Autoimmune Disorders

What triggers Raynaud's phenomenon?

Exposure to cold or stress

What happens in Raynaud's phenomenon?

Vasospasm in the extremities

Where does Raynaud's phenomenon most commonly occur?

Fingers and/or toes

What color changes does the skin go through in Raynaud's phenomenon?

White, then blue

What happens when the affected areas warm in Raynaud's phenomenon?

Painful swelling

What can Raynaud's phenomenon result in if severe?

Amputation

What lab findings are seen in Raynaud's phenomenon?

Lab findings that point to other autoimmune conditions are absent

What causes the symptoms of drug-induced Raynaud's?

Decreased blood flow to the fingers

What symptoms are increased in drug-induced Raynaud's?

Cyanosis and pain

What is the goal of Raynaud's treatment?

Vasodilation to improve blood flow to the affected areas

What nondrug measure helps prevent Raynaud's?

Avoid exposing hands and feet to cold

What drug is commonly used for Raynaud's prevention?

Nifedipine (a calcium channel blocker)

What drug class does nifedipine belong to?

Calcium channel blockers (CCBs)

Can CCBs other than nifedipine be used for Raynaud's?

Yes

What drugs can cause or worsen Raynaud's?

Beta-blockers, bleomycin, cisplatin, and sympathomimetics (amphetamines, pseudoephedrine, and illicit drugs)

Which chemotherapy drugs can cause or worsen Raynaud's?

Bleomycin and cisplatin

Which sympathomimetics can cause or worsen Raynaud's?

Amphetamines, pseudoephedrine, and illicit drugs

How do sympathomimetics cause or worsen Raynaud's?

Vasoconstriction

Can beta-blockers cause or worsen Raynaud's?

Yes

What is psoriasis?

A chronic, autoimmune disease that appears on the skin

What is the most common type of psoriasis?

Plaque psoriasis

What does plaque psoriasis look like?

Raised, red patches covered with a silvery-white buildup of dead skin cells

Where on the body can plaque psoriasis appear?

Any part of the body

What are the 3 main types of psoriasis treatment?

Light therapy, topical medications, and systemic medications

How is most psoriasis treated?

Topical medication and UV light therapy

What nondrug measure can help loosen and remove psoriasis plaques?

Soaking

What are the symptoms of psoriasis?

Red, itchy, scaly patches

Where does psoriasis most commonly occur?

Knees, elbows, trunk, and scalp

What happens to the skin cell life cycle in psoriasis?

It greatly accelerates

What does the accelerated skin cell life cycle in psoriasis lead to?

A buildup of dead cells on the surface of the epidermis

What causes the characteristic psoriatic plaques?

Substantial leukocyte recruitment to the dermis and epidermis

Where are leukocytes recruited to in psoriasis?

The dermis and epidermis

What are the triggers of psoriasis?

Infections, cold/dry weather, skin injury, stress, smoking, heavy alcohol use, certain medications, and rapid withdrawal of corticosteroids

What infections can trigger psoriasis?

Strep throat or skin infections

What type of weather can trigger psoriasis?

Cold, dry conditions

What skin injuries can trigger psoriasis?

A cut or scrape, a bug bite, or a severe sunburn

What smoking-related exposures can trigger psoriasis?

Smoking and exposure to secondhand smoke

What level of alcohol use can trigger psoriasis?

Heavy alcohol consumption

What medications can trigger psoriasis?

Lithium, high blood pressure medications, and antimalarial drugs

What corticosteroid-related trigger can worsen psoriasis?

Rapid withdrawal of oral or systemic corticosteroids

How does UV light exposure help psoriasis?

It causes activated T cells in the skin to die

What does UV light's effect on T cells do for psoriasis?

Slows skin turnover and decreases scaling and inflammation

What sunlight exposure can improve psoriasis?

Brief, daily exposures to small amounts of sunlight

Which psoriasis severity improves most with sunlight?

Mild-moderate symptoms

Why should high-potency topical steroids only be used short term for psoriasis?

Risk of side effects

How can topical steroids be used for psoriasis?

As monotherapy or with other therapies, such as topical calcineurin inhibitors (e.g., tacrolimus)

What is an example of a topical calcineurin inhibitor used with steroids for psoriasis?

Tacrolimus

What is tazarotene combined with for psoriasis?

Halobetasol

What drug class is tazarotene?

Topical retinoid

Tazarotene is similar to products used for what condition?

Acne

What is coal tar combined with for psoriasis?

Salicylic acid

Are coal tar products OTC or prescription?

OTC

Besides psoriasis, what are coal tar products used for?

Dandruff and dermatitis

What are the downsides of coal tar products?

Messy, time consuming, and can stain clothing and bedding

What is an advantage of coal tar products?

Some patients get relief at a reasonable cost

What formulations are available for coal tar products?

Cream, foam, emulsion, ointment, and shampoo

What is the brand name of anthralin?

Zithranol

What type of agent is anthralin?

A keratolytic containing salicylic acid with irritant potential

How should anthralin contact time be managed?

Increase contact time as tolerated, up to 30 minutes

What is the maximum contact time for anthralin?

30 minutes

What is calcipotriene combined with for psoriasis?

Betamethasone

What drug class is calcipotriene?

Vitamin D analog

What is a downside of calcipotriene + betamethasone?

Expensive ($$$)

Where should calcipotriene + betamethasone NOT be applied?

Face, axillae, or groin

What is the brand name of tapinarof?

VTAMA

What are the most common side effects of tapinarof?

Folliculitis, nasopharyngitis, and contact dermatitis

What counseling point is important for tapinarof?

Wash hands after use

What drug class is acitretin?

Retinoid (tablet)

What are the boxed warnings for acitretin?

Hepatotoxicity and pregnancy

When is acitretin used for psoriasis?

Only in severe cases when the patient is not responding to other therapies

What drug class is apremilast?

PDE-4 inhibitor

What are the warnings for apremilast?

Weight loss, depression, and suicidal ideation

What are the common ADRs of apremilast?

Diarrhea, N/V, and headache

What interleukin receptor antagonists are used for psoriasis?

Brodalumab, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab

What is the brand name of brodalumab?

Siliq

What is the brand name of guselkumab?

Tremfya

What is the brand name of ixekizumab?

Taltz

What is the brand name of risankizumab?

Skyrizi

What is the brand name of secukinumab?

Cosentyx

What is the brand name of tildrakizumab?

Ilumya

What is the brand name of ustekinumab?

Stelara

How are interleukin receptor antagonists given?

Subcutaneous injection (single-dose prefilled auto-injectors)

What serious risk do interleukin receptor antagonists have?

Serious infections, including TB

What should be done before starting an interleukin receptor antagonist?

Screen for latent TB

What vaccines should be avoided with interleukin receptor antagonists?

Live vaccines

What are other common ADRs of interleukin receptor antagonists?

Diarrhea and upper respiratory tract infections

What drug class is deucravacitinib?

Selective tyrosine kinase 2 inhibitor

What is the brand name of deucravacitinib?

Sotyktu

What is deucravacitinib FDA approved for?

Moderate-severe plaque psoriasis

What risk does deucravacitinib have?

May increase risk for infections