Psoriasis Flashcards by A Student

What is the recommended initial treatment for significant scalp psoriasis?

A) Daily use of a vitamin D analogue

B) Monthly use of an ultra-high-potency topical corticosteroid

C) Daily use of a moderate- to ultra-high-potency topical corticosteroid

D) Oral corticosteroid therapy

C) Daily use of a moderate- to ultra-high-potency topical corticosteroid

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What is the primary mechanism underlying psoriasis?
A) Overproduction of melanin
B) Dysfunction of sebaceous glands

C) Autoimmune process affecting T-cells and TNF dysfunction

D) Excessive keratin production

C) Autoimmune process affecting T-cells and TNF dysfunction

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Which of the following environmental factors has been linked to the development of guttate psoriasis?
A) Excessive sun exposure
B) Trauma to the skin
C) Streptococcal infections
D) Exposure to cold weather

C) Streptococcal infections

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Which type of psoriasis is the MOST common?

Plaque Psoriasis

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Which of the following medications may trigger or worsen psoriasis in susceptible individuals?
A) Antibiotics
B) Antihistamines
C) Lithium
D) Oral contraceptives

c) Lithium

Certain medications, such as lithium, beta-blockers, and antimalarial drugs, have also been implicated in triggering or worsening psoriasis in susceptible individuals.

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T/F: Psoriasis is primarily caused by an overproduction of melanin in the skin

FALSE!

Psoriasis is primarily an autoimmune disorder involving the DYSFUNCTION of the Immune System and inflammation in the skin, rather than an overproduction of melanin.

The primary mechanism of psoriasis involves the autoimmune process affecting T-cells and TNF dysfunction.

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T/F: Trauma to the skin, such as cuts or burns, can trigger the development of psoriasis plaques at the site of injury.

True!

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T/F: Excessive sun exposure is a known trigger for psoriasis flare-ups.

True!!

** While moderate sun exposure may benefit some individuals with psoriasis,
excessive sun exposure can trigger or worsen psoriasis flare-ups in others.

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If the response to corticosteroids is Inadequate to treat psoriasis, what should be considered as an additional treatment option?

A) Oral antibiotics
B) Oral antihistamines
C) Addition of a vitamin D analogue
D) Phototherapy

C) Addition of a vitamin D analogue

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Which of the following does NOT contain a Vitamin D Analogue that can be used to treat psoriasis?

a) Dovonex (calcipotriol)

b) Diprosalic (betamethasone dipropionate/salicylic acid)

c) Silkis (calitriol)

d) Dovobet Gel, Dovobet Ointment, Enstilar Foam (calcipotriol/betamethasone dipropionate)

b) Diprosalic (betamethasone dipropionate/salicylic acid)

^^ This is classified as a Corticosterioid/Keratolytic Combo agent. It can be used to treat psoriasis in some cases BUT does not possess a Vit D analogue.

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Recommended initial treatment for significant scalp psoriasis involves daily use of a ______ [grade] topical corticosteroid for 4-8 weeks.

Examples could include: betamethasone valerate lotion, clobetasol propionate lotion/shampoo, mometasone furoate lotion, etc.,

… Moderate- to ultra-high-potency [topical corticosteroid]

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T/F: Monotherapy with topical corticosteroids is a less expensive approach initially for treating scalp psoriasis

True!

Since safety profiles between corticosteroids and vitamin D analogues are said to be similar and the fact that combination products provided only a marginal benefit over corticosteroids alone, monotherapy with topical corticosteroids is a reasonable, less expensive approach initially

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Which of the following represents a Keratolytic Agent [drug class] drug that can be used to treat psoriasis?

a) Coal tar

b) Salicylic acid 3-10%

c) Diprosalic (betamethasone dipropionate/salicylic acid)

d) Dovobet or Enstilar Foam (calcipotriol/betamethasone dipropionate)

b) Salicylic acid 3-10%

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What is the purpose of scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid in significant scalp psoriasis cases?
A) To increase hair growth
B) To reduce inflammation
C) To improve penetration of topical corticosteroids and/or vitamin D analogues
D) To prevent infection

C) To improve penetration of topical corticosteroids and/or vitamin D analogues

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Which combination product is available for scalp psoriasis and contains both corticosteroid and salicylic acid?
A) Shampoo
B) Lotion
C) Foam
D) Gel
E) All of the above

a) Shampoo

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T/F: Scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid is recommended to prevent infection in scalp psoriasis cases.

FALSE!
Scale removal through the use of keratolytic shampoos/solutions containing coal tar and/or salicylic acid is NOT recommended to prevent infection in scalp psoriasis cases.

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T/F: Vehicles such as lotion, solution, gel, or foam are easier to apply to hair-bearing scalp and may increase patient acceptance and adherence in scalp psoriasis treatment.

True!
Vehicles such as lotion, solution, gel, or foam are indeed easier to apply to hair-bearing scalp and may increase patient acceptance and adherence in scalp psoriasis treatment.

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T/F: Psoriasis is relatively uncommon on the face in comparison to other affected sites (elbows, knees, scalp, sacral area).

True! While it may be seen on the upper forehead as an extension of scalp psoriasis, if there are suspicions of psoriasis on the face, should consider other diagnostic considerations.

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HC 1% Cream or Ointment BID might be adequate to treat for some cases of psoriasis that is located on the face region… If this doesn’t work, what can we add to treatment regiment?

Vitamin D Analogue

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Which type of psoriasis is rare and often associated with bacterial infections?

