4. PSORIASIS
Chronic inflammatory skin disease - multisystem
Incidence – 3.2% population (0.4-2.8%)
Presenting features:
Well demarcated red plaques with silver scales
Scalp, elbow, knees and presacral regions
5. PATHOLOGY
Inflammatory immune mediated condition
Involves cutaneous T cells, dendritic cells and keratinocytes
Keratinocytic hyperproliferation Scaly plaques
8. PSORIATIC ARTHRITIS
5-30% of patients with cutaneous psoriasis
Severity depends on:
Initial presentation at early age
Female gender
Polyarticular involvement
Genetic predisposition
13. COAL TAR
Exerts phototoxic action – exposed to light
Relapses common
Use declined – carcinogenicity and photo
toxicity
14. ANTHRALIN
Dithranol – ointment/ paste/ paint
Anti-proliferative effect
Inhibits T- lymphocyte proliferation and epidermal DNA
synthesis
Don’t apply on face and scalp
15. Indication - Mild to moderate or severe psoriasis as 2nd line
treatment in combination
Contraindications
Unstable plaque psoriasis
Pustular psoriasis
Erythrodermic psoriasis
18. TOPICAL RETINOIDS - TAZAROTENE
• Selectively binds to retinoid acid receptors and decrease
epidermal proliferation
• Cream or gel formulation applied once or twice daily
Indication
Mild to moderate psoriasis
19. GLUCOCORTICOIDS
Indications
Mild to moderate psoriasis – monotherapy or combination
Severe psoriasis- combination with Vit D3 analogue, retinoids, anthralin
Monotherapy for flexural or facial psoriasis
Contraindications
Bacterial, viral, mycotic infections
Atrophy of skin
27. CYTOTOXIC AND IMMUNOSUPPRESSANT
DRUGS
METHOTREXATE
Moderate to severe psoriasis
MOA – suppress immunocompetent cells
Decrease the expression of CLA positive T cells
10-25 mg once weekly as single dose
Psoriatic arthritis
Hepatic cirrhosis on long term use
37. Golimumab
Once a month s.c. injection
Certolizumab
s.c. injection of 200 mg
Plaque psoriasis &
Psoriatic arthritis
38. IL 12/23 INHIBITORS
USTEKINUMAB
Moderate to severe plaque psoriasis and psoriatic arthritis
RISANKIZUMAB
For moderate to severe psoriasis
For candidates of phototherapy and systemic therapy
40. IL 17 INHIBITORS
IL 17 stimulation causes increased keratinocyte
expression of inflammatory cytokines
SECUKINUMAB
Moderate to severe plaque psoriasis in adults
41. IXEKIZUMAB – Plaque psoriasis and psoriatic arthritis
160 mg s.c. 80 mg twice weekly
BRODALUMAB (2017)
Moderate to severe psoriasis
s.c.
43. T CELL ACTIVATION INHIBITORS
Efalizumab
Chronic moderate to severe plaque psoriasis
Withdrawn in 2009 – progressive multifocal leucoencephalopathy
Alefacept
Moderate to severe chronic plaque psoriasis
7.5mg once a week i.v. / 15mg once a week i.m. for 12 weeks
According to area of manifestations
Scalp, Flexural, Nail, Oral mucosa
Emollients – Soothe or soften the skin – paraffin, cocoa butter apllied after bath – 3 times a day
Cytostatic agents – death or inhibition of growth or dividing of a cell
crude preparation containing phenolic compounds
2 hrs before bath – wash off
80% patients experience total clearing of psoriasis within 3-5 weeks of treatment in IP setting
Unstable – poorly defied plaques – can lead to erythrodermic
Vit D3 inhibits epidermal proliferation
suppress proliferation of keratinocytes and enhance differentiation
respond in 4-8 weeks
Prodrug - Tazarotenic acid
Type I O2 independent
Type II O2 dependent energy transfer
ROS
Inhibition of amino-imidazolecarboxamide ribonucleotide(AICAR) transformylse and thymidylate synthetase
Cutaneous lymphocyte associated antigen
IL 12 promotes Th1 activity thereby TNF alpha and gamma production
IL23 activates Th17 cells that produce IL 17A ( regulates tissue inflammation and autoimmune response)
ADR
Nasopharyngitis, URTI, diarrhea
Recombinant IL 4 in preclinical stage for psoriasis