human monoclonal antibody
2. IgG1
3. TNF-alpha
4. Receptor antibody fusion protein
5. p75 TNF receptor and Fc IgG1
6. chimeric monoclonal antibody
7. variable
8. human IgG1
9. SC
10. IV

Question 4

Since 1) is the only chimeric mouse-human antibody of the three TNF alpha target drugs, it will have the adverse effect of 2). Black box warnings are 3), 4), 5); do not use with 6).

Answer 4

1. Infliximab
2. murine protein hypesensitivity
3. infection, including fungal/myco-bacterial/viral
4. neoplasia
5. TB
6. immunosuppresive or vaccinate concurrently

Question 5

Ustekinumab is another 1) drug directed at 2) signaling rather than TNFalpha. It has the same adverse effect of 3) as the TNFalpha target drugs. It binds to the 4) subunits of IL-12 and 5) which are over expressed in psoriasis plaques, and in turn suppresses pro-inflammatory 6) and 7) formation. Contraindicated are 8) and pt must be tested for 9) prior to initial tx.

Answer 5

1. monoclonal antibody
2. Interleukin signaling
3. immune suppression
4. p40
5. IL-23
6. Th1
7. Th17
8. live virus vaccination
9. latent TB

Question 6

Retinoids are needed for 1), 2), 3), 4). Effects of retinoids are modulation of 7), inhibition of 8), alteration of cellular 9), decreased 10) secretion and 11) gland size, immunologic and 13) effects, 14) prevention and therapy, induction of 15), and 16) matrix component effects.

Answer 6

1. embryological development
2. bone development
3. testicular and ovarian function
4. maintenance of mucosal and epithelial surfaces
5. proliferation and differentiation
6. keratinization
7. cohesiveness
8. sebum
9. decreased sebaceous
10. anti-inflammatory
11. tumor
12. apoptosis
13. extracellular

Question 7

Topical application of retinoid activates 1) in the 2), causing activation transcriptional factors leading to synthesis of 3) and 4). These cause proliferation of of basal 5) and induces thickening of epidermis, inducing 6) of 7). The bacterium 8) involved in acne and 9) production are unaffected.

Answer 7

1. RAR/RXR heterodimers
2. suprabasal keratinocytes
3. heparinbinding epidermal growth factor (HB-EGF)
4. amphiregulin (AR)
5. keratinocytes
6. peeling/flaking
7. stratum corneum
8. propionibacterium acnes
9. sebum

Question 8

Two families of retinoic acid receptors are 1 and 2, whereas the first target more 3 and the second 4

Answer 8

1. RARs
   2 RXRs
2. cellular differentiation and proliferation
3. induces apoptosis

Question 9

Drugs targeting RAR are 1, 2, 3, and used in 5, 6, 7

Answer 9

1. tretinoin
2. adapalene
3. tazarotene
4. acne
5. psoriasis
6. photoaging

Question 10

Drugs targeting RXR are 1, 2, and used in 3, 4

Answer 10

1. bexarotene
2. alitretinoin
3. mycosis fungoides
4. Kaposi’s Sarcoma

Question 11

Most common evident adverse effect of retinoid therapy is 1.

Answer 11

1. skin changes due to topical application

Question 12

What are routine tests for pt on retinoid therapy?

Answer 12

CBC, serum lipids, transaminases, pregnancy (teratogen); suicidal ideations; RARs –> mucocutaneous and MSK symptoms; RXR –> physiochemical changes

Question 13

What is the first line of tx for non inflammatory (comedonal) acne?

Answer 13

topical retinoids

Question 14

MOA of topical retinoids?

Answer 14

inhibits MMP in response to UV radiation, induce epidermal hyperplasia in atrophic skin, reduce keratinocyte atypia

Question 15

Adverse effects of retinoids?

Answer 15

Erythema, desquamation, burning, stinging; risk of severe sunburn due to increased UV radiation sensitivity

Question 16

What are two nuclear targeted drugs used for psoriasis?

Answer 16

Calcipotriene and calcitriol, RXR receptor actions

Question 17

MOA of Calcipotriene?

Answer 17

binds Vit D receptor, complex associates with RXR and binds DNA Vit D response element; modulates epidermal differentiation and inflammation

Question 18

Adverse effect of Calcipotriene?

Answer 18

hypercalcemia, hypercalciuria, increased UV sensitivity (UV induced skin cancer)

Question 19

How does Calcitriol differ from Calcipotriene?

Answer 19

Hormonally active form of Vit D3 and is better tolerated in intertriginous and sensitive area of skin

Question 20

What is the main use of benzoyl peroxide?

Answer 20

decreases resistance of antibiotics, prevent Propionibacterium acnes from developing resistance

Question 21

MOA of Benzyol Peroxide?

Answer 21

an oxidant, free radical liberation, kills P. Acnes

Question 22

Side effects of Benzyol Peroxide?

Answer 22

drying of skin, increased peeling, erythema, irritation; avoid eyes and mucous membrane; bleaches hair/colored fabrics

Question 23

Topical clindamycin resistance should be noted if there is no response in __ weeks

Answer 23

4-8 wks

Question 24

Corticosteroids are not only anti-inflammatory, but also 1, and 2 via production of 3 and decreased 4

Answer 24

1. antipruiritic
2. vasoconstrictive
3. anti-inflammatory lipocortins
4. PGs, kinis, histamine, liposomal enzymes and complement systems

Question 25

Topical glucocorticoid potency is based upon ___

Answer 25

ability to produce cutaneous blanching

Question 26

For intertriginous areas and face, ___ (potent) preparations of steroids should be used, whereas high potency may be needed for __

Answer 26

1. low potency

2. hyperkeratotic or lichenified dermatoses and diseases involving palms and soles

Question 27

Area of skin with most penetration is __ followed by __

Answer 27

1. scrotal skin
2. Vulvar skin
   forehead, scalp, palm, forearm, plantar foot arch

Question 28

___ shouldn’t be applied to face because __

Answer 28

fluorinated topical steroids; perioral rash could occur

Question 29

Adverse effects of corticosteroids (topical)

Answer 29

1. Dermal atrophy
2. Cushings (systemic and protracted topical use)
3. steroid acne

Question 30

Adverse effects of corticosteroids (topical)

Answer 30

4. hypopigmentation

5, hypertrichosis

Question 31

Adverse effects of corticosteroids (topical)

Answer 31

6. increased intraocular pressure

7. allergic contact dermatitis

Question 32

Salicylic acid is used for __

Answer 32

acne
psoriasis
verrucas

Question 33

MOA of topical keratolytic (salicylic acid)

Answer 33

desquamation of horny layer of skin

Question 34

Adverse effect of salicylic acid?

Answer 34

hepatic impairment (metabolite of asprin); secreted in breast milk