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Psoriasis - Coggle Diagram

- - - - Betamethasone valerate
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Betamethasone dipropionate (Diprosone® cream/ointment; Daivobet® ointment/gel)
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Diflucortolone valerate
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Hydrocortisone butyrate
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Mometasone furoate
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Methylprednisolone aceponate
        
        Refer to Atopic Eczema/Dermatitis coggle
    - - Betamethasone dipropionate (Diprosone OV® cream/ointment)
        
        Refer to Atopic Eczema/Dermatitis coggle
      - Clobetasol propionate
        
        Refer to Atopic Eczema/Dermatitis coggle
  - - - MM = Methotrexate on Monday; FF = Folic acid on Friday
      - Folic acid - 5mg once a week taken on a different day to methotrexate
  - - - TNFα inhibitor - TNF bound to adalimumab is prevented from causing the inflammation that results in psoriasis plaques
      - Prescription; 20mg/0.4mL, 40mg/0.8mL, 40mg/0.8mL (prefilled device) Subcutaneous Injection
      - Dose: initially 80 mg; each injection should be given at least 3 cm from the last injection site; then 40 mg every 2 weeks starting 1 week after initial dose
      - Other medications including methotrexate and acitretin can usually be continued during treatment with adalimumab
      - Monitoring
        
        Routine blood count, liver and renal function, fasting lipids and antinuclear antibody before starting adalimumab, in females, a pregnancy test may be appropriate and also every 6 months or so during treatment
        
        Blood levels of adalimumab may be used to monitor adherence to therapy and determine the optimum dose in an individual.
        
        Patients should be screened for TB, active or latent viral hepatitis (HAV, HBV, HCV) and HIV - if present, these infections should be treated before starting adalimumab; should also check immunisation status - if necessary, vaccines should be updated prior to treatment
        
        TB testing should also be repeated from time to time.
      - Adverse effects: mild to moderate injection site reactions (redness, swelling, itching, pain)
      - Education points: contact your doctor immediately if persistent cough, weight loss, fever, sore throat, bruising, or bleeding develop; if self-injecting, thigh or abdomen can be used and the sites changed for each injection - don't inject in an area that is bruised, red, hard, or tender; store in fridge at 2–8°C in the outer carton
    - - TNFα inhibitor
      - Refer to Adalimumab
      - Dose: may be initiated at 50 mg twice weekly for up to 12 weeks; maintenance 50 mg once weekly or 25 mg twice weekly, with an interval of 3–4 days between doses
      - Prescription; 25mg/mL, 50mg/mL Subcutaneous Injection, 25mg powder for injection
    - - IL-17 agent - binds to and neutralises the pro-inflammatory cytokine IL-17A to reduces manifestations of IL-17A overexpression including chronic inflammation and immune response activation
      - Prescription; 150mg/mL Subcutaneous Injection
      - Dose: may be initiated at 50 mg twice weekly for up to 12 weeks; maintenance 50 mg once weekly or 25 mg twice weekly, with an interval of 3–4 days between doses
      - Refer to Adalimumab + extra education point: avoid injecting into areas of the skin that show psoriasis