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Systemic treatment for psoriasis

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Systemic treatment for psoriasis

  1. 1. Systemic treatment for Psoriasis Nick Harper
  2. 2. Topical treatment • Calcipotriol (Dovonex) • Eumovate/Betnovate • Dovobet • Coal tar • Dithranol • Tazarotene (Zorac) • Salicylic acid
  3. 3. Systemic treatment Methotrexate Retinoids Ciclosporin
  4. 4. Methotrexate • Folic acid antagonist • Anti-inflammatory & immune modulator • Once a week 7.5-15mg PO •Liver toxicity –Nausea, vomiting –Abdo discomfort –Dark urine •Blood dyscrasia –Sore throat –Bruising –Mouth ulcers –Teratogenicity – 3 months • FBC • Renal function • liver function
  5. 5. Ciclosporin • Immunosuppressant (organ transplants) • 2.5-5mg/kg • Usually max 8 weeks • Control/flares Nephrotoxic Hypertension Skin cancer Lymphoma BP Renal function Serum creatinine
  6. 6. Retinoids • Acitretin • 25-50mg OD PO • Pustular psoriasis • Re-PUVA Teratogenicity (3 years) Cracked lips Itching Peeling skin Hyperostosis
  7. 7. Which to choose? • NICE & Cochrane still pending Drug PASI 75 Indication Main SE Check UV Notes Methotrexat e 60% Severe psoriasis Hepatotoxic FBC Renal fx Liver fx Avoid Teratogeni c (1 month) Ciclosporin 70% Severe psoriasis Nephrotoxi c BP Renal fx Avoid Cancer risk Acitretin 30% Pustular psoriasis Cracked lips Peeling skin - RE- PUVA Teratogeni c (3 years)
  8. 8. Which to choose? • NICE & Cochrane still pending Drug PASI 75 Indication Main SE Check UV Notes Methotrexat e 60% Severe psoriasis Hepatotoxic FBC Renal fx Liver fx Avoid Teratogeni c (1 month) Ciclosporin 70% Severe psoriasis Nephrotoxi c BP Renal fx Avoid Cancer risk Acitretin 30% Pustular psoriasis Cracked lips Peeling skin - RE- PUVA Teratogeni c (3 years)

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