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Psoriasis Flashcards

1
Q

How is skin with psoriasis different than healthy normal skin?

A

Psoriasis skin is hyperkeratotic, which means that the skin cells turn over very frequently. Every 3 days
In psoriasis, the skin may form armour in the form of silvery plaques
Normal skin turns over every 30 days

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2
Q

What is psoriasis?

A

A skin disease that causes red/silver, itchy, scaly patches.
It is most commonly found on the knees, elbows, trunk, and scalp
May occur in cycles with itching, discomfort, and sometimes pain
Two peaks of onset 20-30 and 50-60

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3
Q

What is the most common presentation of psoriasis?

A

Plaque formation
90% are of this type
It shows silver scaling on skin level

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4
Q

What are the percentages of severity for psoriasis?

A

Mild - less than 3% of the body
isolated patches on the knees, elbows, scalp, hands and feet

Moderate 3-10% of the body
appears on the arms, torso, scalp and other regions

Severe - more than 10% of the body
affects large areas of the skin
face and palms/soles considered as severe

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5
Q

How does psoriasis look like on black skin?

A

White/ or silver patches

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6
Q

What is the clinical presentation of psoriasis on the scalp?

A

Generally the same
Dry scaly, can be red and inflammatory

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7
Q

What are some characteristics of psoriasis on the scalp?

A

Lesions linger longer in this area due to skin thickness
Most difficult to treat
50-80% of patients have some degree of scalp involvement

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8
Q

What is the clinical presentation of psoriasis on the nails?

A

You will see pitting/pits on the nails
Silvery lesions possible

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9
Q

What are the less common forms of psoriasis?

A

Guttate
Pustular
Palmo-plantar
erythrodermic

We don’t treat these, we are out, beyond our scope

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10
Q

What is guttate psoriasis?

A

Less common form of psoriasis
Looks like hives, not hives because it doesn’t move

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11
Q

What is pustular psoriasis?

A

You see pus filled stuff
MD territory

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12
Q

What helps with psoriasis? What makes psoriasis worse?

A

Sunlight -> UV light therapy

Worsened by cold weather, stress, trauma

Lesions resolve without scarring

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13
Q

What is healing process for psoriasis?

A

Initially crusty, dry, and white scaling
Then, flat red patches
Finally, clear skin no condition

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14
Q

What are the causes of psoriasis?

A

Autoimmune (T-cell and TNF dysfxn)
Genetic and environmental factors (infection, trauma, some drugs)
12X the normal rate of skin cell production

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15
Q

What are the impacts of psoriasis on patients?

A

Can be physically debilitating
Social aspects
Risk factor for other diseases
Affects 1M Canadians

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16
Q

What are the tx options for psoriasis?

A

Topicals: steroid crm, moisturizers, rx retinoids, SA, coal tar
Systemic drugs:
Non biologics - methotrexate and cyclosporine
Biologics - sterlara and enbrel
Phototherapy: Narrowband UVB therapy
Broad UVB therapy
Excimer laser therapy
Psoralen +UVA (PUVA)

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17
Q

Rank the psoriasis treatments based on toxicity and effectiveness

A

Least effective and least toxic: Topical
moderate toxicity and moderate effectiveness: Photo
Most toxic and most effective: systemic

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18
Q

What are emollients?

A

They are standard dry skin products that are used between flare ups
Also known as steroid saving products
Trial-and-error in finding the best one

Central/essential to routine skin care

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19
Q

Are emollients used alone or with other products?

A

With other products such as in a combination treatment option

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20
Q

What type of dry skin products do we look for for patients with psoriasis?

A

Use the eczema grade products

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21
Q

How do emoillents work?

A

They create a barrier on the skin’s surface and coat it with oils, allowing the skin to rehydrate
Reduced dryness and irritation

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22
Q

What are Keratolytics?

A

They are agents that help by softening scales
They are very mild agents
They won’t take care of plaque

ex) Salicylic acid (OTC)

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23
Q

What is the function of a combo product with SA and a steroid? Are they OTC or Rx? Examples?

A

The SA increases the penetration of the steroid
These products are Rx.

Diprosalic, Nerisalic

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24
Q

What is tar shampoo good for? What are some of the side effects?

A

Mild cases of psoriasis on the scalp can be treated with OTC shampoos
They have anti-proliferative/ antimitotic properties
S/e: irritating, smell, folliculitis

