Psoriasis

Question 1

casues/Risk factors of Psoriasis

Answer 1

1) Enviromental –> cold weather, trauma, infectio, alcohol and certain drugs (e.g,Steroid withdrawel)
2) Genetic –> Human leukocyte antigen Cw6 (HLA-Cw6) gene, IL-23R and IL-12.
3) Immnulogic –> High levels of dermal and circulating TNF- α
- increased activity of T cells in the underlying skin

Question 2

clinical presentation of Psoriasis

Answer 2

1) skin rash
2) itching
3) fine scaling
4) pain
5) Generalized erythema

Question 3

Non-pharmacological management of Psoriasis

Answer 3

• Stress reduction.
• Reduce alcohol and smoking.
• Climatotherapy, sun exposure, emollients

Question 4

Pharmacogical management of Psoriasis

Answer 4

1) Topical medication
2) Phototherapy and psoralens
3) Topical Corticosteroids
4) Ophthalamic Corticosteroids

Question 5

indication of Topical Corticosteroids

Answer 5

mild to moderate plaque psoriasis

Question 6

MoA of Topical Corticosteroids

Answer 6

reduce plaque formation

Question 7

Adverse effects of Topical Corticosteroids

Answer 7

• Skin atrophy, striae, allergic dermatitis.
• Slow withdrawal to avoid sudden flares.

Question 8

Exmaples and Topical Steroids and their indication

Answer 8

1) Hydrocortisone topical –> mild potency – for face.
2) Betamethasone topical –> strong potency – truncal area

Question 9

Indication of Betamethasone topical

Answer 9

Strong potency- truncal area

Question 10

Indication of Hydrocotisone Topical

Answer 10

Mild potency- for face

Question 11

indication of Ophthalmaic Corticosteroids

Answer 11

• Treat conjunctival and corneal inflammation.
• Control infiltration and delay vascularization.

Question 12

Opthalmaic corticosteroids

Answer 12

1) Prednisolone ophthalmic.
2) Betamethasone ophthalmic.

Question 13

AE of Systemic Corticosteroids

Answer 13

–> IM corticosteroids are not recommended
for the management of psoriasis.
– >High risk of flare upon withdrawal

Question 14

Indication of Vitamine D analogues

Answer 14

mild to moderate plaque
psoriasis in combination with steroids
–> Used in patients with lesions on the faceor
exposed areas

Question 15

Category of Calcipotriol Topical

Answer 15

vitamin D Analog

Question 16

MoA of Calcipotriol topical

Answer 16

–> Inhibits epidermal proliferation.
* Less irritating in sensitive areas of skin

Question 17

indication of Calcipotriol tropical

Answer 17

mild to moderate plaque psoriasis in combination with steroids
–> on the FACE

Question 18

Category of Methotrexate

Answer 18

Cytotoxic/Immunosuppressive drugs

Question 19

Indication of Methotrexate

Answer 19

symptomatic control of severe,
refractory, disabling psoriasis

Question 20

PK/PD of Methotrexate

Answer 20

Can be used for as long as it remains effective and well-tolerated.

Question 21

Adverse effetcs of Methotrexate

Answer 21

1) Monitor patients closely for bone marrow, liver,
lung and kidney toxicities
2) Teratogenic – contraindicated in pregnancy

Question 22

Category of Apremilast

Answer 22

PED4 inhibitor
*PED4 : Phosphodiesterase-4 inhibitor

Question 23

MoA of Apremilast

Answer 23

increase in cAMP which causes an increased gene expression of anti-inflammatory mediators

Question 24

Indication of Apremilast

Answer 24

moderate-to-severe plaque psoriasis in
candidates for phototherapy or systemic therapy and
for patients with active psoriatic arthritis

Question 25

Adverse effects of Apremilast

Answer 25

1) Nausea, 2) headache

Question 26

Category of Infliximab, etanercept, adalimumab

Answer 26

TNF-α inhibitors

Question 27

MoA of Infliximab, etanercept, adalimumab

Answer 27

neutralize the effects of TNF-α.

Question 28

Indication of Infliximab, etanercept, adalimumab (TNF-α inhibitors)

Answer 28

1) **chronic, severe plaque psoriasis** in candidates for systemic therapy and when other systemic therapies are medically **less appropriate** 2) reducing signs and symptoms in patients with **active psoriatic arthritis**

Question 29

Adverse effects of Infliximab, etanercept, adalimumab

Answer 29

1) infections, 2) infusion reactions

Question 30

Category of Ustekinumab

Answer 30

Interleukin Inhibitor

Question 31

MoA of Ustekinumab

Answer 31

monoclonal antibody directed against **interleukin-12 and interleukin-23** → interferes with **T-cell differentiation and activation**

Question 32

Indication of Ustekinumab

Answer 32

**moderate-to-severe plaque psoriasis** who are candidates for phototherapy or systemic therapy and also for patients with **active psoriatic arthritis**

Question 33

Adverse effects of Ustekinumab

Answer 33

1) infections, 2) back pain

Question 34

Category of Acitretin

Answer 34

Retinoids

Question 35

Administration of Acitretin

Answer 35

Orally

Question 36

Indication of Acitretin

Answer 36

1) **severe extensive plaque psoriasis** resistant to other forms of therapy and also for 2) **first-line treatment of pustular psoriasis**

Question 37

MoA of Retinoids

Answer 37

vitamin A analogue *MoA of oral retinoids same as of topical retinoids (e.g. tazarotene topical).

Question 38

Precautions followed during the use of Retinoids

Answer 38

1) Category X medication - **teratogenic** 2) **Contraindicated in pregnancy and hyperlipidaemia** 3) Use of **sunscreens during treatment** and avoid exposure to sunlight. 4) Avoid use of alcohol.

Question 39

Adverse effects of Acitretin (oral)

Answer 39

1) hepatotoxicity, 2) cheilitis (inflammation of the lips) 3) alopecia, 4) skin peeling.

Question 40

Adverse effects of Tazarotene (Topical Retinoid)

Answer 40

1) desquamation, 2) pruritus, 3) erythema, 4) burning.

Question 41

the 2 types of Phototherapy treatments of Psorisis

Answer 41

1) UVB- ultraviolet B light 2) PUVA- Psoralen and ultraviolet A

Question 42

MoA of UVB

Answer 42

UVB penetrates the skin and slows the growth of affected skin cells.

Question 43

MoA of PUVA

Answer 43

**UVA is relatively ineffective** unless used w/ a light-sensitive meciation called **psoralen** (topically or orally)

Question 44

Indication of UVB and PUVA

Answer 44

1) **extensive and widespread disease** or 2) resistance to topical treatment in combination with other pharmacological treatment

Question 45

Adverse effects of PUVA treatment

Answer 45

higher risk of skin cancer