Psoriasis is a chronic autoimmune disease characterized by abnormal skin cell proliferation and differentiation. It has several subtypes including plaque, guttate, pustular, and nail psoriasis. Treatment involves topical therapies like corticosteroids, vitamin D analogues, and tar-based treatments. Phototherapy using UVB or PUVA is also used. For more severe cases, systemic therapies like methotrexate, ciclosporin, and biologics that target TNF-α may be used. Psoriasis has links to psoriatic arthritis and inflammatory bowel disease and is triggered by factors like infection, stress, and trauma.
this is a case study on tonsillitis , this details about the diagnosis, management, treatment, patient counselling & pharmacist interventions , regarding medication etc , and also describes in detail about all aspects of tonsillitis .
please comment if you read this
thank u
The document describes a case of a 19-year-old male student who sustained a tibia fracture 4 months ago during a rugby match and was admitted for surgery to treat a non-union of the fracture. Examination found deformity, restricted movement, and mobility at the fracture site. The patient will undergo surgery involving fibular osteotomy, removal of necrotic bone, reamed intramedullary nailing, and compression plating to treat the non-union.
The patient, a 45-year-old female, presented with right-sided weakness, vomiting episodes, and left mouth deviation. She has a history of rheumatic heart disease and previous stroke. Laboratory tests revealed elevated liver enzymes and abnormalities in cell counts. She was diagnosed with cerebrovascular accident and hemiplegia due to a previous cardioembolic stroke. Her treatment plan includes anticoagulants, antiplatelets, statins, and physical therapy to manage symptoms and prevent future strokes.
This document provides information on urticaria (hives), including:
- Urticaria is characterized by itchy pink swellings (wheals) that appear on the skin and do not last more than 24 hours. It is classified as acute (<6 weeks) or chronic (>6 weeks).
- Urticaria is caused by mast cell degranulation releasing histamine, causing increased capillary permeability and fluid leakage leading to wheal formation.
- There are different types of physical urticarias triggered by factors like cold, heat, sunlight, pressure, water, etc. Investigation and treatment depends on the identified cause.
- Antihistamines are the main treatment for symptom
This document discusses five auxiliary methods of treatment in homeopathy:
1. Galvanism and electricity, which can stimulate weak muscles but may later cause paralysis.
2. Magnetism, where poles of a magnet are applied to affected areas for varying lengths of time.
3. Mesmerism, introduced by Mesmer, where a mesmerizer transfers their vital energy to a patient through passes with or without contact. There is positive and negative mesmerism.
4. Massage given by a good-natured person to restore muscle tone and circulation.
5. Baths in pure water, with lukewarm baths helpful for certain conditions and cold baths useful for deficient vital heat after a
Psoriasis is a chronic, inflammatory skin condition characterized by red scaly patches that is genetically determined. It has various clinical types including plaque, guttate, pustular and erythrodermic psoriasis. Treatment involves topical therapies like emollients, dithranol and topical steroids. For moderate to severe cases, phototherapy using PUVA or systemic therapies like methotrexate are used. Management in health posts focuses initially on topical therapies with referral for extensive or pustular psoriasis requiring further treatment.
Case presentation on pemphigus vulgarisRumana Hameed
This document presents a case presentation on Pemphigus Vulgaris. The patient is an 85 year old female who presented with fluid filled lesions all over her body. On examination, multiple fluid filled blisters were seen over the limbs and trunk along with oral lesions. A skin biopsy showed features of Pemphigus Vulgaris. The patient was started on medications including antibiotics, corticosteroids, antacids and topical steroids. She was counselled about her disease, medications, lifestyle modifications and potential drug interactions.
Eczema herpeticum is a skin infection caused by the herpes simplex virus that commonly causes cold sores. It occurs in people with inflammatory skin conditions like atopic dermatitis. The herpes virus infects large areas of compromised skin. Symptoms include clusters of small, painful blisters that ooze pus and can cause fever. Prompt diagnosis is important as eczema herpeticum can spread widely and become serious without treatment.
this is a case study on tonsillitis , this details about the diagnosis, management, treatment, patient counselling & pharmacist interventions , regarding medication etc , and also describes in detail about all aspects of tonsillitis .
please comment if you read this
thank u
The document describes a case of a 19-year-old male student who sustained a tibia fracture 4 months ago during a rugby match and was admitted for surgery to treat a non-union of the fracture. Examination found deformity, restricted movement, and mobility at the fracture site. The patient will undergo surgery involving fibular osteotomy, removal of necrotic bone, reamed intramedullary nailing, and compression plating to treat the non-union.
