psoriasis treatment problems in practice
TRANSCRIPT
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Psoriasis Treatment
By
Dr. Aliaa El-Husseiny M.Daifalla
Lecturer of Dermatology and AndrologyBenha University
2016
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Psoriasis Treatment Problems in Practice
General measures
Topical Treatment
Systemic Treatment
Biologics Treatment
Aim of therapy
PhototherapyPhotochemotherapy
CASES
YOUR OPINIO
N
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As a result of therapy, lesions may disappear.
If the attack is completely controlled, the relapse rate is low.
The aim of therapy is to reduce extent of disease so it doesn't hamper daily quality of life.
Psoriasis adversely affects patients QoL causing physical / psychological burden, impact on work ability/ social outlook / and patient perception of self
No cure Treatment is only
palliativeRecurrences are almost
certain Burden of treatment: non-
compliance to complex regimens / non-adherence to topical / long-term complications of systemic agents
Why to treat? When to treat ? When treatment is not recommended?
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Case (1): Guttate psoriasis Case (2): Psoriasis
presenting for first time after B-blockers
Case (3): Male patient when started NB-UVB, psoriasis plaques increased in size and number.
Case (4): Male patient, his 2 daughters have psoriasis. He has psoriasis plaques over both knees.
Will guttate psoriasis shift to chronic plaque psoriasis or not? Will it recur?
Is it going to be chronic even after stopping the drug?
What made him worse?
When not to treat psoriasis?
CASES
First: Aim (=Goals) of Psoriasis Therapy YOUR
OPINION
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Second: General Measures The existing provocative factors should be studied
and eliminated as far as possible. Also other possible factors should be avoided to
prevent a new episode of psoriasis or exacerbating pre-existing disease.
1. Avoid trauma e.g: physical injury, wounds, sunburn2. Control of streptococcal Infection3. Relieving stress and depression4. Weight reduction 5. Dietary supplementation 6. Cessation of smoking
Psoriasis Treatment ?
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Third: Psoriasis Choice of Therapy ?Systemic
Treatment Topical
Treatment
PhototherapyPhotochemotherapy
Quality of Life (DLQI)
Surface Area (BSA)
Severity(PASI)
Site of lesions
-face-flexures-scalp-palms+soles
Clinical Type
Age of the
patient
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Third: Psoriasis Choice of Therapy ?
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Psoriasis Topical Treatment Problems in Practice
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Psoriasis Topical Treatment
Case (5): Female psoriasis patient, 48 years old,
have been using Dermovate ointment For 10 years.
How to get the patient off steroids without rebound ?
How to prevent steroids misuse ?
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Fifth: Psoriasis Systemic
Treatment
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Case (6) Female patient, 45
years old suffering from GPP, started at age of 30, did not respond to NB-UVB or acitretin.
On Mxt for 3 years.Reached Mxt total
cumulative 150 two times
Liver Biopsy done 2 times.
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Case (7)
Male patient, 56 years old, HCV +ve, has GPP, responded to Acitretin in initial course.
Re-adminstration of retinoids in next attack did not give response.
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Psoriasis Treatment Problems in Practice
In Children
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Case (8) Female child, Rana,5 years old, presented
with erythrodermic psoriasis, She was given in a private clinic systemic
steroids Initial improvement but then worsen.She was given Mxt but leukopenia developed
after 2 weeks It was stopped and replaced with acetretin.Attempts to reduce retinoids dose resulted in
worsening of psoriasis.
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Psoriasis Treatment Problems in Practice
In Pregnancy
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Moderate-Severe Psoriasis in PregnancyAcitretin Methotrexate Cyclosporin A
X category-The drug is contraindicated in women who are or may become pregnant
D category-There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation)
C category-Studies on animals revealed teratogenic or embryocidal effects and there are no controlled studies in women-It should be given only if the potential benefit justifies the potential risk to the fetus
Is topical treatment safe in pregnancy?
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A 27-year-old pregnant woman (G1P0 at 36 weeks gestation) presents with erythema and pustular lesions in her flexures.
She is diagnosed with impetigo herpetiformis.
The condition generalizes rapidly.
Case (9)
What is the most appropriate initial management for this patient?
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Case (10) Female patient, 23 years old, has generalized plaque
psoriasis, started 5 years agoShe had winter exacerbation and was on Mxt therapy.She will marry and wish to get pregnant. Mxt was gradually tapered and stopped. Fatma had her first child safely. Psoriasis improved and the condition remitted for few
months. Next winter she came with exacerbation, PUVA was started
but with moderate response. She was given Mxt with strict contraception. After 4 months, in monthly follow-up she was found to be
pregnant.
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