PSORIASISBen BasgerBasgers Pharmacy North BondiPharmacy Practice, The University of Sydney

Psoriasis - references

•Co-morbidities in patients with psoriasis - The American Journal of Medicine (2009) 122, 1150.e1-1150.e9

•Diagnosis of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance - BMJ 2010;341:c5623 doi: 10.1136/bmj.c5623

Psoriasis eTG34, 2011

• Psoriasis is a disease of the skin characterised by erythema and scale

• Psoriasis is chronic , recurrent and benign• Treatment can control the disease in most cases• Psychological effects can be disproportional• Stress may aggravate the disorder• Certain drugs may aggravate the disorder• Treatments are not curative• Treatment is based on location, severity, clinical

response, adverse effects, cost and time commitments

Psoriasis eTG34, 2011

• Psoriasis is strongly familial• The presentation is variable and the clinical

manifestations numerous, from mild presentation in one site to total skin involvement with pustulation and constitutional symptoms

• Approximately one third of patients have arthritis• Psoriasis is activated by specific trigger factors

such as infection, stress, trauma, drugs• Two peaks of onset; 16-22 yrs (more severe

disease) and 57-60 yrs – milder; family history may be absent

Psoriasis – treatment of different typesType of psoriasis Treatment options

Plaque – mild to moderate Tars, topical corticosteroids, calcipotriol, dithranol

Flexural Mild-moderate topical corticosteroids

Palmoplantar Tars, topical corticosteroids, keratolytics, systemic therapy

Scalp Tar shampoo, topical corticosteroid lotions

Psoriasis – topical therapies eTG34, 2011

• Emollients – scaling, irritation• Keratolytic – salicylic acid• Topical corticosteroids – anti-inflammatory, anti-

mitotic• Tars – anti-inflammatory and antipruritic• Calcipotriol – regulates proliferation and

differentiation of keratinocytes• Dithranol – antiproliferative effect

Psoriasis – systemic therapy eTG34, 2011

• Methotrexate – slows epidermal cell proliferation; immunosuppressant

• Acitretin – proliferation and differentiation of keratinocytes; anti-inflammatory

• Cyclosporin – immunosuppressant• Biological therapies e.g. Adalimumab

• PHOTOTHERAPY/PUVA

Psoriatic arthritis eTG34, 2011

• Typically presents in young to middle aged adults

• May involve hands and feet; spine; sacroiliac joints; a variable number or peripheral joints (oligo- or polyarticular)

• TREATMENT – oral NSAIDs, oral corticosteroids, DMAARDs, TNFα inhibitors