The patient, a 45-year-old female, presented with right-sided weakness, vomiting episodes, and left mouth deviation. She has a history of rheumatic heart disease and previous stroke. Laboratory tests revealed elevated liver enzymes and abnormalities in cell counts. She was diagnosed with cerebrovascular accident and hemiplegia due to a previous cardioembolic stroke. Her treatment plan includes anticoagulants, antiplatelets, statins, and physical therapy to manage symptoms and prevent future strokes.
This document provides information on urticaria (hives), including:
- Urticaria is characterized by itchy pink swellings (wheals) that appear on the skin and do not last more than 24 hours. It is classified as acute (<6 weeks) or chronic (>6 weeks).
- Urticaria is caused by mast cell degranulation releasing histamine, causing increased capillary permeability and fluid leakage leading to wheal formation.
- There are different types of physical urticarias triggered by factors like cold, heat, sunlight, pressure, water, etc. Investigation and treatment depends on the identified cause.
- Antihistamines are the main treatment for symptom
This document discusses five auxiliary methods of treatment in homeopathy:
1. Galvanism and electricity, which can stimulate weak muscles but may later cause paralysis.
2. Magnetism, where poles of a magnet are applied to affected areas for varying lengths of time.
3. Mesmerism, introduced by Mesmer, where a mesmerizer transfers their vital energy to a patient through passes with or without contact. There is positive and negative mesmerism.
4. Massage given by a good-natured person to restore muscle tone and circulation.
5. Baths in pure water, with lukewarm baths helpful for certain conditions and cold baths useful for deficient vital heat after a
Psoriasis is a chronic, inflammatory skin condition characterized by red scaly patches that is genetically determined. It has various clinical types including plaque, guttate, pustular and erythrodermic psoriasis. Treatment involves topical therapies like emollients, dithranol and topical steroids. For moderate to severe cases, phototherapy using PUVA or systemic therapies like methotrexate are used. Management in health posts focuses initially on topical therapies with referral for extensive or pustular psoriasis requiring further treatment.
Case presentation on pemphigus vulgarisRumana Hameed
This document presents a case presentation on Pemphigus Vulgaris. The patient is an 85 year old female who presented with fluid filled lesions all over her body. On examination, multiple fluid filled blisters were seen over the limbs and trunk along with oral lesions. A skin biopsy showed features of Pemphigus Vulgaris. The patient was started on medications including antibiotics, corticosteroids, antacids and topical steroids. She was counselled about her disease, medications, lifestyle modifications and potential drug interactions.
Eczema herpeticum is a skin infection caused by the herpes simplex virus that commonly causes cold sores. It occurs in people with inflammatory skin conditions like atopic dermatitis. The herpes virus infects large areas of compromised skin. Symptoms include clusters of small, painful blisters that ooze pus and can cause fever. Prompt diagnosis is important as eczema herpeticum can spread widely and become serious without treatment.
Cellulitis is an acute skin infection caused by bacteria such as staphylococcus or streptococcus entering through a break in the skin. It causes redness, pain, warmth and swelling at the infection site. Risk factors include skin injuries, insect bites, vascular or immune diseases. Treatment involves antibiotics, pain relief, and elevating the infected area. With proper treatment, a full recovery is expected within 7 to 10 days. However, cellulitis can cause serious complications if not treated promptly.
A 5-year-old boy presented with vomiting 7-8 times per day for 2 days. On examination, he had some signs of dehydration. Investigations showed normal results. He was managed conservatively with IV fluids, electrolytes, antibiotics, and symptomatic treatment. The summary provides the key details about the patient's presentation and management in 3 sentences.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Coma is a common medical emergency that requires careful management to prevent further brain damage. Emergency treatment focuses on maintaining oxygenation, circulation, controlling seizures, reducing intracranial pressure, and maintaining normal body temperature. Ongoing care involves monitoring vital signs, providing nutrition, preventing infection, and stimulating the patient as appropriate. The cause of coma must be determined through examination, investigations, and monitoring the patient's response to treatment.
This document provides an overview of the principles of shock management. It defines shock and describes its causes, including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The pathophysiology of shock is explained at the cellular, microvascular, and systemic levels. The stages of shock - non-progressive, progressive decompensated, and decompensated - are outlined. Signs and symptoms of shock are provided. Finally, the document discusses the general management of shock, which aims to improve oxygen delivery and utilization to prevent organ injury through restoration of perfusion and supportive care.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
This case presentation summarizes a 36-year-old male admitted with acute ischemic stroke presenting with right hemiparesis and reduced vision in the right eye. Diagnostic workup including CT scan revealed an acute infarct in the left occipito-parietal region. He was diagnosed with acute ischemic stroke and treated with medications including aspirin, clopidogrel, atorvastatin, and mannitol. His symptoms improved over his hospital stay and he was discharged on aspirin and clopidogrel with counseling on medication adherence and lifestyle modifications to prevent further complications.