Guttate Psoriasis

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Which type of psoriasis may require the use of ultra-high-potency topical corticosteroids due to the increased thickness of the skin?
A) Plaque psoriasis
B) Guttate psoriasis
C) Nail psoriasis
D) Palmoplantar psoriasis

D) Palmoplantar psoriasis

^^^ affects the skin of the palms and soles of the feet.

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Which type of vehicle is considered the most effective for topical treatments in palmoplantar psoriasis due to its ability to increase penetration through thickened, scaly skin?

A) Creams
B) Gels
C) Ointments
D) Lotions
E) None of the above

c) Ointments

Ointments are the most effective vehicle at this site as they increase penetration of the drug through the thickened, scaly skin. However, creams are cosmetically more acceptable and may be preferred, especially for morning application.

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What is the purpose of using cotton gloves or socks after application of moisturizers and/or medicated topical products to the hands or feet?

A) To prevent sweating
B) To enhance penetration and protect irritated skin
C) To keep the skin cool
D) To increase moisture retention
E) To enhance likelihood of adherence of ointment applications

B) To enhance penetration and protect irritated skin

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Dermatologist-guided phototherapy, including psoralens with _____ or ______, may be combined with topical agents such as coal tar, anthralin, vitamin D analogues, topical corticosteroids, or tazarotene.

UVA (or PUVA), or UVB

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T/F: Thicker, more occlusive agents such as ointments and creams are less effective in hydrating the skin compared to lotions

False! Thicker, more occlusive agents such as ointments and creams are MORE effective in hydrating the skin compared to lotions.

T/F: Maintenance application of a topical agent 2–3 times per week is recommended for individuals with recurrent psoriasis.

True! Once control has been achieved after the initial therapy, maintenance application of a topical agent 2–3 times per week may be helpful in individuals with recurrent psoriasis.

What is the purpose of dermatologist-guided phototherapy (PUVA/UVA and/or UVB) in psoriasis treatment? A) To reduce hair growth B) To provide pain relief C) To induce skin pigmentation D) To treat more severe cases

D) To treat more severe cases

Once control has been achieved in initial therapy, which topical agent may be useful in maintenance therapy for individuals with recurrent psoriasis? A) Antibacterial agents B) Antifungal agents C) Topical corticosteroids D) Vitamin D analogues E) Topical corticosteroids combo with Vit D analogues

C) Topical corticosteroids

Systemic therapy is considered for more advanced palmoplantar psoriasis and may include options such as acitretin, apremilast, biologic agents, cyclosporine, deucravacitinib, and ______

Methotrexate (MTX)

T/F: Dermatologist-guided phototherapy is primarily used to induce skin pigmentation in individuals with psoriasis

False! Phototherapy is used **to treat more severe cases** of psoriasis, (**not** to induce skin pigmentation).

Which area is commonly affected by classic plaque psoriasis? A) Abdomen B) Palms of the hands C) Extensor elbows and forearms D) Soles of the feet

C) Extensor elbows and forearms

Which condition presents with multiple macules (i.e., area of skin discolouration) that merges together into patches on the upper torso, with a fine scale apparent when scratched? A) Pityriasis (tinea) versicolor B) Pityriasis rosea C) Atopic dermatitis D) Tinea corporis

A) Pityriasis (tinea) versicolor * Colour may be reddish-brown, pink or more pale than the background skin tone.

What postinflammatory changes may persist for months after psoriatic plaques have been successfully treated, particularly in darkly pigmented skin?

**Post-Inflammatory Hyperpigmentation** ** Postinflammatory hyperpigmentation may persist for months after psoriatic plaques have been successfully treated, particularly in darkly pigmented skin.

_______ presents with a "herald" patch followed by an eruption of oval pink (in lightly pigmented skin) or grey/brown/black (in darkly pigmented skin) plaques with a fine collarette of central scale a) Pityriasis (tinea) vesicolor b) Pityriasis rosea c) Hives d) Tinea corporis

b) **Pityriasis Rosea** Pityriasis rosea is a rash that often begins as an oval spot on the face, chest, abdomen or back. This is called a herald patch and may be up to 4 inches (10 centimeters) across. Then you may get smaller spots that sweep out from the middle of the body in a shape that looks like drooping pine-tree branches. The rash can be itchy.

T/F: Classic plaque psoriasis commonly presents with well-demarcated, inflamed plaques with overlying scale on the palms of the hands.

False! Classic plaque psoriasis commonly presents with well-demarcated, inflamed plaques with overlying scale on the extensor elbows and forearms, not on the palms of the hands. - Psoriasis on the palms of the hand = Palmoplantar psoriasis

T/F: Atopic dermatitis is characterized by very itchy, lichenified, and excoriated skin lesions

True!

Which phototherapy modality is associated with an increased risk of skin malignancies? A) Narrow-band UVB (NBUVB) B) UVA therapy C) PUVA D) Topical corticosteroids

C) PUVA The "P" in PUVA refers to psoralens, a photosensitizing agent. Photosensitizing agents like these are associated with an increased risk of skin malignancies.

Phototherapy may be combined with which other types of therapies? A) Surgical procedures B) Oral antibiotics C) Topical or systemic therapies D) Physical therapy exercises

C) Topical or systemic therapies Phototherapy may be combined with topical or systemic therapies to enhance treatment effectiveness.

