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PSORIASIS Ben Basger Basgers Pharmacy North Bondi Pharmacy Practice, The University of Sydney Psoriasis - references • Co-morbidities in patients with psoriasis - The American Journal of Medicine (2009) 122, 1150.e11150.e9 • Diagnosis of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance - BMJ 2010;341:c5623 doi: 10.1136/bmj.c5623 Psoriasis eTG34, 2011 • Psoriasis is a disease of the skin characterised by erythema and scale • Psoriasis is chronic , recurrent and benign • Treatment can control the disease in most cases • Psychological effects can be disproportional • Stress may aggravate the disorder • Certain drugs may aggravate the disorder • Treatments are not curative • Treatment is based on location, severity, clinical response, adverse effects, cost and time commitments Psoriasis eTG34, 2011 • Psoriasis is strongly familial • The presentation is variable and the clinical manifestations numerous, from mild presentation in one site to total skin involvement with pustulation and constitutional symptoms • Approximately one third of patients have arthritis • Psoriasis is activated by specific trigger factors such as infection, stress, trauma, drugs • Two peaks of onset; 16-22 yrs (more severe disease) and 57-60 yrs – milder; family history may be absent Psoriasis – treatment of different types Type of psoriasis Treatment options Plaque – mild to moderate Tars, topical corticosteroids, calcipotriol, dithranol Flexural Mild-moderate topical corticosteroids Palmoplantar Tars, topical corticosteroids, keratolytics, systemic therapy Scalp Tar shampoo, topical corticosteroid lotions Psoriasis – topical therapies eTG34, 2011 • • • • • Emollients – scaling, irritation Keratolytic – salicylic acid Topical corticosteroids – anti-inflammatory, anti-mitotic Tars – anti-inflammatory and antipruritic Calcipotriol – regulates proliferation and differentiation of keratinocytes • Dithranol – antiproliferative effect Psoriasis – systemic therapy eTG34, 2011 • Methotrexate – slows epidermal cell proliferation; immunosuppressant • Acitretin – proliferation and differentiation of keratinocytes; anti-inflammatory • Cyclosporin – immunosuppressant • Biological therapies e.g. Adalimumab • PHOTOTHERAPY/PUVA Psoriatic arthritis eTG34, 2011 • Typically presents in young to middle aged adults • May involve hands and feet; spine; sacroiliac joints; a variable number or peripheral joints (oligo- or polyarticular) • TREATMENT – oral NSAIDs, oral corticosteroids, DMAARDs, TNFα inhibitors