Neurogenic shock is a life-threatening condition caused by damage to the spinal cord or central nervous system, which disrupts blood circulation. Common causes include motor vehicle accidents, falls, violence, and sports injuries. Symptoms include extreme back pain, paralysis, numbness, difficulty breathing, and abnormal heart rate or blood pressure. Treatment focuses on stabilizing the spine, preventing complications, and managing symptoms through medications, immobilization, or surgery. Long term care aims to support mobility and independence through assistive devices and rehabilitation.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
Urticaria, commonly known as hives, is a skin rash with pale red, itchy bumps that appear and disappear quickly. It is characterized by transient wheals (swellings) and angioedema (swelling of deeper layers of skin). Urticaria can be caused by allergic reactions, infections, physical stimuli like heat, cold, pressure, or vibrations. It is classified as acute, chronic, physical or contact urticaria. Treatment involves identifying and avoiding triggers, and using antihistamines.
AURUM METALLICUM Homoeopathic materia medica slide show presentation by Dr.H...Dr.hansraj salve
AURUM METALLICUM Homeopathic materia medica slide show presentation by Dr.Hansraj salve. Learn whole homeopathic Materia medica in new style with Dr.hansraj salve click on the linkTo start study and For daily new drug update visit to our Website - hmmslideshow.esy.es
This document discusses atopic dermatitis (AD), also known as eczema. Some key points:
1. AD is a chronic, relapsing inflammatory skin disease that is most common in childhood. It affects 15-20% of children in industrialized nations.
2. Symptoms vary by age but commonly include itchy, red, scaly skin rashes. Lesions typically affect the face, neck, hands and skin folds.
3. AD results from a complex interaction between genetic and environmental factors. Triggers include wool, harsh soaps and emotional stress. Treatment focuses on reducing triggers and includes emollients, topical steroids and antihistamines.
This document discusses cellulitis, a spreading skin infection caused by bacteria. It describes the typical symptoms of cellulitis like redness, swelling and pain. Common causes include injuries, diabetes, and low immunity. The document outlines treatments like antibiotics and rest. It also discusses other common skin conditions like itching, pain, discoloration, numbness and increased sensitivity. Prevention through education is mentioned.
Surgical infections are a major challenge, accounting for 1 in 3 surgical patients. Factors like adequate microorganisms, virulence, suitable environment, and susceptible host contribute to infections. Common pathogens include Streptococci, Staphylococci, and Gram-negative organisms. Treatment involves debridement, drainage, antibiotic therapy tailored to the specific pathogen, and supportive measures. Antibiotic prophylaxis based on wound classification can help reduce postoperative infection risk.
Pemphigus is a rare autoimmune blistering disease of the skin and mucous membranes caused by antibodies against desmoglein proteins. There are three main types - pemphigus vulgaris affects the mouth and skin, pemphigus foliaceus affects the scalp and upper trunk, and paraneoplastic pemphigus is the most severe and associated with cancer. Diagnosis involves biopsy and detecting antibodies. Treatment aims to control the disease and involves high-dose corticosteroids sometimes with steroid-sparing immunosuppressants or other therapies like intravenous immunoglobulins or plasmapheresis.
The document provides guidance on conducting a dermatological history and examination. It outlines taking a thorough history including details of the presenting complaint, past medical history, medications, and social history. The examination section describes inspecting the skin lesions carefully, noting their characteristics, distribution, and secondary changes. The examiner is advised to obtain consent, ensure comfort, and summarize findings and differential diagnosis.
A 22-year-old female presented with 5 months of nasal blockage and headache. Examination found proptosis of the eyes, swelling of the right cheek, and polyps obstructing the nasal cavity. Imaging showed haziness of the sinuses and obliteration of the nasal cavity. She underwent surgery including polypectomy and Caldwell Luc procedure on the right side to address suspected fungal sinusitis with polyps.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
The document provides an overview of psoriasis including prevalence, genetics, clinical variants, and treatment options. It states that psoriasis affects 2-4.6% of the population and has genetic and immune system factors. The most common form is chronic plaque psoriasis presenting as raised red lesions often located on the elbows and knees. Treatment includes topical corticosteroids, vitamin D analogs, retinoids, phototherapy, and systemic therapies like methotrexate, cyclosporine, and acitretin. All treatments have potential side effects and limitations.
This document provides an overview of psoriasis including its prevalence, genetics, clinical variants, and treatment options. Psoriasis affects approximately 2-4.6% of the population worldwide. It has a genetic component and is associated with the immune system. Treatment includes topical therapies like corticosteroids and vitamin D analogues, phototherapy like UVB and PUVA, and systemic therapies like methotrexate, cyclosporine, and biologics which have side effects and require monitoring.
Cellulitis is an acute skin infection caused by bacteria such as staphylococcus or streptococcus entering through a break in the skin. It causes redness, pain, warmth and swelling at the infection site. Risk factors include skin injuries, insect bites, vascular or immune diseases. Treatment involves antibiotics, pain relief, and elevating the infected area. With proper treatment, a full recovery is expected within 7 to 10 days. However, cellulitis can cause serious complications if not treated promptly.
A 5-year-old boy presented with vomiting 7-8 times per day for 2 days. On examination, he had some signs of dehydration. Investigations showed normal results. He was managed conservatively with IV fluids, electrolytes, antibiotics, and symptomatic treatment. The summary provides the key details about the patient's presentation and management in 3 sentences.
Erythroderma is defined as the scaling erythematous dermatitis involving 90% or more of the cutaneous surface.
Also known as exfoliative dermatitis
Idiopathic exfoliative dermatitis – also known as the “red man syndrome”, is characterized by marked palmoplantar keratoderma, dermatopathic lymphadenopathy,increased IgE.
Increased skin perfusion leads to
Temperature dysregulation >
Resulting in skin loss and hypothermia >
High output state >
Cardiac failure
BMR raises to compensate for heat loss
Increased dehydration due to transpiration (similar to burns)
All lead to negative nitrogen balance and characterized by edema, hypoalbuminemia, loss of muscle mass.
Coma is a common medical emergency that requires careful management to prevent further brain damage. Emergency treatment focuses on maintaining oxygenation, circulation, controlling seizures, reducing intracranial pressure, and maintaining normal body temperature. Ongoing care involves monitoring vital signs, providing nutrition, preventing infection, and stimulating the patient as appropriate. The cause of coma must be determined through examination, investigations, and monitoring the patient's response to treatment.
This document provides an overview of the principles of shock management. It defines shock and describes its causes, including hypovolemic, cardiogenic, obstructive, distributive, and endocrine shock. The pathophysiology of shock is explained at the cellular, microvascular, and systemic levels. The stages of shock - non-progressive, progressive decompensated, and decompensated - are outlined. Signs and symptoms of shock are provided. Finally, the document discusses the general management of shock, which aims to improve oxygen delivery and utilization to prevent organ injury through restoration of perfusion and supportive care.
This case involves a 25-year-old woman who presented to the emergency department with shortness of breath and an expanding rash. She has a history of asthma and allergies to aspirin and shellfish. On exam, she was tachypnic, hypertensive, and had periorbital edema and scattered wheals. Her symptoms and history are concerning for anaphylaxis.
This case presentation summarizes a 36-year-old male admitted with acute ischemic stroke presenting with right hemiparesis and reduced vision in the right eye. Diagnostic workup including CT scan revealed an acute infarct in the left occipito-parietal region. He was diagnosed with acute ischemic stroke and treated with medications including aspirin, clopidogrel, atorvastatin, and mannitol. His symptoms improved over his hospital stay and he was discharged on aspirin and clopidogrel with counseling on medication adherence and lifestyle modifications to prevent further complications.
Neurogenic shock is a life-threatening condition caused by damage to the spinal cord or central nervous system, which disrupts blood circulation. Common causes include motor vehicle accidents, falls, violence, and sports injuries. Symptoms include extreme back pain, paralysis, numbness, difficulty breathing, and abnormal heart rate or blood pressure. Treatment focuses on stabilizing the spine, preventing complications, and managing symptoms through medications, immobilization, or surgery. Long term care aims to support mobility and independence through assistive devices and rehabilitation.
This document provides an overview of burns, including their anatomy, physiology, incidence, causes, classifications, stages of treatment, complications, and nursing management. It begins with definitions of burns and classifications according to depth and extent. It then discusses the pathophysiology and presents the three phases of burn care - emergent/resuscitative, acute/intermediate, and rehabilitation. Nursing priorities and treatments are outlined for each phase, including wound care, pain management, and psychological support. Surgical procedures and potential complications are also reviewed.
Urticaria, commonly known as hives, is a skin rash with pale red, itchy bumps that appear and disappear quickly. It is characterized by transient wheals (swellings) and angioedema (swelling of deeper layers of skin). Urticaria can be caused by allergic reactions, infections, physical stimuli like heat, cold, pressure, or vibrations. It is classified as acute, chronic, physical or contact urticaria. Treatment involves identifying and avoiding triggers, and using antihistamines.
