front 1 Drug Risk Factors for psoriasis Most evidence for worsening | back 1 • Beta-blockers |
front 2 Drug Risk Factors for psoriasis less evidence for worsening | back 2 • Cardio: ACEI, amiodarone, clonidine, digoxin, quinidine,
CCBs |
front 3 if a lesion is flat and greater than 1 cm it is called a .... | back 3 plaque |
front 4 if a lesion is raise and greater than 0.5 mm it is called a .... | back 4 papule |
front 5 if a lesion is raised and less than 0.5mm and filled with puss it is called a .... | back 5 pustule |
front 6 psoriasis is less common in skin folds, palms and soles. | back 6 facts |
front 7 • well-demarcated,
irregular, erythematous, flat-topped, round-oval
plaques. • extensor surfaces, scalp, trunk, or buttocks.(location) | back 7 Plaque psoriasis |
front 8 (aka intertriginous, aka flexural) • erythematous plaques • minimal scale | back 8 Inverse psoriasis |
front 9 • generalized erythema • varying degrees of scaling | back 9 erythrodermic psoriasis-THIS IS A MEDICAL EMERGENCY treated very heavy handedly with anti inflammatorie |
front 10 Pustular psoriasis-less common=puss involved | back 10 • Localized, monomorphic, sterile pustules on painful, inflammed
skin |
front 11 Guttate psoriasis. spots look like hyperpigments fine spots on back | back 11 • 1- to 10-mm (dew-drop like) pink papules • fine scaling • primarily on trunk and proximal |
front 12 eczema and plaq psoriasis affect the same spots. and use the same treatment=topical steroid plaq psoriasis itchy but milder than atopic dermatitis | back 12 the difference is that atopic dermatitis(eczema) is dry/inflammed but no scaling. history of asthma or allergic rhinitis is a precipitating factor |
front 13 psoriasis is auto immune | back 13 more symetrical compared to tinea corporis (ring worm) plaq psoriasis has multiple lesions usually, tinea has singular lesions. |
front 14 mild psoriasis =<3-5% BSA , moderate =3-10% BSA | back 14 no involvement of hands, feet ,scalp, face, or genitals note: sever=>10% involves most parts + genitals |
front 15 treatment options for mild to moderate are? | back 15 topical treatments sever= eligible for systemic treatments |
front 16 kk has smooth erythematous lesions on his armpits and antecubital fossae classify his condition? | back 16 flexural psoriasis |
front 17 does psoriasis involvement of other areas (e.g nails, joints)change treatment approach? | back 17 nail=no change joints(psoriatic arthritis)= changes therapeutic options |
front 18 Complications and Comorbidities Think about screening for these other conditions | back 18 • Psoriatic arthritis |
front 19 Measures of Disease note: PASI has no MCID Physician global assessment (aka total severity score)=has MCID | back 19 • Psoriasis area and severity index (PASI) |
front 20 Physician global assessment (aka total severity score)=has MCID what are the 3 items of the PGA? | back 20 Eryethma Induration Scaling of major lesions min=0 max=4 3 item PGA MCID= 0.5 |
front 21 Investigator assessment of global improvement Improvement from baseline | back 21 0-4 |
front 22 patient outcome scales for psoriasis | back 22 SF-36- (0 worst-100 best)Physical functioning, role physical, bodily pain, general health, vitality, social functioning, role emotional, and mental health. MCID: 2 points in the SF-36 PCS 3 points in the SF-36 MCS Dermatology Quality of Life (10 items:0 no effect-30 extremely large effect) MCID: 2.2-6.9 (let’s call it about 5) Patient global improvement-Improvement from baseline(0 clear-4 severe) If 0-10 scale, then MCID = 3, < 2 ~ PASI-90 |
front 23 Therapeutic Options Topical Therapies | back 23 • Topical corticosteroids |
front 24 Systemic Therapies for psoriasis | back 24 • Methotrexate |
front 25 MC is a 23 year old female who presents with well-demarcated,
irregular, round-oval, flat topped lesions with silvery scale on her
forearms, hands, and legs affecting a total of ~7% BSA. Which of the
