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Scaly skin diseases

Systemic therapy key points test

Systemic therapy should be considered for: # Nail psoriasis #! Pustular psoriasis #! Erythrodermic psoriasis #! Psoriatic arthritis Explanation: Systemic therapy should be considered for severe psoriasis i.e. those with more than 10% to 20% body surface involvement, pustular psoriasis, erythrodermic psoriasis, psoriatic arthritis and more localized, recalcitrant or unsightly psoriasis. The PASI (Psoriasis Area and Severity Index) combines assessments of: #! The percentage of body area affected #! Erythema # Pruritus #! Induration Explanation: The PASI ( Psoriasis Area and Severity Index) combines assessments on the percentage of body area affected, erythema, desquamation, and induration to produce a score ranging from 0 to 72. Regarding methotrexate: # It is a calcineurin inhibitor that inhibits T cell activation #! It is administered once weekly # It is an oral retinoid # It is used to treat ichthyosis Explanation: Methotrexate is probably effective because of its immunosuppressive effects but as a synthetic analogue of folic acid it also may have direct effects on keratinocyte proliferation. Methotrexate is generally administered once weekly. It is used to treat psoriasis and sometimes other inflammatory skin diseases including dermatitis. It has no effect on ichthyosis. Common adverse reactions of methotrexate include: # Nephrotoxicity #! Bone marrow suppression #! Hepatic fibrosis # Mucocutaneous effects Explanation: Adverse reactions of methotrexate include gastrointestinal effects, mouth ulceration, pulmonary fibrosis, bone marrow suppression and hepatic fibrosis. Regarding acitretin: # It is a calcineurin inhibitor that inhibits T cell activation # It is administered once weekly #! It is an oral retinoid #! It is used to treat ichthyosis Explanation: Acitretin is an oral retinoid (vitamin A derivative) prescribed as a once daily dose for psoriasis and other disorders of keratinisation such as ichthyosis. Common adverse reactions of acitretin include: # Nephrotoxicity # Bone marrow suppression # Hepatic fibrosis #! Mucocutaneous effects Explanation: Adverse effects of acitretin include teratogenicity, various mucocutaneous effects especially dryness, arthralgias, myalgias, raised intracranial pressure, decreased night vision, acute hepatotoxicity and hypertriglyceridaemia. Regarding cyclosporin: #! It is a calcineurin inhibitor that inhibits T cell activation # It is administered once weekly # It is an oral retinoid # It is used to treat ichthyosis Explanation: Cyclosporin is an effective immunosuppressive agent used to prevent allograft rejection. It is very effective in the treatment of all forms of psoriasis. It is useful for severe atopic dermatitis and other inflammatory skin diseases. Cyclosporin is a calcinerin inhibitor, which inhibits T cell activation and so reduces the production of cytokines especially IL-2 and interferon-? Common adverse effects of cyclosporin include: #! Nephrotoxicity # Bone marrow suppression # Hepatic fibrosis # Mucocutaneous effects Explanation: Adverse effects of cyclosporin include nephrotoxicity and hypertension but it may be prescribed in patients with liver disease. Other adverse effects include gastrointestinal symptoms, headache, myalgias, arthralgias, paraesthesias and fatigue, hypertrichosis and gingival hypertrophy. Biologics effective for psoriasis include: #! Ustekinumab # Interleukin 2 #! Etanercept # Imiquimod Explanation: Biologics effective for psoriasis that are undergoing phase 3 and 4 trials include alefacept, etanercept, efalizumab and infliximab. Imiquimod is a topically active immune modulator effective in the treatment of skin cancer and viral warts; it appears to locally aggravate psoriasis. Interleukin treatment may cause severe psoriasis; the cytokine is involved in the pathogenesis of the disease.