Why is NBUVB used more often than PUVA in phototherapy? A) Due to a higher efficacy in treating psoriasis B) Due to convenience and a more favourable safety profile C) Due to lower cost D) Due to a shorter treatment duration

B) Due to convenience and a more favourable safety profile NBUVB (Narrowband UVB) is used more often than PUVA in phototherapy due to its convenience (no need for a photosensitizing agent) and a more favourable safety profile.

In skin folds (e.g., armpits, under breasts, groin), the diagnosis of psoriasis can be more challenging, as psoriasis often lacks the characteristic ______. However, specific clinical findings can be helpful in differentiating psoriasis from other possible intertriginous skin diseases

Silvery scale

Potassium hydroxide (KOH) stain is a diagnostic test for what kind of skin diseases? a) Psoriasis b) Atopic dermatitis (eczema) c) Fungal infections d) Bacteria infections e) Viral infections

c) Fungal infections If KOH tests come back positive, it could be indication of things like tinea or candidiasis, for example. Whereas things like psoriasis and eczema will come back with negative-KOH.

List 3 Nonpharmacologic considerations that can be helpful to reduce irritation and maceration and prevent worsening of psoriasis due to skin trauma.

- Reduce friction and reduce any obstruction of the affected areas or skin folds. - Wear loose-fitting clothes - Use moisture-wicking fabrics

HC 1% Cream is often the standard choice of initial treatment of psoriasis in the skin folds areas. What is the frequency in usage/dosing per day for HC 1% in this case?

AAA BID

It is possible for secondary candidiasis to occur in complicated cases of psoriasis affecting the skin folds. In such cases, what are two common anti-fungal agents that can be used in combination of HC 1% cream (if the site is has sofened lesions or has a foul odour)?

Clotrimazole or ketoconazole

Which of the following topical drug classes have a favourable safety profile for long-term use intertriginous psoriasis? a) Phosphodiesterase-4 Inhibitors b) Systemic non-biologic therapies c) Corticosteroids d) Vitamin D analogues e) Biologic therapies

d) Vitamin D analogues

T/F: Psoriasis often improves during pregnancy.

True! Some studies have observed that a significant number of pregnant women reported improved or no changes in their psoriasis during their pregnancy. HOWEVER, Pregnant patients with psoriasis may be at increased risk of adverse pregnancy outcomes due to comorbidities associated with psoriasis such as diabetes and obesity.

_______ _________ therapy options for psoriasis include methotrexate, acitretin, apremilast, cyclosporine and deucravacitinib

Systemic, Non-Biologic

When a patient is on methotrexate, which demographics have contraindications?

- Pregnant women (should stop 3 months before conceiving, if possible) - Individuals at-risk of: liver disease, Hep B, Hep C, Tb - CKD

According to the RX Schematic of Psoriasis Treatment Ladder [Slide 21 of Psoriasis section of Winter semester], which Treatment kind has "lesser" effectiveness? a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar) b) Systemic (biologics, ciclosporins, MTX, retinoids) c) Phototherapy (PUVA and UVB) d) Antifungals (Clotrimazole, ketoconazole) e) None of the above have "lesser" effectiveness, they are all relatively similar to each other.

a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar)

According to the RX Schematic of Psoriasis Treatment Ladder [Slide 21 of Psoriasis section of Winter semester], which Treatment kind has "greater" effectiveness? a) Topicals (corticosteroids, calcipotriol, anthralin, coal tar) b) Systemic (biologics, ciclosporins, MTX, retinoids) c) Phototherapy (PUVA and UVB) d) Antifungals (Clotrimazole, ketoconazole) e) None of the above have "lesser" effectiveness, they are all relatively similar to each other.

b) Systemic (biologics, ciclosporins, MTX, retinoids)

Emollients/Moisturizing products to treat psoriasis includes _______ - They are to be used PRN between flares - Often a "trial and error" period until the person finds the "best" moisturizing product that works for them. - Should be CENTRAL to their routine skin care - Will also be using other agents

[...] Standard dry skin products.

Which type of therapy should be used as needed between flares and is considered an essential part of routine skin care for individuals with psoriasis? A) Keratolytics B) Tar products C) Emollients/Moisturizing therapy D) Topical steroids E) Both c and d

C) Emollients/Moisturizing therapy Emollients/Moisturizing therapy should be used as needed between flares and should be a standard part of routine skin care for individuals with psoriasis. Use of dry skin products can also help reduce the use of steroids, for instance.

What is the primary benefit of using combination prescription products like Diprosalic, which contain both corticosteroid + salicylic acid? A) Enhanced anti-inflammatory effect B) Enhanced penetration of salicylic acid C) Enhanced penetration of corticosteroid D) Enhanced moisturization E) All of the above

C) Enhanced penetration of corticosteroid Using combination prescription product Diprosalic (corticosteroid + SA) will be beneficial as using SA with the steroid helps enhance the steroid penetration but note that the steroid is the main benefit for the treatment.

Psoriasin, an over-the-counter product (OTC) containing only coal tar as a medicinal ingredient, is unlikely to provide significant therapeutic benefits because: A) It lacks the anti-inflammatory properties of corticosteroids B) Coal tar is not effective in treating psoriasis C) It is not applied frequently enough D) Coal tar alone is considered a very mild agent with little therapy benefits for psoriasis

D) Coal tar alone is considered a very mild agent with little therapy benefits for psoriasis

Using single entity OTC agents that only have SA or Coal Tar as a medicinal ingredient is unlikely to provide significant therapeutic benefits because: A) It lacks the anti-inflammatory properties of corticosteroids B) Neither are not effective in treating psoriasis C) It is not applied frequently enough D) Using each alone is considered a very mild agent with little therapy benefits for psoriasis

D) Using each alone is considered a very mild agent with little therapy benefits for psoriasis

T/F: Emollients/Moisturizing therapy should only be used during psoriasis flares to provide relief from symptoms

FALSE! Emollients/Moisturizing therapy should be used as needed BETWEEN flares and should be a standard part of routine skin care for individuals with psoriasis.

T/F: The primary benefit of using keratolytics like salicylic acid in psoriasis treatment is their anti-inflammatory effect.

FALSE! The primary benefit of using Keratolytics like salicylic acid is to enhance the penetration of other active ingredients, such as corticosteroids.

T/F: Psoriasin, an OTC product containing only salicylic acid, is likely to provide significant therapeutic benefits for psoriasis.

FALSE. - It contains coal tar - Has little to no effect in treating psoriasis.

Keratolytics such as salicylic acid __-___% is considered to be small, low-level therapy with very little benefit on its own...

3-10%

Diprosalic (betamethasone dipropionate/salicylic acid) is a combination topical agent to treat certain kinds of psoriasis. What drug class is this agent?

Corticosteroid/Keratolytic Combination

Keratolytics (as monotherapy or on its own) is considered to be very ____ agent with ____ therapy benefits when used on its own.

mild; little

What are the primary properties of tar products like Coal Tar in psoriasis treatment? A) Anti-inflammatory B) Antimicrobial C) Anti-proliferative D) Antihistaminic E) Anti-fungal

C) Anti-proliferative inhibit cell-cycle pathways to limit T cell proliferation

How often should tar shampoos be used for satisfactory scale removal and control of mild scalp psoriasis (at least)? A) Once per week - leaving it in for 7-10 minutes B) Twice per month - leaving it in for 10+ minutes C) Twice per week - leaving it in for 5+ minutes D) Daily - penetrate for at least 2 minutes

C) Twice per week - leaving it in for 5+ minutes

What is the approximate concentration of Coal Tar in tar shampoo products used for psoriasis? A) 5% B) 10% C) 1% D) 2%

C) 1% (approx)

Liquid Carbonis Detergens (LCD) 5% is an alcoholic extract of coal tar and equates to __________ of crude coal tar in potency.

1% of crude coal tar in potency

T/F: People can use their own regular shampoos following or after an adequate amount of contact with Tar shampoo if they wish to, as long as the tar shampoo has been in contact with the scalp for at least 5 minutes

True!

T/F: Regimens containing coal tar products have high patient adherence due to their pleasant odor and lack of staining

False! Regimens containing coal tar products may have poor patient adherence due to their pungent odour, staining, and the need for chronic treatment.

T/F: Worsening cases of scalp psoriasis are likely to see benefits from over-the-counter tar shampoos and do not require referral to a healthcare professional.

FALSE! Worsening cases of scalp psoriasis are not likely to see benefits from over-the-counter tar shampoos and should be referred to a healthcare professional for further treatment.

Salicylic Acid is an example of a ______ agent.

Keratolytic

Clobetasol propionate, Halobetasol propionate, and Betamethasone dipropionate glycol are all creams classified as which potency grade of topical steroid scale and should only be used on thicker skin areas and/or reserved for resistant cases?

Grade 1: Ultra-High Potency (highest potency grade)

Topilene Glycol (Betamethasone dipropionate glycol), Topicort (Desoximetasone), Dovobet (Betamethasone diporpionate + Calcipotriol) Mometasone Betaderm (betamethasone valerate) are examples of topical steroids that are classified as which potency levels?

Grade 2-3: High Potency (potencies)

Spectro Eczema Care (Clobetasone butyrate) is classified as a Grade 4 potency scale... What does this mean? a) This product is classified as the highest or ultra potency available steroid b) This product is classified as a high potency steroid c) This is a product that is moderate in potency level d) This is a lower potency agent

c) This is a product that is moderate in potency level

Hydrocortisone (HC) 2.5%, 1%, and 0.5% are all listed as which grade of potency for topical steroids?

Grade 7 -- Lowest potent topical steroid

Which potency level(s) is considered to be the strongest (ultra)? a) Grade 1 b) Grades 2-3 c) Grades 4-5 d) Grades 6-7 e) None of the option

a) Grade 1

Which potency level(s) is considered to be high? a) Grade 1 b) Grades 2-3 c) Grades 4-5 d) Grades 6-7 e) None of the option

b) Grades 2-3

What is the primary reason for poor patient adherence to regimens containing coal tar products? A) Unpleasant odor B) Slow efficacy C) Lack of availability (RX only) D) Low cost

A) Unpleasant odor Due to odour, staining and the need for chronic treatment, regimens containing coal tar products may have poor patient adherence.

In the treatment of worsening cases of scalp psoriasis, what treatment options are likely to be prescribed by healthcare professionals? A) Over-the-counter tar shampoos B) Topical corticosteroids and/or vitamin D analogue gel or foam products C) Oral antibiotics D) Antifungal medications

B) Topical corticosteroids and/or vitamin D analogue gel or foam products Worsening cases of scalp psoriasis is not going to see benefits if trying to use OTC Tar Shampoos and should be referred - where they are likely to be prescribed a steroid or a Vitamin D analogue gel or foam product.