following is the most appropriate assessment? | back 25 b) Plaque psoriasis, severe |
front 26 KK is a 59 year old male who presents with smooth, erythematous
lesions on his armpits and antecubital fossae. Which of the following
is the most appropriate assessment? | back 26 b) Flexural psoriasis |
front 27 Approximately how many people out of 10 will experience improvement
in plaque symptoms with topical corticosteroids? | back 27 c) 7/10 |
front 28 Which of the following statements best describes the average
magnitude of improvement by potent topical corticosteroids according
to a 6-point scale investigator assessment of global improvement (IAGI
0-5)? | back 28 a) 1 point improvement |
front 29 Which of the following statements are true regarding potent and
superpotent corticosteroids? | back 29 a) Superpotent corticosteroids are about twice as effective than potent corticosteroids |
front 30 MC is a 23 year old female who presents with well-demarcated,
irregular, | back 30 c) Potent topical corticosteroid + methotrexate |
front 31 Which of the following is the most appropriate starting dose of
methotrexate? | back 31 d) Methotrexate 15 mg PO once weekly |
front 32 Category of TCS based on ability to produce ............... (not clinical endpoint) | back 32 vasoconstriction |
front 33 class 1 corticosteroids example creams (very potent steroids) | back 33 Clobetasol, Halobetasol, betamethasone dipropionate glycol, amcinonide |
front 34 Class 2 and 3 Corticosteroids -aka Potent steroids | back 34 Betamethasone dipropionate, amcinonide (class 3 ) Desoximetasone 0.25%, fluocinonide (class 2) |
front 35 Class 4 and 5 Corticosteroids= mid potency | back 35 Beclomethasone dipropionate, clobetasone, desoximetasone Class V Corticosteroids Betamethasone valerate 0.1%,
|
front 36 Class VI and Class VII (Low potency) | back 36 Class VI Corticosteroids Desonide 0.05% (few studies included in
potent steroid category) |
front 37 Class I Corticosteroids aka very potent steroids are equivalent to a ........................on a 6-point IAGI scale | back 37 Equivalent to 1.8 on a ex: Clobetasol, Halobetasol, betamethasone dipropionate glycol, amcinonide |
front 38 potent steroids: class 2-5 steroids are equivalent to a .........on a 6-point IAGI scale | back 38 Equivalent to 1.0 on a 6-point IAGI scale note: no direct head to head comparison of very potent and potent steroids |
front 39 Once daily or twice daily dosing? Conflicting. | back 39 • Twice-daily application of the same intervention offers no
important |
front 40 • Combination TCS + Vit D analogue BID application > once daily application | back 40 • BID IAGI improvement 1.44 (1.12-1.76) |
front 41 The most common local skin adverse effects of topical corticosteroid use include? | back 41 burning, itching, skin atrophy, striae, folliculitis, telangiectasia, purpura
Areas of greater risk: Face, intertriginous areas,
chronically treated areas |
front 42 “The daily use of ultrahigh- and high-potency (class 1-3) corticosteroids for up to 4weeks is generally safe with minimal risk of skin atrophy” | back 42 • Otherwise only general comments. |
front 43 TCS Systemic Adverse Effects | back 43
• Hypothalamic pituitary adrenal axis suppression
• Rare systemic adverse effects include Cushing syndrome and
osteonecrosis
of the femoral head
|
front 44 1.1 Methotrexate is recommended for the treatment of moderate to
severe psoriasis in adults. A
| back 44 A=strong recomendation |
front 45 MTX Safety | back 45 •Fatigue, anorexia, nausea, stomatitis -Change PO to SC or IM -Divide single weekly dose TID over 24h • Pneumonitis = change |
front 46 •Biologics abt 70-80% achieve a PASI-75 what are common ADRs? | back 46 • URTIs, injection site reaction |
front 47 • Precautions when using biologics for psoriasis | back 47 • TNF: infection history, malignancies, HF, demyelinating disease,
live |