Psoriasis Treatment

By

Dr. Aliaa El-Husseiny M.Daifalla

Lecturer of Dermatology and AndrologyBenha University

2016

Psoriasis Treatment Problems in Practice

General measures

Topical Treatment

Systemic Treatment

Biologics Treatment

Aim of therapy

PhototherapyPhotochemotherapy

CASES

YOUR OPINIO

N

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?

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

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 ?

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

Third: Psoriasis Choice of Therapy ?

Psoriasis Topical Treatment Problems in Practice

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 ?

Fifth: Psoriasis Systemic

Treatment

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.

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.

Psoriasis Treatment Problems in Practice

In Children

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.

Psoriasis Treatment Problems in Practice

In Pregnancy

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?

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?

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.

THANK YOU