9 skin disorders: Psoriasis

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90 Terms

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Psoriasis (inherited autoimmune disorder)

T cells reproduce uncontrollably and travel to surface of skin -> inflammation and build up of cells

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Inflammation with psoriasis causes

Skin cells to form faster than they are shed (thickened layer of the skin cells)

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Clinical manifestations of psoriasis depend on

The type of psoriasis

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Most common type of psoriasis

Plaque psoriasis

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Clinical manifestations of plaque psoriasis

Red raised plaques covered by silvery scales

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Plaque psoriasis is common on

Traumatized areas like the elbows and knees

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The silvery scales with plaque psoriasis are

The shedding of skin cells

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Guttate psoriasis causes

Droplet like lesions on the trunk

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Guttate Psoriasis may be triggered by

Strep infection

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Nail psoriasis clinical manifestations

Pitting, deformed nails, separation, yellow-brown discoloration

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Due to psoriasis being a systemic disease and not just a skin disease, what could occur?

Psoriatic arthritis

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Psoriatic arthritis

Joint, stiffness, pain, edema

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Palmoplantar psoriasis

Can cause a lot of pain due to scaly skin that can crack on hands and feet

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Primary Psoriasis treatment

Avoid triggers of psoriasis

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What can be done to treat psoriasis

Avoid damage to skin from scratching, infection, medications (beta blockers, NSAIDs), stress, alcohol, smoking, winter months when skin is not exposed to sun

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Should a patient with psoriasis take a cold, warm, or hot shower?

Warm but not hot because heat can make it worse

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A patient with psoriasis should do what right after taking a shower?

Moisturize using a fragrance-free moisturizer

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What prevents moisture loss?

Occlusive agents (petrolatum, mineral oil, cocoa butter, shortening)

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What pulls moisture up from lower layers of skin?

Humectants (Glycerin, urea, and gelatin)

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What do some moisturizer products do?

Combine agents of both of these categories, which could cause something to absorb well, but still feel greasy

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With psoriasis, you should

Expose the affected area to sunlight but AVOID sunburn

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Some topical agents that are used to treat psoriasis might also cause

Photosensitivity (skin is more sensitive to light)

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Potential issues with photosensitivity and people with darker skin

May not be used to having problems with the sun, but do have problems now

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With increased exposure to the sun

Higher risk of premature aging and skin cancer

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Topicals for psoriasis may be

Covered with plastic wrap to increase absorption of the topical agent

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Should you cover every topical agent with plastic wrap?

Only if recommended for that drug

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Topical keratolytics

Peeling agents help soften and remove psoriasis scales, helping other medications penetrate plaques

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Examples of topical keratolytics

Salicylic acid or urea

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Topical corticosteroids for psoriasis

Anti-inflammatory

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What kind of psoriasis are topical corticosteroids used for?

Mild to moderate Psoriasis

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Topical corticosteroids may cause

thinning of the skin

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Can you use topical corticosteroids on large areas?

No, because they have systemic absorption

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Corticosteroids can also be injected into the cuticle for

Nail Psoriasis

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Injection into cuticle is extremely

Uncomfortable

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Topical retinoids are derivative of

Vitamin A (also used for acne)

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Common side effect of topical retinoids

Dry skin

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Topical retinoids increase

Photosensitivity so use of sunscreen is very important

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Topical retinoids must be used on no more than

20% of the skin surface at one time (1% is palm-sized)

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People may do what for being sure topical retinoids are applied to all needed areas?

Locations where the medication is applied are rotated through (only a thin layer)

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Topical retinoids cannot be taken during pregnancy because

Could have teratogenic effects as oral retinoids caused birth defects in the past

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Topical vitamin D3 derivatives have what restricted

Total amount used

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Topical vitamin D3 derivatives may cause

Skin irritation initially

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Topical vitamin D3 derivatives is used for

Scalp psoriasis, which is applied at bedtime and covered with a cap

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Old treatment for psoriasis

Topical coal tar derivatives

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Topical coal tar derivatives reduce

Scaling, itching, and inflammation

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Topical coal tar derivatives may still be used for

Scalp psoriasis (leave on during shower, then shampoo)

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Topical coal tar derivatives have a low compliance d/t

Staining and odor as well as discoloring light hair

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Topical immunomodulators (TIMs)

Pimecrolimus and Tacrolimus (anti-inflammatory)

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Medications for moderate to severe psoriasis

With widespread psoriasis, topicals are not as effective as it is a large area to apply a topical agent to

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Actiretin

Oral retinoid derived from Vitamin D

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Actiretin reduces

Multiplication of skin cells

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Actiretin can not be used during pregnancy due to

Severe birth defects

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Side effects of Actiretin

Dryness, alopecia, nausea, Increased Triglycerides

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Cyclosporine po

Immunosuppressant

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Cyclosporine po was originally used for

kidney transplant patients to decrease the risk of the kidney being rejected

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Side effects of Cyclosporine po

Increased risk for infection, increased risk of cancer, and renal impairment

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What is important to monitor with cyclosporin po?

Renal function

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Methotrexate po

Cancer chemo drug (blocks cell division)

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Methotrexate po suppresses

Plaque formation and the immune system (infection risk)

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Why is methotrexate po used for psoriasis?

slowing down cell division.

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What type of cancer is increased down the road with methotrexate po?

Lymphomas

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Sulfasalazine po

Anti-inflammatory drug for Crohn's disease (but works well with psoriasis)

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Opremilast po

Oral phosphodiesterase 4 (PDE4) inhibitor

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Opremilast po is used for

Plaque and psoriatic arthritis

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Side effects of Opremilast PO (systemic) (Most serious side effects)

N&V, diarrhea, weight loss, depression, and suicidal thoughts interact with certain medications

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Biologics used for psoriasis are very

Expensive (often advertised on TV)

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Biologics decrease

Inflammation

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Biologics are given via

SubQ self injection

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Biologics for psoriasis

Adalimumab, etanercept inhibit tumor necrosis factor 4 (TNF4)

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More biologics for psoriasis

Usetekinumab, ixekizumab, risankizumab-rzaa inhibit interleukins

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Biologics increase the risk of

Infection

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What should you screen for prior to biologic treament?

TB

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What else could become reactivated with biologics?

Hepatitis B

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Can you get live virus vaccines with biologics?

NO, could have a systemic effect

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Biologics increase risk of

Certain types of cancers

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Light treatments for psoriasis?

UVB light treatments

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What are more effective and less likely to cause skin cancer for psoriasis treatment?

Narrow band UVB treatments

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What areas are covered with UVB light treatments?

Unaffected and sun sensitive areas (eyes, lips, genitalia)

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UVB light used over UVA

UVB may be more effective and less likely to cause cancer compared to UVA

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Psoralen and ultraviolet A (PUVA) treatments

Psoralen orally or as a soak sensitizes skin to Ultraviolet A light

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PUVA treatments are administered in a

Whole body cabinet or hand treatment unit

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With PUVA

Unaffected/ sensitive areas are covered and the patient wears UVA protective goggles

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Psoralen oral affects

All the skin on the body

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Psoralen soak would be good for a patient with

Palmoplantar psoriasis

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PUVA cabinet

Fluorescent bulbs to treat the whole body all at once

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With incorrect timing of PUVA cabinet

Person can get a huge skin reaction

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Side effects of PUVA

Sunburn, nausea, skin aging, increase risk of skin cancer

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Oral psoralen can make skin and eyes

more sensitive for 24 hours (wear sunglasses and keep skin covered

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Laser treatment for psoriasis

Smaller areas can be targeted precisely

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What could laser treatment be great for

Elbow or knee psoriasis