Thursday, March 11, 2010

Psoriasis

Psoriasis - Chronic
Rahul Soman, M. Pharm


 

Definition  

A chronic, inflammatory, hyperproliferative skin disorder, particularly of the keratinocytes, characterized by well-demarcated, erythematous, scaly plaques, and characterized by spontaneous flares and remission .


 

Medical History  

* Family history of Psoriasis

* Streptococcal infectious disease

* HIV positive

* White

* Seasonal Variations

* Stress

* Antimalarial use

* Beta-Adrenergic Blocker use

* Lithium use

* Alcohol Abuse

* Smoking

* Past medical history of Wound of skin


 

Findings  

* Pustule

* Diarrhea

* Fever with chills

* Pustule

* Auspitz's sign

* Change in nail appearance

* Change in nail texture

* Köbner phenomenon

* Psoriatic nail pitting

* Skin plaque

* Arthralgia

* Painful swelling of joint


 

Tests  


 

Suspected psoriasis  

* Biopsy of skin: Skin biopsy findings may help differentiate psoriasis from various other inflammatory skin diseases .


 

Differential Diagnosis  

* Atopic dermatitis - Chronic

* Nummular eczema

* Psoriasis - Chronic

* Seborrheic dermatitis, chronic

* Guttate psoriasis

* Pustular psoriasis

* Primary cutaneous T-cell lymphoma

* Seborrheic psoriasis

* Erythrodermic psoriasis

* Pityriasis rosea


 

Treatment  


 

Drug Therapy  


 


 

Psoriasis  


 

ALCLOMETASONE DIPROPIONATE  

Adults: Apply a thin film topically to affected area 2 to 3 times daily; massage gently until the medication disappears

Pediatrics (1 year of age and older): Apply a thin film topically to affected area 2 to 3 times daily; massage gently until medication disappears; use for no more than 3 weeks


 

FLUTICASONE PROPIONATE  

Adults: Apply a thin film topically to affected area twice daily; rub in gently

Pediatrics (3 months and older): Apply a thin film topically to affected areas twice daily; rub in gently; maximum duration of treatment 4 weeks


 

CLOBETASOL PROPIONATE  

Adults: Apply topically to affected area twice daily for a maximum of 2 weeks; maximum dose 50 grams/week

Adults (shampoo for scalp psoriasis): Apply topically to affected areas of scalp only once daily in a thin film; leave in place 15 minutes before lathering and rinsing, maximum 50 mL per week

Pediatrics: Shampoo is not indicated for children under the age of 18 years


 

FLUOCINONIDE  

Adults: Apply 0.1% cream once or twice daily to the affected area for maximum of 2 weeks; maximum 60 grams/week


 

Betamethasone Dipropionate  

Adults: Apply topically to affected area once or twice daily for a maximum of 2 weeks; maximum doses of 45 grams/week for the cream or ointment, 50 grams/week for the gel, and 50 mL/week for the lotion

Pediatrics: Apply thin film topically 1 to 3 times daily; the augmented formulation is not recommended for children under 13 years of age


 

Betamethasone Valerate  

Adults: Apply foam to scalp twice daily


 

FLUOCINOLONE ACETONIDE  

Adults: Apply topically to affected area 2 to 4 times daily

Pediatrics: Apply topically 2 to 4 times daily for a maximum of 4 weeks (0.2% strength is not recommended for age 2 years and younger)


 

TRIAMCINOLONE ACETONIDE  

Adults: Apply topically to affected areas 2 to 4 times a day

Pediatrics: Apply 0.025% cream, lotion, or ointment topically to affected areas 1 to 2 times/day

Pediatrics: Apply 0.1% or 0.5% formulations topically once daily


 

AMCINONIDE  

Adults: Apply cream topically to affected area 2 to 3 times daily

Adults: Apply lotion or ointment topically to affected area twice daily

Pediatrics: Apply cream topically to affected area 2 to 3 times daily

Pediatrics: Apply lotion or ointment topically to affected area twice daily


 

DIFLORASONE DIACETATE  

Adults: Apply a thin film topically to affected area 1 to 4 times/day

Pediatrics: Apply a thin film topically to affected area 1 to 4 times/day


 

DESOXIMETASONE  

Adults: Apply a thin film topically to affected area twice daily

Pediatrics (10 years and older): Apply a thin film topically to affected area twice/day


 

HALOBETASOL PROPIONATE  

Adults: Apply cream or ointment topically to affected area once or twice daily for a maximum of 2 weeks; maximum dose 50 grams/week

Pediatrics (age 12 years and older): Apply cream or ointment topically to affected area once or twice daily for a maximum of 2 weeks, maximum dose 50 grams/week


 

HALCINONIDE  

Adults: Apply cream, ointment, or solution topically to affected area 2 to 3 times/day

Pediatrics: Apply smallest effective dose of cream, ointment, or solution topically to affected area 2 to 3 times/day


 

DESONIDE  

Adults: Apply a thin film topically to affected area 2 to 3 times/day

Pediatrics: Apply a thin film topically to affected area 2 to 3 times/day


 

HYDROCORTISONE  

Adults: Apply cream, ointment, or lotion topically to affected area 2 to 4 times/day

Pediatrics: Apply cream, ointment, or lotion topically to affected area 2 to 4 times/day


 

CALCITRIOL  

Adults: Apply topically to affected areas twice daily; maximum dose 200 g of ointment per week


 

CALCIPOTRIENE  

Adults: Apply a thin layer of cream or scalp solution topically twice daily for a maximum of 8 weeks

Adults: Apply a thin layer of ointment topically once or twice daily for a maximum of 8 weeks


 

TAZAROTENE  

Adults: Apply 0.05% or 0.1% gel or cream topically at bedtime to affected area

Pediatrics: Apply 0.05% or 0.1% gel or cream topically at bedtime to affected area


 

SALICYLIC ACID (Related toxicological information in SALICYLATES)  


 


 

COAL TAR  

Adults: Apply cream topically to affected areas 1 to 4 times daily

Adults: Apply shampoo topically to hair and scalp, rinse, repeat, leave on 5 minutes, rinse again; use twice weekly for 2 weeks then once weekly or as needed


 

Procedural Therapy  


 

Moderate to severe psoriasis  

* Ultraviolet light therapy: Both PUVA (UV-A+oral psoralen) and UV-B phototherapies improve moderate/severe psoriasis, but benefits must be weighed vs potential long-term risks .


 

Non-Procedural Therapy  


 

Psoriasis  

* Self-care

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence