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PSIORIASIS MEDICATIONS - Coggle Diagram

- - - - Localised PUVA
        
        For treatment of small areas only such as smaller hand of foots unit
        
        Bathwaters PUVA is preferrable. Other option is topical PUVA (psoralens lotion or gel)
        
        The hands or feets are soaked in a methoxsalen solution for 30mins, then immediately exposed to UVA
        
        Topical PUVA is applied to the affected areas 10mins before UVA exposure.
      - Whole-body PUVA
        
        a. Oral PUVA (recommended for adult psoriasis)- taken 2 hrs before UV treatment
        
        b. Bathwaters PUVA- patient soaks in bath contain psoralens solution
        
        During UV treatment
        
        Wear googles to protect the eyes from exposure to the radiation
        
        Use underpants only for whole body exposure, but for arms and legs exposure need to wear SAME clothing each treatment to prevent inetvertently exposing a new area of skin
      - Side effects
        
        Burning
        
        Itching
        
        Nausea
        
        Eye damage
        
        Skin ageing and skin cancer
      - Contraindications in pregnancy
        
        Psoralens are a known mutagens
      - Frequency of treatment
        
        2-3 times per week
      - Duration of treatment
        
        First few exposure- less than five mins
        
        Next exposure - up to maximum 30mins per session
      - Counselling
        
        Patients must wear protective eye gear and sunscreen throughout the day due to photosensitizing effect of psoralens
    - - Technique- Undressed and stand in a speciality designed cabinet containing fluorescent light tubes
      - Side effects
        
        Sunburn
        
        Skin ageing and skin cancer
      - Frequency of treatment
        
        3 times per week
      - Duration of treatment (same as PUVA)
- - - - Initial- 0.5-1mg/kg/day (for 2-4 weeks)
      - Maintenance- 25-50mg everyday (max: 75mg/day)
  - - - Initial- 2.5mg/kg/d in 2 divided doses a day
      - Maintenance- increase every 4-6 weeks with max dose of 5mg/kg/d
  - - - Can be taken as single dose or divided into 3 doses and take them at 12-hour intervals for 2 consecutive days
      - c) Maintainence- may be increase from 7.5mg per week to a max of 20mg per week.
        
        a) Initial- 5-7.5mg per week
        
        b) Supplement- 5mg folic acid is taken everyday except the day of MTX or taken once a week