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23 Cards in this Set
- Front
- Back
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Systemic, chronic, genetic disease
Not contagious Characterized by raised, thick, inflamed patches of the skin that are covered by silvery-white scales and are associated with local itching or burning |
psoriasis
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Normal cell matures and sheds in 30 days
Psoriatic skin cell matures in _-_ days Instead of shedding, the cells build up and form plaques |
Normal cell matures and sheds in 30 days
Psoriatic skin cell matures in 3-4 days Instead of shedding, the cells build up and form plaques |
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plaque? definition
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raised palpable lesion >1cm
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What's Guttate psoriasis
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can follow URI. Small circles different from usual.
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What's Psoriasis inversus:
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in the body folds
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Clinical Definition of Psoriasis: Mild
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Psoriasis on <5% of BSA
Does not Impact on patient’s quality life Treatment Moisturizers, OTC products, topical steroids, vitamin D3 and A derivatives Treatments have no known serious risks |
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Clinical Definition of Psoriasis: Moderate to Severe
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Body surface area
Psoriasis 5% of BSA Impact on patient’s life Psoriasis does impact quality of life Expectation is that therapies will improve quality of life Treatment Phototherapy, topicals, and systemic oral medications Therapies have toxicities associated with long term use that limit effectiveness and may be inconvenient, expensive, and time-consuming |
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Clinical definition of Severe Psoriasis
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Body surface area
Psoriasis on generally >10% of BSA Impact on patient’s life Disease may alter the patient’s quality of life Patients may be willing to accept medications with potentially significant side effects Treatment A satisfactory response is usually not achieved by treatments that have minimal risks |
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Psoriatic arthritis characteristics and main location
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sausage digits
pencil in a cup (fingers) mostly in the SPINE |
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Cure for psoriasis?
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no
goal: decrease psoriasis influence on pt's life with lifelong therapy |
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1, 2,3, 4 approach to treatment of psoriasis
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1.Over-the-counter Products: creams, ointments
2. Prescription Topical Agents: steroids, vitamin D analogs (Dovonex), retinoids (Tazorac) 3. Phototherapy: UVA, UVB 4. Systemic Therapy: Methotrexate, Cyclosporine, Soriatane, or Biologics |
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Initial therapeutic choice for mild to moderate psoriasis
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Emollients
Keratolytics (salicylic acid, lactic acid, urea) Vitamin D3 analogues (Dovonex) Corticosteroids Retinoids (tazarotene) |
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how does phototherapy help treat moderate to severe
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Phototherapy causes death of inflammatory T cells in the skin, and slows the rapid growth of skin cells
Natural sunlight Ultraviolet A and B light Usually 2-3 treatments/week for 2 to 3 months is needed Risks: Burns, premature aging, skin cancers |
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Systemic therapy for psoriasis refractory to topical therapy
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Psoralen + UVA light
Oral retinoids: Soriatane (+/- phototherapy) Methotrexate Cyclosporine Biologics |
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What's Psoralen?
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Applied to skin and absorbs UV light - enhances UVA therapy.
Psoralen is a drug that causes a toxic reaction to skin lymphocytes when it is activated by UVA Effective treatment—longest remissions of any treatment available |
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Side effects of Psoralen
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Nausea, burning, pruritus
Risk of cancer with cumulative use—both squamous cell carcinoma and melanoma >160 cumulative treatments |
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Side effects of MTX therapy
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Headache, nausea
Bone marrow and liver toxicity Liver biopsy required after cumulative dose of 1.5 g |
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Why don't we just shoot psoriatic pt full of steroids?
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No place for steroid treatment in psoriasis: it will clear it up, but soon it will come back and may be worse
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What is Soriatane?
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One of the safest systemic drugs, but it is not very effective.
Adverse events—fewest dose-related side effects Peeling/dry skin, alopecia, muscle pain Avoid in liver disease Teratogenic:must avoid pregnancy! |
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The downside of cyclosporine
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Use not recommended for >1 year
Renal (kidney) toxicity Patients relapse 2 to 4 months after discontinuing Adverse events Hirsutism, gingival hyperplasia, muscle pain, infection Serious: hypertension, renal failure |
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Why don't more people treat their psoriasis?
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Current treatments:
Do not work well Have cumulative toxicity that leads to long-term adverse events Don’t provide long-term sustainable relief Cause relapse to occur too rapidly Can be inconvenient Require safety monitoring |
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What are some biologic drugs to treat psoriasis
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Enbrel- Etanercept
Raptiva- Efalizumab Amevive- Alefacept Remicade- Infliximab Humira- Adilumimab |
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Psoriatic plaques have high levels of what cytokine
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TNF
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