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Psoriasis - Coggle Diagram
Psoriasis
Treatment
General Principles
Ongoing, strategy varies with disease activity, counselling, support groups, risk:benefit ratio
Topical
Corticosteroids, Vitamin D, Retinoid, Rofluimilast, Tar
For mild/localized disease, complement phototherapy, compliance issues, cosmetically accetable base/vehicle
Corticosteroids is most frequently used, non-irritant, quick onset of action, rapid flare of discontinuing
Calcipotriol vitamin D, fortuitous discovery, slower onset of action than corticosteroids
Tar: Mixture of hydrocarbons, becomes less popular, crude forms is more effective but messy
Phototherapy
NB UVB
Administered in dedicated clinics, concentrated in major cities, three times weekly for several months, gradually increase dose to avoid burns
Systemic
Methotrexate, acitretin, cyclosporine, apremilast, deucravacitinib
Methotrexate: Effective for all types, folate antagonist, immunosuppressant, anti-inflammatory, once weekly dose PO
Acitretin: Retinoid, less effective than methotrexate, dose not help for psoriatic arthritis, not immunosuppressant, teratogenic
Cyclosporine: Rapid onset of action, effective for all forms of psoriasis, short course recommended
Apremilast: Phosphidiesterase 4 inhibitor, anti-inflaammatory, not potent immunosupressant
Sotyktu: Newest oral treatment, TYK2 inhibitor
Biologics: Targeted therapies, monoclonal antibodies, immunosuppressive, block cytokines implicated in psoriasis, IV/SC, generally very effective well tolerated and safe
Pathophysiology
Genetics
Polygenic, Heterogenous, having parents and sibling with ps -> 50% risk in next sibling
Pathogenesis
Changes in epidermal kinetics are secondary to inflammation
Immune Mediated
Natural Killer cells, Natural killer T cells, Neutrophils
Dendritic cells, Th-1 cells, Th-17 cells, IL-17
Triggers
Infections
Beta hemolytic streptococci
Drugs
Lithium, Antimalarials, beta blockers, interferons
Comorbidities
Metabolic syndrome (Obesity, hyperlipidemia, Hypertension, diabetes, prediabetes)
CV disease, Chron's disease, Depression, Cancer
Clincial Features
5 Main Types
Psoriasis Vulgaris
Papulosquamous disease with well-circumscribed erythematous silvery scaled
Highly variable size, shape, number, degree of scale/thickening, variable pruritus
Localized and only few areas involved
Guttate Psoriasis
Eruptive, widespread, can resemble pityriasis roseas, variable pruritius, self-limiting 3-6 months, 2 weeks after strep throat infection or viral infection
Generalized Pustular Psoriasis
Rare, generalized painful erythema with sterile pustules, acute onset, fever, systemically unwell
Palmoplantar Pustular Psoriasis
Occurs on the palms of the foot and hands
Recurrent crops of large pustules, sterile, pain, itch, pustules dry into erythema, resistant to therapy
Erythrodermic Psoriasis
Erythema of most of skin surface, rapid/gradual onset, itchy, tender, systemically unwell, Complicaitons (hypothermia, hypoaluminemia, leg edema, cardiac failure, sepsis)
Nail Psoriasis
Fingers > Toes, Pits, Onycholysis, oil drop sign, subungual hyperkeratosis
Cutaneous Psoriasis
Highly variable, life-long with exacerbations, protracted remissions can occur, no reliable predictors of disease activity
Differential Diagnosis
Papulosquamous disorders, mycosis fungoides, parapsoriasis, cutaneous lupus erythematosus, Tinea capitis, coporis
Exacerbating factors