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19 Cards in this Set
- Front
- Back
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Psoriasis Treatment Options
4 Approaches |
Topical (70~80%)
Phototherapy Systemic Oral Drug Therapy Biologicals |
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Keratolytics
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Removes scales
Has salicyclic acid Avoid applyign large areas to prevent, N, V, Tinnitus, Hyperventilation |
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Corticosteriods
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Reduce Inflammation
Inhibit cell proliferation Anti Pruritic ADR-dilated blood vessels brusing, hypopigmentiaion (AKA steriod skin) |
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Low Potency
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Hydrocortisone (Hytone, Penecort, Synacort)
Fluocinolone (Synalar) |
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Low to Mid Potency
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Hydrocortisone valerate (Westcort)
Hydrocortisone (Locoid) Desonide (Tridesilon) |
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Medium Potency
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Fluticasone Propionate (Cutivate)
Clocortolone Pivalate (Cloderm) |
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High Potency
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Betametasone (Diprolene)
Mometasone fuorate (Elocon) Halobetasol propinate (Ultravate) Diflorasone diacetate (Maxiflor, Florone, Psorcon) |
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Potency for Different Areas
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Scalp: Potent Steriod
Face: Low Potency Thick Plaque on Extendors: High Potency with occlusion |
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Coal Tar
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Inhibits enzymes that contributes to psoriasis associated with cell proliferation
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Anthralin
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Drithocreme (R)
- in hibits DNA synthesis and cell proliferation -recommended for chronic and not acute psoriasis or inflamed eruptions |
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Anthralin
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Drithocreme (R)
inhibit DNA synthesis and cell proliferation recommended for chronic and not acute psoriasis and inflamed eruptions |
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Calcipotriene
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Dovonex (R)
Vit D3 analog regultes cell proliferation and suppresses lymphocytic activity well tolerated; convenient safe and effective for long term and short term use |
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Topical Retinoids
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Tazarotene (R)
Vit A derivatives used for mild to moderate psoriasis improvement in one weeks of treatment in 70% of patietns systemic toxicity unlikely |
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Calcineurin Inhibitors
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Tacrolimus (Protopic) Pimecrolimus (Elidel)
good for facial lesions and axillary psoriasis possible link to skin cancer in adults and children |
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Methotrexate
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Rheumatrex (R)
antimetabolite - folic acid analog and blocks purine and thymidine synthesis 2.5 ~ 7.5 mg po at 12 hr intervals for 3 doses per week 2.5 mg daily for 5 days then 2 days off can improve mod to mild |
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Methotrexate Toxicities
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GI: Nausea, Vomitting, Mucositis
Bone Marrow - rare but decrease incidence with folic acid supplementation. |
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Methotrexate DDI
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Decresed renal elimination - slicylates, nsaids, probenicid, most beta lactams
Displacement of methotrexate for protein binding sites - salicylates, phenytoin, warfarin, retinoids, bactrim, probenicid, barbiturates Hepatotoxicity: concomitant liver toxins |
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Oral Retinoids
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Acitretin (Soriatane)
Replaced etretinate cleared in undetectable levles in 4 weeks except when drinking. Watch for hypervitaminosis A syndrome: Skin thinning, thin, soft nails, reversible hair loss, rash, extraspinal tendon and ligament calcifications |
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Biologicals
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Alefacept (Amevive) Efalizumab (Raptiva)
Inhibit T cell activation watch for infusion related reactions serious infecitons: actute and reactivation of chronic infections long term effects still not known. |