Tar products like Coal Tar have anti-proliferative properties, slowing down the turnover rate on psoriatic skin and aiding in ______

[...] Scale Removal

Tar shampoos should be used for at least __________ for satisfactory scale removal and control of mild scalp psoriasis

2x per week

T/F: Coal tar products are commonly associated with rapid efficacy in the treatment of psoriasis due to their potent anti-inflammatory properties.

False. Coal tar products are NOT commonly associated with rapid efficacy in the treatment of psoriasis.

T/F: People can use their own regular shampoos immediately after applying tar shampoo without waiting for a specific contact time.

False... People should allow tar shampoo to remain in contact with the scalp for at least 5 minutes for satisfactory scale removal and control of mild scalp psoriasis.

Tar products like Coal Tar has anti-________ properties.

[...] Anti-Proliferative

What is the active ingredient in T-Gel?

Coal Tar 1%

What is T-Gel therapeutic shampoo? What properties does this have? Treats what? Side effects?

- Coal Tar 1% - Anti-proliferative properties - Available in Canada as an OTC shampoo to treat mild cases of scalp psoriasis - Side Effects: Odour, Folliculitis and Irritation.

Why are topical steroids favored by many dermatologists and doctors in the treatment of psoriasis? A) They have potent antimicrobial properties B) They inhibit the action of skin cell turnover and suppresses inflammation and immune response in the skin. C) They have little to no side effects D) They are covered by most insurance plans E) Both b and c F) Both b and d

b) They inhibit the action of skin cell turnover and suppresses inflammation and immune response in the skin. - Topical steroids slows down the action of skin cell turnover via the use of the steroids while also trying to taper down the inflammation and immune response from this autoimmune disease... This is why steroids can be a first choice for many mild-to-moderate cases. Option d is not necessarily the best answer as the favourability among MDs in terms of $ would be more about how some insurance plans will NOT cover for Two agents of treatment for psoriasis for example. While many steroids are covered by different plans, each plan is different not to mention how

Which combination product is becoming the drug of choice for psoriasis pharmacological treatment? A) Topical corticosteroids + antifungals B) Topical corticosteroids + vitamin C analogues C) Topical corticosteroids + vitamin D analogues D) Topical corticosteroids + antibiotics

C) Topical corticosteroids + vitamin D analogues Combination products containing both Topical Steroids plus Vitamin D analogues are becoming THE drug of choice for psoriasis pharmacological treatment

For which areas of the skin are mild potency topical steroids recommended? A) Extensor surfaces B) Scalp and skin folds C) Palms of the hands and soles of the feet D) Face and skin folds E) Face and neck

D) Face and skin folds

Why is it important to advise patients with psoriasis not to abruptly discontinue treatment with topical steroids? A) To prevent allergic reactions B) To prevent skin infections C) To avoid rebound flares D) To maintain skin hydration

C) To avoid rebound flares Once improvement has occurred via initial therapy, patients should continue to using therapy for 2-3 times per week for one more week (or otherwise indicated by MD) to lessen chances of rebound flare-ups.

How many fingertip units (FTUs) of topical steroid are typically needed to cover the entire [front of] chest plus the abdomen in psoriasis treatment? A) 3 FTUs B) 5 FTUs C) 7 FTUs D) 10 FTUs ****NEED TO KNOW THIS****

C) 7 FTUs [via adult hand]

What is the equivalent quantity measured in grams (g) of topical corticosteroid when using 2 fingertip units (FTUs)? a) 0.5 g b) 1 g c) 2 g d) 5 g ***NEED TO KNOW THIS***

b) 1 g 2 FTUs = 1 gram of topical steroid

If I were to want to treat an entire hand (e.g., my right hand including my fingers and both sides of my hand), how many FTUs of topical steroid would cover this area being treated? a) 1 FTU b) 2 FTUs c) 2.5 FTUs d) 3.5 FTUs e) 7 FTUs ***NEED TO KNOW THIS***

a) 1 FTU of topical corticosteroid would ideally cover an entire hand on both sides, including each finger in said hand.

How many FTUs is estimated to be required to treat an adult sized back and buttocks using a topical corticosteroid? **NEED TO KNOW THIS** a) 1 FTU b) 2 FTUs c) 2.5 FTUs d) 3.5 FTUs e) 7 FTUs

e) 7 FTUs of topical steroid is likely to be sufficient covering the back and buttocks regions of an adult.

T/F: 1 FTU = 0.5 grams of topical medication/product **Need to know this!**

True!

**Need to know all these FTUs** In order to cover or treat an entire arm and hand of an adult, I would need _____ worth of topical steroid. a) 1 FTU b) 2 FTUs c) 3 FTUs d) 4 FTUs e) 8 FTUs

d) 4 FTUs

_____ FTUs are needed to cover or treat an entire leg and foot with a topical medication.

8 FTUs

** Need to know all these FTUs** 7 FTUs are required if were to treat the front of the chest + abdomen, OR 7 FTUs could also cover the entire back + butt region... --- If 1 FTU is equivalent to 0.5 grams worth of topical medication, how many grams would 7 FTUs be equivalent to in grams?

7 FTUs = 3.5 grams

How many grams of topical medication would be acquired if applying once daily to the front of my chest + abdomen after 7 days of use?

25 grams per week [ (7 FTUs x 0.5 g) x 7 days ]

How many grams of topical medication would be used if applying Zoryve, a non-steroidal topical cream, to my face and neck once daily for 14 days?