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25
What is the difference between coal tar and LCD (liquor carbonis detergens)?
Coal tar is the OG, leave on scalp for several minutes and use 2X per week; 1% LCS is a dilutant of coal tar; 10%
26
What are the number one treatments for psoriasis?
Topical steroids and Vit D derivatives?
27
Topical steroids: Efficacy benefit of 2 rx agents combo with other agents effect of dry skin lotions
Mainstay of therapy only use it if the pt can afford it Combined with dry skin lotions Dry skin lotions decrease steroid use (steroid-sparring) and central to routine care - separate by 1 hour!
28
True or false: mild potency topical steroids work for psoriasis
False, we need mid-potency to treat (unless for sensitive areas like the face or skin folds)
29
What happens when we stop tx suddenly when using a topical steroid?
Pt might get a rebound flare up there's no evidence of tapering off, but should do it, lower or skip every second day
30
What is the agent used to treat psoriasis on the face?
HC 1%
31
True or false: Medium and high-strength corticosteroids can be used long-term (for several months) on the face
False, avoid using for several months on the face
32
What are the side effects of topical steroids?
Skin atrophy, Striae, and Telangiectasia (spider veins) Rebound flare-ups on d/c (for the potent and strong agents)
33
What are the guidelines for topical steroids?
No continuous use over 3 weeks Apply thinly, don't go crazy
34
When does skin atrophy occur from steroid use?
When topical steroids are continuously applied to the skin even after the skin has returned to normal or normal thickness
35
What additional risks are associated with using high potency agents?
Increased risk of cutaneous and systemic side effects
36
How much skin does 1 FTU cover?
One palm on both sides
37
How many FTU's do you need to cover the entire chest + abdomen?
7 FTU's
38
What can be said about patients with moderate/severe psoriasis?
They are candidates from phototherapy or systemic therapy because the application of topical agents to large areas are not practical for most ppl
39
What is the formulation preference for acute and chronic stage eczema? What about psoriasis?
Acute eczema - Lotion is better Chronic eczema - ointments are better Acute psoriasis - Lighter steroid (may seem like need stronger agent due to the silver and raised skin, but the skin barrier is weakened Chronic psoriasis - stronger steroid as the skin is intact and need better penetration
40
What is calcipotriol/ene?
It is a vitamin D analogue that is very popular for psoriasis tx Drug of choice Decreases skin turnover rate effective for mild-moderate cases not recommended for the face
41
What are the max use guidelines for calcipotriol/ene?
100g crm 60ml scalp lotion max weekly adult guidelines
42
What are some examples of calipotriol/ene?
Dovonex - pure vit D Dovobet - contains betamethasone (steroid) Xamiol scalp gel (off the market)
43
How many grams of topical medication is one FTU? Two FTUs?
1 FTU = 0.5 grams 2 FTUs = 1 gram
44
What is special about xamiol scalp gel?
The manufacturer claimed that the combo drug is less irritating with minimal s/eat 52 weeks It is the same as dovobet, but just off the market now
45
What is said about using a vitamin D analogue such as dovonex and a vitamin supplement?
Some ppl say that you can't use them together ex) cholecalciferol and vitamin D - the drug interaction is that they may cause the blood calcium to increase; patient may feel dizzy, weakness, lethargy, muscle pain, headache, nausea, vomitting and seizures
46
How will a doctor choose to treat scalp psoriasis?
A potent or very potent steroid is better than a D analogue alone A d analogue combo is a bit better than using a steroid alone - The combo features very low to placebo-like side effects
47
What is special about clobetasol proprionate?
It is very expensive at 225$
48
How can dovobet be formulated?
As a gel or as a gel contained in an applicator device The device likely to compete with the generic version of this formulation
49
What can we say about a patient using a vit d analogue with a steroid for a few months? Is this a concern?
This is a slight red flag, but really not because the manufacturer states that the product is safe for 1 year However, the patient should d/c after the skin returns to normal (don't use it permanently)
50
What are the tips for scalp medications?
Try not to scratch the scalp Relieve the itch by treating the psoriasis Shampoo gently Remove scale with care Derms recommend using a scale softener Try not to stress out
51
How do retinoids work against psoriasis?
They utilize the retinoid receptor and decrease cell proliferation
52
What type of psoriasis is tazorac (tazarotene) used for? What are some tips with using it?
mild to moderate cases indicated for the face (because it is an ance med) Concurrent use with a steroid is recommended - to decrease irritation There is a pregnancy concern
53
What is an example of a good tazarotene product?
Combo one ex) Duobrii (halobetasol propionate + tazarotene)
54
What is the expectations for improvement for Calciotriol/betamethasone dipropionate combo, Vit D analogue monotherapy, and retinoid therapy?
Calciotriol combo: 1 week Vit D analogue (mono): 2 weeks Retinoid therapy: 1-4 weeks
55
What is anthralin?
It is a common medication for psoriasis in europe Anti-mitotic Not common in Canada Quite ancient
56
Explain phototherapy for psoriasis
historically, sent pt to mineral spas Now, Narrow band UVB and PUVA rapidly decreases cell proliferation (UVB and UVA at certain spectrums)
57
Explain narrow band UVB treatment
At a specific spectrum Expose to UVB 2-3 times a week More common over UVA due to less side effects Can be done at home
58
Explain PUVA treatment
PUVA is UVA and psoralen Pt needs to go to a clinic for treatment Requires photoactive agent oral or topical psoralen (accelerator) Tx is v itchy and eyes can be sensitive, avoid sunlight the day after
59
Is psoralen OTC or Rx in Canada?
Rx
60
What are biologic agents?
They are anti-inflammatories for severe cases of psoriasis Mostly injections and they are expensive Serious side effects such as infections or cancers (attenuate on part of the skin, a cancer part gets activated), but safety record is growing
61
What are two examples of biologic agents?
TNF-a and IL-23 antagonists secukinumab (injectable), apremilast (pill)
62
What is psoriatic arthritis?
Psoriasis and arthritis in patients Affects 20% of psoriasis patients Fingernails are often involved
63
How do you treat psoriatic arthritis?
Methotrexate (anti-mitotic) Cyclosporine (Anti-rejection med for transplants) TNF-a blockers
64
What do all of the psoriatic arthritis treatments have in common?
They are all serious agents with bad side effects Biologics: prescribed with moderate treatment not effective can prevent further joint damage target the parts of immune sys linked to PsA improves pain in 3 mo and mood quickly

Pharm 154* (18 decks)

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