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PSORIASIS THERAPY :smiley: - Coggle Diagram
PSORIASIS THERAPY :smiley:
Overview of Psoriasis Therapy
Focus: Address both skin symptoms and related comorbidities.
No Cure: Emphasis on management strategies, natural history, and referrals.
Individualized Therapy: Based on disease extent, quality of life, past treatments, treatment benefits/side effects, time commitment, and cost.
TX OPTIONS :hospital::
SYSTEMIC MEDICATIONS :syringe:
Methotrexate
Inhibits cell division; used for severe cases and psoriatic arthritis.
Requires regular lab monitoring; pregnancy category X.
Severe/pustular/erythrodermic/ nail
psoriasis and psoriatic arthritis
Contraindications: low blood counts, liver disease, immunodeficiency, unreliable patient, immunodeficiency, many drug interactions, etc.
Acitretin (Systemic Retinoid)
Not recommended for women wanting to conceive for up to 3 years post-tx.
Frequently used for palmar plantar pustular psoriasis
Cyclosporine
(calcineurin inhibitor) Prevents cytokine release; (IL 2)
Not to be used with PUVA; Phototoxicity!
Caution with hypertension and kidney issues.
Tx duration limited to 1 year.
PHOTOTHERAPY :rotating_light:
Broadband and Narrowband UVB :sunny:
Photochemotherapy (PUVA):
Combines psoralen with UVA exposure. :partly_sunny_rain: Psoralen is a natural compound found in plants :four_leaf_clover:
Excimer Laser:
Targeted treatment for localized psoriasis.
:flashlight:
Contraindications:
Increased photosensitivity, certain medications, history of skin cancer.
Tx Schedule: :timer_clock: Usually 3 times a week for 12 weeks.
PROS & CONS
:check:
Useful for generalized disease, efficacious, long
duration of effect
:warning:
Risk of skin cancer (PUVA, UVB)
Squamous cell carcinoma (Stern RS. JID >260 PUVA - one-third developed BCC)
Melanoma concerns
Requires frequent patient visits (co-pay each time)
Cost and availability
Photodamage
Lentigines (PUVA)
Burns (UVB, NB-UVB)
Slow onset of response (PUVA, UVB)
BIOLOGICS :money_mouth_face:
( also a systemic agent )
Used for psoriasis and psoriatic arthritis.
Requires review of medical history, severity, previous treatments; monitor for infections and side effects.
Restrictions: No live vaccines (e.g., shingles, intranasal flu).
Targets: Focus on T cells and cytokines (TNF-α, IL-12/23, IL-17).
Cost: Up to $60,000/year in the US, €35,000 in Europe.
TOPICAL 🧴
Corticosteroids
:sparkles: (ointments, creams, gels). Mainstay for mild to moderate psoriasis, especially in sensitive areas. Side effects: skin atrophy, hypopigmentation, tachyphylaxis.
Vitamin D3 Analogues
(e.g., Calcipotriene) :sparkles: Reduces skin cell growth and promotes normal differentiation. Often combined with corticosteroids. Caution in kidney and calcium metabolism issues.
Topical Retinoids
(e.g., Tazarotene) :sparkles: Second-line treatment that decreases skin cell growth. Side effects: irritation, pruritus; max area treated is 10-20% of the body.
Salicylic Acid
:sparkles: Keratolytic effect. s softening and breaking down the outer layer of the skin so other topical tx can better penetrate
Coal Tar
:sparkles: Anti-inflammatory; potential mutagenic effects (CA causing)
Calcineurin Inhibitors
(e.g., Tacrolimus) :sparkles: Used in facial and flexural areas - skin folds- (sensitive areas).
Blocking the action of calcineurin, an enzyme involved in the activation of T cells