Psoriasis Flashcards
Diagnosis and management
Subtypes of psoriasis, name 3
Plaque psoriasis
Pustular psoriasis
Nail psoriasis
Subtypes of plaque psoriasis
Inverse psoriasis
Guttate psoriasis
Erythrodermic psoriasis
Nail psoriasis, clinical findings. Name 6.
- Often many nails affected.
- Nail pitting
- Onycholysis
- “Oil drop sign”.
- Subungual hyperkeratosis
- Splinter hemorrhages
Clues to onychomycosis, name 5.
- Isolated to 1 or 2 nails
- Uncommon on hands
- Nail plate thickening
- Yellow discoloration
- Signs of tinea pedis
Differential diagnosis of psoriasis, name 5
- Nummular dermatitis
- Lichen simplex chronicus
- Subacute cutaneous lupus
- Lichen planus
- Mycosis fungoides
Psoriasis, associated conditions. Name 4
- Psoriatic arthritis
- Cardiovascular disease
- Depression
- Smoking
Prevalence of psoriatic arthritis
Up to 30%
Screening tool for psoriatic arthritis
PEST
Classes of topical agents to treat psoriasis, name 5
- Topical steroids
- Calcineurin inhibitors
- PDE 4 inhibitors
- Vitamin D analogues
- Combination product
Name 4 topical steroids commonly used
- BMV 0.1% ungt
- Clobetasol propionate 0.05%n ungt
- Clobetasol propionate 0.05% solution
- Fluocinolone acetonide 0.01% oil (Derma-Smoothe)
Name 1 calcineurin inhibitor used in psoriasis
Tacrolimus 0.1% ungt (Protopic)
Name 1 PDE 4 inhibitor used in psoriasis
Roflumilast 0.3% cream (Zoryve)
Name 2 vitamin D analogs used in psoriasis
- Calcipotriol 50 mcg/g ungt (Dovonex)
- Calcitriol 3 mcg/g ungt (Silkis)
Name 4 combination products used in psoriasis
- Calcipotriol/BMD 0.05% gel (Dovobet)
- Calcipotriol/BMD 0.05% ungt (Dovobet)
- Calcipotriol/BMD 0.05% foam (Enstilar)
- Halobetasol propionate 0.01/tazarotene 0.045% lotion (Duobrii)
Phototherapy for psoriasis: What frequency of light is used?
Narrowband UVB (administered in office or at home)
Phototherapy for psoriasis: What is the frequency of application
2-3 times weekly for 3 months minimum
Systemic agents used for treatment of psoriasis. Name 5 classes
- Methotrexate
- Cyclosporine
- Apremilast
- Acitretin
- Biologics and small molecules
Criteria for biological agents: Pharmacare criteria. Name 4.
Psoriasis area and severity index (PAS I) greater than 12
BSA greater than 10%
Failed or no access to phototherapy
Tried and failed 3 months of:
Methotrexate 20 mg/week (15 mg/week if greater than 65 years old)
Cyclosporine 4 mg/kg/day
Or contraindications to above agents
Baseline labs for systemic agents, name 7
CBC and differential
Creatinine
Liver enzymes
Potassium and magnesium
Lipid profile
Hepatitis B and C
HIV serology
Pregnancy test if appropriate
Administration of methotrexate for psoriasis: Dosage
20 mg orally weekly (15 mg if >65 years old)
Switch to subcutaneous if GI upset
Administration of methotrexate for psoriasis: What medication should be administered concurrently?
Folic acid 5 mg daily
Administration of methotrexate for psoriasis: Lab monitoring. Which labs?
CBC and differential
Creatinine
Liver enzymes
Administration of methotrexate for psoriasis: Lab monitoring frequency.
Every 2 weeks twice,
Monthly 3 times,
And every 3 months.
Administration of methotrexate for psoriasis: Onset of action.
Slow, approximately 2 to 3 months.