17.5 grams [ (2.5 FTUs x 0.5 g) x 14 days] = 17.5 grams in a 14 day span so far

In what occasion would a mild potency of a topical steroid be more preferred in treatment of psoriasis over a moderate potency?

Mild potency agents such as ones from Potency Levels 6-7 would be acceptable to use to treat psoriasis affecting places such as the face or skin folds.

If combo Vitamin D analogues + corticosteroid agents are becoming the drug of choice to treat psoriasis, why is it that pharmacists and health care providers are still highly encouraging or recommending the continued use of Dry Skin Lotions/Emollients/Moisturizers (or Eczema Guide Products just as before?

They should still be used between flare-ups and in an as needed basis since these kinds of products can also see some added therapeutic benefits and can help decrease the use of steroids... Which is another reason why still consider it to be a central component of therapy.

Individuals using ultra (Grade 1) or high (Grades 2-3) potency topical steroid agents should limit use to less than ____ weeks and should be reserved for use in resistant cases or thicker skinned areas due to potential for local & systemic adverse effects

< 3 weeks of use!

Why are mild potency topical steroids recommended for use on the face and neck in psoriasis treatment? A) They have stronger anti-inflammatory properties in these areas B) These areas have thicker skin and require higher potency steroids C) Mild potency steroids are less likely to cause side effects in sensitive areas D) Mild potency steroids penetrate deeper into the skin in these areas E) None of the above - can use moderate potency agents for those areas of the body.

C) Mild potency steroids are less likely to cause side effects in sensitive areas

Which adverse effect is associated with the prolonged use of high or ultra-potency topical steroid agents? A) Hypopigmentation B) Skin thickening C) Increased hair growth D) Skin atrophy

D) Skin atrophy Potential for local & systemic adverse effects such as: Skin Atrophy, Straie, Telangiectasia (Spider Veins) as well as Rebound Flare-Ups upon discontinuation are all possible side effects.

How long should individuals limit the use of high or ultra-potency topical steroid agents to minimize adverse effects? A) Less than 1 week B) Less than 2 weeks C) Less than 3 weeks D) Less than 4 weeks

C) Less than 3 weeks

Which of the following adverse effects of topical steroid use is characterized by the development of small, dilated blood vessels on the skin's surface? A) Skin atrophy B) Striae C) Telangiectasia D) Rebound flares

C) Telangiectasia (AKA: Spider Veins)

List the (4) Potential Local and/or Systemic Adverse Effects that can occur as a result of long-term (or longer than recommended) use of [ultra and high grade] topical corticosteroids:

- Skin Atrophy, - Straie, - Telangiectasia (Spider Veins) as well as - Rebound Flare-Ups upon discontinuation are all possible side effects

T/F: Potency Steroid Products that are Grades 1 and Grades 2 are the ones that should not be used for more than 3 weeks.

True!!!

Calcipotriol & Calcipotriene

Vitamin D Analogues used to treat psoriasis.

What is the primary mechanism of action of vitamin D analogues in the treatment of psoriasis? A) Decreasing inflammation B) Inhibiting skin cell turnover C) Increasing blood flow to the skin D) Reducing proliferation rate E) Strengthening the skin barrier

B) Inhibiting skin cell turnover This is done by modulating keratinocyte proliferation and differentiation.

Which combination product is considered the drug of choice for psoriasis treatment due to its faster onset of action and fewer side effects? **** A) Diprosalic (betamethasone dipropionate/salicylic acid) B) Duobrii (halobetasol propionate/tazarotene) C) Dovobet (calcipotriol/betamethasone dipropionate) D) Zoryve

C) Dovobet (calcipotriol/betamethasone dipropionate) -- is a Vitamin D analogue (calcipotriol)/corticosteroid (betamethisone) combination agent that is currently THE drug of choice due to faster onset of action and fewer side effects. ~ Diprosalic is an example of a corticosteroid/keratolytic combo ~ Duobrii is an example of a corticosteroid/retinol combo ~ Zoryve is a single medicinal agent that has no steroid cream but shows promise but very expensive

What is the maximum recommended weekly use of cream containing calcipotriol for an adult with psoriasis? A) 50 grams B) 75 grams C) 100 grams D) 125 grams

C) 100 grams PER WEEK of calcipotriol maximum!

List the expected timeframe in which onset of action is to occur for the following agents to treat psoriasis: - Calcipotriol & Calcipotriene - Topical Corticosteroids - Topical Retinoids

- Calcipotriol & Calcipotriene -- 1 week - Topical Corticosteroids --- 2 weeks - Topical Retinoids --- 1 to 4 weeks

Why are calcipotriol and calcipotriene not recommended for use on the face? A) They are ineffective in treating facial psoriasis B) They can cause skin thinning and atrophy C) They can lead to excessive hair growth on the face D) They can cause irritation and burning on facial skin

B) They can cause skin thinning and atrophy

Dovonex vs Dovobet? - Contents - Frequency of use per day - Duration of approved use (safety)

Dovonex (calcipotriol): Only contains Vit D analogue... BID... Takes 2 weeks to see any changes but can take up to 8 weeks to see considerable improvements BUT safety profile for longer term use is not known. Dovobet (calcipotriol/betamethasone dipropionate): Vit D analogue + corticosteroid... OD/QD use... Usually can expect to see changes within a week of use. Can take up to 8 weeks to see considerable improvements BUT longer term use is safe.

