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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