psoriasis Flashcards
(18 cards)
what is psoriasis vulgaris
chronic plaque
what age is it most common
15-25 then 55-60
definition of psoriasis
chronic inflammatory disorder of skin and joints. relapsing and remitting.
pathophysiology
inflammatory cells in all layers of psoriatic skin, leading to epidermal hyper proliferation
risk factors
stress, genetics, obesity, smoking, alcohol, medications, skin injury, infection
symptoms
red plaques with overlying white scale, thick, may bleed if scales are scraped off
commonly affected areas
buttocks, lower back, scalp, elbows, knees and nails
complications
psoriatic arthritis, depression and anxiety, metabolic syndrome, CVD
treatment regimen
4 week blocks with regular reviews
MILD treatment
- emollients
- topical corticosteroid +/- topical vit D analogue e.g. calcitriol
- calcineurin inhibitor - tacrolimus
- coal tar / dithranol
MODERATE treatment
topical therapy +
1st line = oral methotrexate / ciclosporin
- oral ACITRETIN (synthetic) –> moa decreases hyper keratinisation, risks ; hyperlipidaemia, hepatotoxic, teratogenic (longer t1/2)
-PHOTOTHERAPY - narrowband UVB 2-3/7, psoralen + UVA 3/7. disrupts DNA synthesis slowing basal cell to normal growth.
risks = teratogenic, premature skin ageing and pigmentation.
SEVERE treatment
add a biological agent
e.g. INFLIXIMAB - anti TNF
risks : cancer and CVD, infection and neurological risk
what kind of treatment is used on the face, flexures and genitals
MILD-MOD steroid start term treatment
long term treatment may be needed with calcineurin inhibitor
application of emollients
apply daily in the direction hair growth before other topical applications to improve absorption
side effect of vit d analogues
skin irritation + photosensitivity
what symptoms should be reported immediately
joint symptoms
methotrexate moa risks and interactions
folic acid antagonist inhibits dihydrofolate reductase blocks dna synthesis slows basal cell proliferation risks: teratogenic, hair loss, gi symptoms, liver cirrhosis interactions; nsaids trimethoprim
ciclosporin moa and risks and interactions
blocks calcineurin dependent factor
risks: teratogenic, nephrotoxic, hypertension
interactions: grapefruit