Which combination agent failed in the pharmaceutical industry primarily due to marketing reasons? A) Dovonex B) Dovobet C) Xamiol D) Enstilar

C) Xamiol

What is the maximum recommended weekly use of scalp lotion containing calcipotriol for an adult with psoriasis? A) 50 mL B) 60 mL C) 70 mL D) 80 mL

B) 60 mL per week

What is the potential consequence of using Dovonex and high-dose vitamin D supplements simultaneously? A) Increased efficacy of Dovonex B) Reduced risk of drug interactions C) Elevated risk of drug interactions D) Decreased absorption of vitamin D supplements

C) Elevated risk of drug interactions KEEP IN MIND that there is a Drug Interaction when using Dovonex and Vitamin D supplements as Dovonex is a Vitamin D Analogue (not a combo FYI -- check if should apply to both dovonex and dovobet or just dovonex****). Some research has shown that it is possible that Vitamin D supplement dosage has an influence on the drug interactions. If a person were using Dovonex for psoriasis and were to take 1000 IU of Vitamin D, drug interaction is very likely; however if the Dovonex user was to use only 400 IU of Vitamin D, drug interactions between the Dovonex and the Vitamin D supplement is Less likely.

According to some research, what dosage of Vitamin D supplement intake would be safer to take and limit the risks of increased drug interactions while using Dovonex (calcipotriol)?

400 IU of Vitamin D supplements

According to some research, what dosage of Vitamin D supplement intake would be likely harmful to take and increase the risks of increased drug interactions while using Dovonex (calcipotriol)?

1000 IU of Vitamin D supplements

When treating psoriasis on the scalp, combination of Vitamin D Analogue/Corticosteroid is considered little bit more effective than using a ________ on its own - regardless of disease severity.

Topical Steroids

What is the primary mechanism of action of topical retinoids like Tazorac (Tazarotene) in the treatment of psoriasis? A) Suppressing the immune response B) Decreasing skin cell proliferation rate C) Increasing skin cell turnover rate D) Reducing inflammation

B) Decreasing skin cell proliferation rate (via utilization of the retinoid receptor)

Which area of the body is NOT recommended for the application of Duobrii, a corticosteroid/retinoid combination agent? A) Scalp B) Arms C) Face D) Lower back

C) Face This is because it contains a topical steroid and therefore not to be used for areas like the face and skin folds.

T/F: Duobrii is the only combination topical agent that contains both a corticosteroid (betamethasone) and a retinol (tazarotene) that is used to treat psoriasis.

False!! Duobrii IS the only available combo agent for psoriasis that contains a corticosteroid (HALOBETASOL) + a retinol (tazarotene).

What is the typical timeframe for significant improvements to be observed with the use of topical retinoids like tazarotene, as monotherapy in psoriasis treatment? A) 1 day B) 1 week C) 4 weeks D) 12 weeks

D) 12 weeks Some changes can be seen somewhere within 1-4 weeks of starting BUT significant improvements are said to be seen within 12 weeks.

Why is the use of topical retinoids like Tazorac not recommended for pregnant women with psoriasis? A) They increase the risk of birth defects B) They may cause skin thinning C) Their safety during pregnancy is not documented D) They have a high risk of systemic absorption

C) Their safety during pregnancy is not documented

Which combination agent contains both halobetasol and tazarotene and is applied once daily? A) Dovobet B) Enstilar C) Xamiol D) Duobrii E) Zoryve

D) Duobrii

What is phototherapy, and why is it strictly supervised by a doctor or dermatologist? A) It involves the use of light therapy to treat psoriasis, and it requires precise dosage and monitoring to avoid adverse effects. B) It involves the use of medications to treat psoriasis, and it requires a doctor's expertise to prescribe the appropriate regimen. C) It involves surgical procedures to treat psoriasis, and it necessitates specialized training to perform safely. D) It involves lifestyle modifications to manage psoriasis, and it necessitates guidance from a healthcare professional.

A) It involves the use of light therapy to treat psoriasis, and it requires precise dosage and monitoring to avoid adverse effects.

What is the primary mechanism of action of both narrow-band UVB and PUVA in the treatment of psoriasis? A) Increasing skin cell turnover rate B) Suppressing the immune response C) Reducing inflammation D) Rapidly reducing cell proliferation rates

D) RAPIDLY reducing cell proliferation rates

What is a key difference between narrow-band UVB and PUVA in terms of safety profile? A) Narrow-band UVB has a higher risk of skin cancer compared to PUVA. B) PUVA is considered safer for long-term use compared to narrow-band UVB. C) Narrow-band UVB is considered safer for long-term use compared to PUVA. D) Both narrow-band UVB and PUVA have similar safety profiles.

C) Narrow-band UVB is considered safer for long-term use compared to PUVA.

Why is it important for the doctor and patient to conduct a risk-benefit analysis before starting phototherapy for psoriasis? A) Phototherapy can lead to skin thinning and increased risk of infection. B) Phototherapy can cause permanent skin discolouration and scarring. C) Phototherapy carries a risk of skin cancer, so the potential benefits must outweigh the risks. D) Phototherapy can trigger severe allergic reactions in some individuals.

C) Phototherapy carries a risk of skin cancer, so the potential benefits must outweigh the risks.

What is a characteristic feature of PUVA treatment that distinguishes it from narrow-band UVB therapy? A) It can be performed at home. B) It requires the use of a photoactive agent (psoralen). C) It is associated with fewer side effects. D) It involves the use of UVB light only.

B) It requires the use of a photoactive agent (psoralen).

