Psoriasis Flashcards
Chronic, inflammatory skin condition
Mostly on elbows, knees, umbilicus
Classified by severity and body surface area
Exacerbations: stress, seasonal change, environmental factors, meds (NSAIDS, anti-malarias, BB, lithium, steroid withdrawal
Psoriasis
Psoriasis Flow
Mild: Topical
Mod-severe: Topical with specialist referral.
Immunosuppressants (Methotrexate, cyclosporine, azathioprine) and oral retinoids (Acitretin) as well as
Systemic agents; 12 + biologics and Apremilast (oral)
Emollients/Moisturizers
Best to get non-cosmetic and fragrance free creams, ointments, and lotions to reduce further irritation.
Lubricate and moisturize skin for all patients
Provides barrier and reduction of water loss
Softens psoriasis plaques and scales to improve skin
Apply LIBERALLY, can’t overdo it
Salicylic Acid
IND: Removal of excess Keratin in Psoriasis, acne, dermatitis
MOA: Dissolves intracellular matrix, leading to keratinized tissue to swell, soften, macerate and desquamate
BOX:N/A
CONTRA: Hypersensitivity to salicylates
ADR: Local reactions
Anthralin
IND: Chronic STABLE plaque psoriasis
MOA: Reduction of mitotic rate and proliferation of epidermal cells via inhibition of DNA SYNTHESIS to affected areas. Less DNA = less epidermal cell turnover
BOX: N/a
CONTRA: Acute or actively inflamed psoriatic eruptions
ADR: Staining of fingers, area, and fabrics. Redness (decrease dose). Skin irritation
Coal Tar
IND: Psoriasis, dandruff, seborrheic dermatitis. Helpful as an adjunct to corticosteroids
MOA: loosens and softens scales and crusts and has antiseptic, antibacterial, anti-inflammatory, antiproliferative and anti-seborrheic properties
BOX:N/A
CONTRA: N/A
ADR: Photosensitivity, hair discoloration, dermatitis, folliculitis, skin irritation
Urea
IND: Hyperkeratotic conditions (psoriasis, dermatitis, eczema)
MOA: Softens hyperkeratotic areas; dissolves intracellular matrix
BOX:N/a
CONTRA: Irritated, infected, or open skin
ADR: Increased photosensitivity
Topical Corticosteroids
IND: First line treatment of psoriasis, dermatitis, etc. Relief of inflammation and pruritis
MOA: Decrease endogenous mediators of inflammation ( kinins, histamines, prostaglandins)
BOX: n/a
CONTRA: n/a
ADR: Varies depending on potency. Thinning of skin, atrophy once skin has returned to normal thickness. Acneiform lesions. Localized reactions.. Steroid rosacea on face
Lots of different routes and application schedules
Super high potency Topical Glucocorticoids
Betamethasone Dipropionate
Clobetasol Propionate
High Potency Topical Glucocorticoids
Fluocinonide
Triamcinolone Acetonide
Medium Potency Topical Glucocorticoids
Betamethasone Valerate
Clocortolone Pivalate
Mometasone Fuorate
Triamcinolone Acetonide 0.1%
Low Potency
Desonide
Triamcinolone Acetonide 0.025%
Least potent: Hydrocortisone 0.5%
Selecting Topical Steroids
Skin integrity Area of body Vehicle selection Occlusive Dressing Patient age
Ointments
Transient occlusion
Promote hydration (barrier)
Enhances active ingredient transport thru skin.
Good for: Dry lesions
Comments: Can cause secondary bacterial infections because of the occlusiveness allowing a POE. Also maceration
Avoid in: moist, weeping, oozing, puncture, or lacerations. Use sparingly in intertriginous areas, MM, and acne prone areas
Creams
Allow fluid to flow freely from lesions
Don’t trap bacteria
Good for: moist, macerated, weeping, oozing
Less occlusive = less effective on dry lesions
Avoid in: Hairy areas ( they don’t reach the skin)
Sol, gel, lotion
Allow free flow of fluid from lesions
Doesn’t trap bacteria
Good for: moist, macerated, weeping, oozing
Can be drying if formulated with alcohol
Avoid in dry lesions, fissures, abraded skin
Selection
Short course of high potency is the preferred method.
Don’t overdo it so once under control, switch to low potency for maintenance
High/super high: chronic hyperkeratotic or psoriasis (thick skin). Super: 2 wks unless limited to a small area.
Med-high: 3 months or less, no face or intertriginous
Low/med: thin, acute, inflammatory skin lesions or topical dermatitis
Low: preferred for face and intertriginous as well as babies and elderly
Absorption and potency are affected by the vehicle
Ointment: thick lesions
Cream: acute/subacute dermatoses
Soln, gel, spray: scalp
Calcipotriene
IND: Plaque psoriasis of body or scalp
MOA: Synthetic Vitamin D3 analog; regulates skin cell production and proliferation
BOX: n/a
CONTRA: Hypercalcemia; vitamin D levels already raising Ca levels. Face use (cream/ointment) or acute psoriatic eruptions (scalp solution)
ADR: Local Reactions
Taclonex is co-formulated calcipotriene and betamethasone
Calcitriol
IND: Mild-moderate plaque psoriasis MOA: Synthetic VD3 BOX: n/a CONTRA: Ophthalmic, oral, intravaginal, face use ADR: Hypercalcemia. Local reactions
Retinoids
Tazarotene
IND: Plaque psoriasis. 2nd line with or without steroid, more effective with high potency steroid
MOA: Synthetic retinoid Vitamin A derivative. Anti-inflammatory and immunologic activity
BOX: n/a
CONTRA: Pregnant
ADR: Photosensitivity, local irritation. Xeroderma, Erythema, desquamation
Calcineurin Inhibitors
Third line. Often used in face or intertriginous areas
Pimecrolimus
Topical cream
IND: Atopic dermatitis, intertriginous or facial psoriasis
MOA: Inhibit calcineurin by binding FKB-12, blocking cytokine production and inhibiting T cell activation
BOX: Avoid long term use. Skin cancer/lymphoma increased incidence. Avoid in kids under 2
CONTRA:
ADR: Infections d/t T cell deactivation. URIs and Influenza.
Tacrolimus
Ointment
IND: Atopic dermatitis, intertriginous or facial psoriasis
MOA: Inhibit calcineurin by binding FKB-12, blocking cytokine production and inhibiting T cell activation
BOX: Skin cancer/lymphoma increased incidence. Avoid in kids under 2
CONTRA:
ADR: Infections d/t T cell deactivation. URIs and Influenza.
Psoralens
Methoxsalen
IND: Last line, severe recalcitrant disabling psoriasis
MOA: Inhibits DNA synthesis and cell turnover. “Excited” by radiation
BOX: Require specialized training/competence in psoriasis and photochemotherapy. Do NOT interchange oral psoralen products
CONTRA: Diseases with photosensitivity
ADR:
