Podcast
Questions and Answers
What should be assessed before initiating phototherapy?
What should be assessed before initiating phototherapy?
Phototherapy is risk-free and does not increase the chances of skin cancer.
Phototherapy is risk-free and does not increase the chances of skin cancer.
False (B)
How often is phototherapy typically administered?
How often is phototherapy typically administered?
Two to three times per week
Doses of phototherapy are titrated up by ______ to ______ percent with each treatment.
Doses of phototherapy are titrated up by ______ to ______ percent with each treatment.
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Match the following terms with their descriptions related to phototherapy:
Match the following terms with their descriptions related to phototherapy:
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What is the most prevalent form of psoriasis?
What is the most prevalent form of psoriasis?
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Patients with psoriasis have a higher quality of life compared to those without the disease.
Patients with psoriasis have a higher quality of life compared to those without the disease.
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At what ages does the bimodal distribution of psoriasis typically occur?
At what ages does the bimodal distribution of psoriasis typically occur?
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The most severe form of psoriasis is known as __________.
The most severe form of psoriasis is known as __________.
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Match the psoriasis types with their characteristics:
Match the psoriasis types with their characteristics:
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Which of the following can exacerbate psoriasis symptoms?
Which of the following can exacerbate psoriasis symptoms?
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Genetics and environmental factors both play a role in the development of psoriasis.
Genetics and environmental factors both play a role in the development of psoriasis.
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What role does patient preference play in the treatment of psoriasis?
What role does patient preference play in the treatment of psoriasis?
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What percentage of patients with psoriasis are affected by psoriatic arthritis?
What percentage of patients with psoriasis are affected by psoriatic arthritis?
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Guttate psoriasis lesions are large and crusty.
Guttate psoriasis lesions are large and crusty.
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Name a common trigger for guttate psoriasis.
Name a common trigger for guttate psoriasis.
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Pustular psoriasis is typically localized to the palms and _____ .
Pustular psoriasis is typically localized to the palms and _____ .
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Match the drug examples with their categories:
Match the drug examples with their categories:
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Which of the following is NOT considered a first-line treatment for mild psoriasis?
Which of the following is NOT considered a first-line treatment for mild psoriasis?
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The Psoriasis Area and Severity Index (PASI) can be used to evaluate the severity of psoriasis lesions.
The Psoriasis Area and Severity Index (PASI) can be used to evaluate the severity of psoriasis lesions.
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What is a psychological aspect that may be considered in the treatment of psoriasis?
What is a psychological aspect that may be considered in the treatment of psoriasis?
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Severe psoriasis may require escalation to _____ therapies.
Severe psoriasis may require escalation to _____ therapies.
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Which of the following lesions are typically found in pustular psoriasis?
Which of the following lesions are typically found in pustular psoriasis?
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Which of the following is NOT an advantage of topical corticosteroids for psoriasis treatment?
Which of the following is NOT an advantage of topical corticosteroids for psoriasis treatment?
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Phototherapy with UV light has been established as a treatment for psoriasis.
Phototherapy with UV light has been established as a treatment for psoriasis.
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Name one advantage of using keratolytics in psoriasis treatment.
Name one advantage of using keratolytics in psoriasis treatment.
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Methotrexate is contraindicated during ______ and lactation.
Methotrexate is contraindicated during ______ and lactation.
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What is a common disadvantage of immunomodulators in psoriasis treatment?
What is a common disadvantage of immunomodulators in psoriasis treatment?
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Emollients provide immediate relief for psoriasis symptoms.
Emollients provide immediate relief for psoriasis symptoms.
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Match the following treatment modalities with their corresponding characteristics:
Match the following treatment modalities with their corresponding characteristics:
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What are two disadvantages of using cyclosporine?
What are two disadvantages of using cyclosporine?
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Topical agents are often considered based on disease severity, cost, and ______.
Topical agents are often considered based on disease severity, cost, and ______.
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What is a significant concern regarding the use of salicylic acid in keratolytics?
What is a significant concern regarding the use of salicylic acid in keratolytics?
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Study Notes
Psoriasis Overview
- Psoriasis is a chronic, proliferative skin disease.
- Plaque psoriasis is the most common type.
- Characterized by well-defined, thickened red skin patches covered with silvery scales.
- Genetics and environmental factors contribute to development and exacerbation.
- Bimodal age distribution, with peaks between ages 18-39 and 50-69.
Pathogenesis
- Psoriatic plaques are marked by epidermal hyperplasia, leukocyte infiltration, and changes in dermal microvasculature.
- Immune-mediated response systems are disrupted, leading to increased keratinocyte proliferation.
Prognosis & Treatment
- Psoriasis negatively impacts quality of life (social, psychological, physical).
- No known cure; it is a treatable condition.
- Shared decision-making is important in treatment selection due to potential side effects.
- Treatment aims for complete clearing of lesions or satisfactory improvement for the patient.
Risk Factors
- Hot weather, sunlight, and humidity can help clear psoriasis, while cold weather is detrimental.
- Anxiety and psychological stress negatively affect the disease course.
- Viral and bacterial infections can trigger psoriasis onset or flare-ups.
- Trauma to the skin (e.g., cuts, burns) can initiate lesion development.
Types of Psoriasis
- Plaque psoriasis: Characterized by sharply demarcated, red, scaly patches; commonly affects elbows, knees, scalp, and trunk.
- Erythrodermic psoriasis: The most severe form; involves intense redness and scaling over >90% of the body surface area.
- Pustular psoriasis: Localized to palms and soles, with a generalized version possible.
- Guttate psoriasis: Small, fine, red scales; often follows strep throat; usually found on the trunk, arms, and legs.
Psoriatic Arthritis
- Psoriatic arthritis is a form of seronegative inflammatory arthritis.
- Affects approximately 25% of psoriasis patients.
Drug-Induced Psoriasis
- Several medications, including antibiotics (e.g., penicillins, sulfonamides), corticosteroids (post-withdrawal), antimalarial agents, and others are linked to psoriasis onset or flare-up.
Classification of Psoriasis
- Psoriasis Area and Severity Index (PASI) is a validated scoring index used in clinical trials to quantify disease severity and extent.
- Severity classification helps guide treatment selection.
- Mild disease: affects limited areas (excluding face, genitals, hands, and feet) and may respond to topical therapies alone.
- Moderate disease: might require phototherapy or non-biological systemic agents
- Severe disease: needs escalation to biologic therapies
Non-Pharmacologic Modalities
- Psoriasis can be emotionally and psychologically challenging for patients.
- It may affect participation in sports/outdoor activities and lead to lifestyle changes.
- Psychological support is crucial to coping and adherence to treatment plans.
Treatment of Mild-Moderate Psoriasis
- Topical therapies are the first-line treatments for mild psoriasis.
- Treatment considerations include disease severity, cost, and convenience.
- Non-pharmacologic therapies like spa therapy or support groups augment treatment plans.
Topical Agents for Psoriasis
- Emollients: basic adjuvants; safe, inexpensive; reduce scaling, itching, and discomfort, but provide minimal relief alone.
- Keratolytics (salicylic acid, urea): reduce hyperkeratosis and help other topical treatments penetrate better but may cause side effects when used extensively.
Additional Topical Treatments
- Topical Corticosteroids: Provide rapid response and control inflammation and itching. Particularly helpful for intertriginous areas and face, with moderate efficacy for psoriasis.
- Coal Tar: Particularly effective for flaky scalp lesions, enhancing psoriasis clearance with UVB treatment; with limited side effects.
Additional Systemic Treatments
- Vitamin D Analogs: Slow onset, expensive, and can impact bone metabolism; used in maintenance therapy.
- UVB: Effective in treating moderate-to-severe psoriasis, eliminating problems often arising with topical corticosteroids; can cause sunburn.
Treatment for Moderate-to-Severe Psoriasis
- Systemic medications like methotrexate, cyclosporine, and immunomodulators are used if milder therapies are ineffective.
- Immunomodulators (etanercept, infliximab, adalimumab, etc.): a targeted therapy; effective for moderate-to-severe cases; maintain remission; expensive and parenteral; with a risk of infections.
Phototherapy
- Phototherapy (using UV light) has a long history in treating psoriasis.
- It may be considered for moderate to severe cases or if topical therapies are insufficient. It can be helpful for mild, refractory cases.
- Important to assess for skin cancer risk and use appropriate photo-protection considerations.
- Treatment dosing is titrated up over time, and may need to be restarted at lower doses if doses are missed.
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Description
Explore the complexities of psoriasis, focusing on its types, pathogenesis, and impact on quality of life. This quiz covers risk factors, prognosis, and treatment options highlighting the importance of shared decision-making in management. Test your understanding of this chronic skin condition.
