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19 Cards in this Set

  • Front
  • Back
Psoriasis Treatment Options

4 Approaches
Topical (70~80%)
Systemic Oral Drug Therapy
Removes scales
Has salicyclic acid

Avoid applyign large areas to prevent, N, V, Tinnitus, Hyperventilation
Reduce Inflammation
Inhibit cell proliferation
Anti Pruritic

ADR-dilated blood vessels brusing, hypopigmentiaion (AKA steriod skin)
Low Potency
Hydrocortisone (Hytone, Penecort, Synacort)

Fluocinolone (Synalar)
Low to Mid Potency
Hydrocortisone valerate (Westcort)

Hydrocortisone (Locoid)

Desonide (Tridesilon)
Medium Potency
Fluticasone Propionate (Cutivate)

Clocortolone Pivalate (Cloderm)
High Potency
Betametasone (Diprolene)

Mometasone fuorate (Elocon)

Halobetasol propinate (Ultravate)

Diflorasone diacetate (Maxiflor, Florone, Psorcon)
Potency for Different Areas
Scalp: Potent Steriod

Face: Low Potency

Thick Plaque on Extendors: High Potency with occlusion
Coal Tar
Inhibits enzymes that contributes to psoriasis associated with cell proliferation
Drithocreme (R)
- in hibits DNA synthesis and cell proliferation
-recommended for chronic and not acute psoriasis or inflamed eruptions
Drithocreme (R)

inhibit DNA synthesis and cell proliferation

recommended for chronic and not acute psoriasis and inflamed eruptions
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
Topical Retinoids
Tazarotene (R)

Vit A derivatives

used for mild to moderate psoriasis

improvement in one weeks of treatment in 70% of patietns

systemic toxicity unlikely
Calcineurin Inhibitors
Tacrolimus (Protopic) Pimecrolimus (Elidel)

good for facial lesions and axillary psoriasis

possible link to skin cancer in adults and children
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
Methotrexate Toxicities
GI: Nausea, Vomitting, Mucositis

Bone Marrow - rare but decrease incidence with folic acid supplementation.
Methotrexate DDI
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
Oral Retinoids
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
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.