Which phototherapy option can technically be done at home but is a lot of money?

Narrow Band UVB

How frequent would an individual be required to complete Narrow Band UVB recommended in order to gain therapeutic benefits of psoriasis?

2-3x per week.

What distinguishes Zoryve from other topical treatments for psoriasis?A) It is the most affordable option available on the market.B) It is the only non-steroidal topical option approved for plaque psoriasis in intertriginous areas.C) It is available in both cream and lotion formulations.D) It is recommended for use only on mild cases of psoriasis.

What distinguishes Zoryve from other topical treatments for psoriasis? A) It is the most affordable option available on the market. B) It is the only non-steroidal topical option approved for plaque psoriasis in intertriginous areas. C) It is available in both cream and lotion formulations. D) It is recommended for use only on mild cases of psoriasis.

B) It is the only non-steroidal topical option approved for plaque psoriasis in intertriginous areas.

How often is Zoryve applied for the treatment of plaque psoriasis? A) Twice daily B) Once daily C) Every other day D) Three times daily

B) Once Daily

Which areas of the body can Zoryve be used to treat plaque psoriasis? A) Scalp only B) Face and skin folds only C) Knees, elbows, trunk, and scalp D) Arms and legs only E) All areas of the body

E) All areas of the body Zoryve is applied once daily and is used to control mild, moderate and severe plaque psoriasis in all areas of the body (including the face and skin folds!)

What are potential side effects of using Zoryve - albeit rare according to CPS, 2024? A) Skin thinning and increased risk of infection B) Dryness and itching C) Burning/stinging at the application site, diarrhea, nausea, and headache D) Allergic reactions and skin discoloration E) Skin atrophy, spider veins, vision loss

C) Burning/stinging at the application site, diarrhea, nausea, and headache

T/F: Zoryve is applied once daily and is used to control mild, moderate and severe plaque psoriasis in all areas of the body (including the face and skin folds!)

TRUE!!!!!!

What is a notable characteristic of Zoryve in terms of cost? A) It is the most cost-effective option for psoriasis treatment. B) It is covered by most insurance plans. C) It is a very expensive drug. D) In SK, it is an EDS drug and only available in brand name right now. E) Only available through Special Request process

C) It is a very expensive drug.

What is the primary purpose of using biologic agents in the treatment of psoriasis? A) To suppress the immune response B) Targets specific cytokines C) Anti-proliferation properties D) Anti-inflammatory E) All of the above

E) All of the above Systemic biologic agents to treat psoriasis: Targets specific cytokines like the TNF-alpha antagonists, IL-17 inhibitors, and IL-23 inhibitors. Modulates immune responses as a result of targeting cytokines, Which decreases inflammation, and also inhibits cell proliferation

What are some potential side effects of using biologic agents for psoriasis? A) Dry skin and itching B) Headache and nausea C) Increased risk of serious infections or cancer D) Allergic reactions and skin discoloration

C) Increased risk of serious infections or cancer When using these kinds of biologics, still worry about serious side effects such as increased risks of serious infections or cancer… BUT safety records are slowly improving.

Which biologic agent is unique in that it is available in oral pill form? A) Cosentyx (secukinumab) B) Otezia (apremilast) C) Humira (adalimumab) D) Enbrel (etanercept) E) None of the above - all are injectables.

B) Otezia (apremilast)

What is a common characteristic of biologic agents used in the treatment of psoriasis? A) They are usually prescribed as first-line therapy. B) They are affordable and widely accessible. C) They are administered topically. D) Most of them are injectables and all often expensive.

D) Most of them are injectables and all often expensive.

Cosentyx (secukinumab) and can be used for what two kinds of psoriasis kinds?

- Plaque psoriasis - Psoriatic arthritis

Psoriatic Arthritis affects approx ____% of psoriasis sufferers.

20%

T/F: Psoriatic arthritis (PsA) commonly affects the fingernails in individuals with psoriasis.

True! PsA can affect the nails often... This is known as psoriatic nail dystrophy, can manifest in various ways and may include pitting of the nails, changes in nail colour, texture, shape, and overall appearance. They often parallel the activity and severity of skin and joint symptoms.

List the 3 specific drugs/agents discussed at the end of the slide deck that can be used to help treat psoriatic arthritis (PsA).

- Methotrexate - Cyclosporin - TNF-alpha antagonists

Psoriatic arthritis is often described as a "double-hit" condition because: A) It primarily affects the skin, leading to joint symptoms as a secondary manifestation. B) It primarily affects the joints, leading to skin symptoms as a secondary manifestation. C) It simultaneously affects the skin and joints, resulting in combined symptoms. D) It affects the internal organs in addition to the skin and joints.

C) It simultaneously affects the skin and joints, resulting in combined symptoms. Psoriatic arthritis is considered as a “double-hit” interns of condition state because not only is the person’s skin affected, but their joints are too. This is not fun.

Which of the following statements best describes a key difference between psoriatic arthritis (PsA) and arthritis? A) Psoriatic arthritis primarily affects the skin, while arthritis primarily affects the joints. B) Psoriatic arthritis is characterized by joint inflammation and skin involvement, whereas arthritis only affects the joints. C) Psoriatic arthritis is caused by bacterial infection, whereas arthritis is primarily an autoimmune condition. D) Psoriatic arthritis is treated with topical medications, while arthritis is managed with systemic medications.

B) Psoriatic arthritis is characterized by joint inflammation and skin involvement, whereas arthritis only affects the joints.