Card Set Information
Psoriasis PHPR524 Test5
What is the epidemiology of psoriasis?
1-3% of the population
Less common in blacks
Even distribution between genders
What is the clinical presentation of plaque psoriasis?
MOST Common type
Erythematous (red) plaques with "silvery" scale.
Most patients have chronic localized disease, but there can be systemic manifestations
Affects the extensor (outside) more than the flexor (pits)surfaces
Usually not on face, palms, soles of feet
What is the etiology of psoriasis?
: 40% have PSORS1 locus in the MHC I region
What is the pathophysiology of psoriasis?
An unknown antigen may inappropriately trigger the APC cells and falsely initiates T-cell activation = cytokine and growth factor overproduction = migration of T-cells to the skin resulting in
increased turnover rate of epidermal cells (keratinocytes)
increased numbers of epidermal stem cells
abnormal differentiation of skin cells (thickened skin)
decreased cell turnover time (37h vs 300h)
What are the risk factors/exacerbating factors for psoriasis?
Overuse of alcohol
Trauma to the skin (scratching, sunburn, or surgery)
What are the complications of psoriasis?
Itching may be experienced and can be severe
Impaired mobility and daily functioning
Infection (Skin and soft tissue, sepsis)
What are the non-pharmacological options for treating psoriasis?
Avoid excessive alcohol consumption
Soaking baths to remove scale, followed by emollient use
Psychological stress reduction
Sun exposure (avoid sunburn)
Phototherapy (UVB and PUVA)
How is UV light used for treatment of psoriasis?
safest treatment for extensive psoriasis in pregnancy
can be combined with Calcipotriene, Tazarotene, Coal tar, or Anthralin
UVA plus Psoralen
UVA penetrates deeper and doesn't burn as readily as UVB
using PUVA plus retinoids (Tazarotene, Acitretin) to reduce dose of PUVA
What are the SE of PUVA?
Photosensitivity (use eye protection with PO Psoralen until eliminated from body)
What are the topical agents used for psoriasis?
Calcineurin inhibitors (Tacrolimus, Pimecrolimus)
Vitamin D analog (Calcipotriene)
What are the systemic agents used for psoriasis?
Retinoid (Acitretin - DON'T use this)
Sulfasalazine (Psoriatic arthritis only)
What are the immunomodulatory agents used for psoriasis?
Ustekinumab (IL-12, IL-23)
What are the SE of salicylic acid in psoriasis?
Burning and stinging of applied areas
Large area application
What is the advantage of topical calcineurin inhibitors (Tacrolimus, Pimecrolimus)?
Desirable for use on face and intertriginous areas (thin-skinned)
What are the SE of Vitamin D analog (Calcipotriene)?
Burning and stinging
Worsening of psoriasis sx (rare)
What are the SE of topical Retinoid (Tazarotene)?
Teratogenic (Do not apply to more than 20% of body surface area)
Burning and stinging
Worsening of psoriasis
What are the SE of Coal tar and Anthralin?
Staining of skin
What is the MOA of Salicylic Acid in psoriasis?
Remove scale, smooth the skin, and decrease hyperkeratosis
What is the MOA of vitamin D analog (Calcipotriene) in psoriasis?
Inhibits growth and differentiation of keratinocytes by binding the vitamin D receptors in the epidermis
What is the MOA of topical retinoid (Tazarotene) in psoriasis?
Interacts with the retinoic acid receptor to control symptoms
What are the SE of systemic retinoid (Actretin)?
Teratogenic (3yrs after DC!)
Hypervitaminosis A (dry lips, mouth, nose, eye, skin; pruritis, scaling, and alopecia)
Hyperlipidemia (esp triglycerides)
Increased intracranial BP when used with TCN
What is the MOA of systemic retinoid (Acitretin) in psoriasis?
Unknown, but works by interacting with the retinoic acid receptor
What are the special considerations for systemic retinoid (Acetretin)?
Do not donate blood for 3yrs after DC
Use at lease 2 forms of birth control
Which biological agent has the quickest onset of action in psoriasis?
Which biological agent has the best SE profile?
Which biological agent has the most convenient dosing schedule for psoriasis?
Which biological agent has the slowest onset of action in psoriasis?
Which biological agent has a restricted distribution (only found in physician offices and specialty pharmacies)?
Which biological agent is contraindicated in HIV patients?