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PSORIASIS
Ben Basger
Basgers Pharmacy North Bondi
Pharmacy Practice, The
University of Sydney
Psoriasis - references
• Co-morbidities in patients with psoriasis - The
American Journal of Medicine (2009) 122, 1150.e11150.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 types
Type 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
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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