AURUM METALLICUM Homoeopathic materia medica slide show presentation by Dr.H...Dr.hansraj salve
AURUM METALLICUM Homeopathic materia medica slide show presentation by Dr.Hansraj salve. Learn whole homeopathic Materia medica in new style with Dr.hansraj salve click on the linkTo start study and For daily new drug update visit to our Website - hmmslideshow.esy.es
This document discusses atopic dermatitis (AD), also known as eczema. Some key points:
1. AD is a chronic, relapsing inflammatory skin disease that is most common in childhood. It affects 15-20% of children in industrialized nations.
2. Symptoms vary by age but commonly include itchy, red, scaly skin rashes. Lesions typically affect the face, neck, hands and skin folds.
3. AD results from a complex interaction between genetic and environmental factors. Triggers include wool, harsh soaps and emotional stress. Treatment focuses on reducing triggers and includes emollients, topical steroids and antihistamines.
This document discusses cellulitis, a spreading skin infection caused by bacteria. It describes the typical symptoms of cellulitis like redness, swelling and pain. Common causes include injuries, diabetes, and low immunity. The document outlines treatments like antibiotics and rest. It also discusses other common skin conditions like itching, pain, discoloration, numbness and increased sensitivity. Prevention through education is mentioned.
Surgical infections are a major challenge, accounting for 1 in 3 surgical patients. Factors like adequate microorganisms, virulence, suitable environment, and susceptible host contribute to infections. Common pathogens include Streptococci, Staphylococci, and Gram-negative organisms. Treatment involves debridement, drainage, antibiotic therapy tailored to the specific pathogen, and supportive measures. Antibiotic prophylaxis based on wound classification can help reduce postoperative infection risk.
Pemphigus is a rare autoimmune blistering disease of the skin and mucous membranes caused by antibodies against desmoglein proteins. There are three main types - pemphigus vulgaris affects the mouth and skin, pemphigus foliaceus affects the scalp and upper trunk, and paraneoplastic pemphigus is the most severe and associated with cancer. Diagnosis involves biopsy and detecting antibodies. Treatment aims to control the disease and involves high-dose corticosteroids sometimes with steroid-sparing immunosuppressants or other therapies like intravenous immunoglobulins or plasmapheresis.
The document provides guidance on conducting a dermatological history and examination. It outlines taking a thorough history including details of the presenting complaint, past medical history, medications, and social history. The examination section describes inspecting the skin lesions carefully, noting their characteristics, distribution, and secondary changes. The examiner is advised to obtain consent, ensure comfort, and summarize findings and differential diagnosis.
A 22-year-old female presented with 5 months of nasal blockage and headache. Examination found proptosis of the eyes, swelling of the right cheek, and polyps obstructing the nasal cavity. Imaging showed haziness of the sinuses and obliteration of the nasal cavity. She underwent surgery including polypectomy and Caldwell Luc procedure on the right side to address suspected fungal sinusitis with polyps.
BELL'S PALSY IS AN IDIOPATHIC LMN TYPE FACIAL PALSY..THE SEMINAR TELLS YOU OF COURSE OF NERVE..FACIAL MUSCLES THEIR ACTION..HOW TO EXAMINE..THE SEQUELAE OF FACIAL PALSY...LOOK AT IT..
The document provides an overview of psoriasis including prevalence, genetics, clinical variants, and treatment options. It states that psoriasis affects 2-4.6% of the population and has genetic and immune system factors. The most common form is chronic plaque psoriasis presenting as raised red lesions often located on the elbows and knees. Treatment includes topical corticosteroids, vitamin D analogs, retinoids, phototherapy, and systemic therapies like methotrexate, cyclosporine, and acitretin. All treatments have potential side effects and limitations.
This document provides an overview of psoriasis including its prevalence, genetics, clinical variants, and treatment options. Psoriasis affects approximately 2-4.6% of the population worldwide. It has a genetic component and is associated with the immune system. Treatment includes topical therapies like corticosteroids and vitamin D analogues, phototherapy like UVB and PUVA, and systemic therapies like methotrexate, cyclosporine, and biologics which have side effects and require monitoring.
This document summarizes psoriasis, including its pathogenesis, clinical presentations, management options, and natural history. Psoriasis is a common immune-mediated disease affecting the skin. It has both genetic and environmental triggers. Management includes general measures, topical therapies like steroids and vitamin D analogues, phototherapy, and systemic agents for more severe cases. Treatment aims to control symptoms and improve quality of life, as psoriasis can have a significant psychosocial impact despite usually not being severely symptomatic.
This document discusses antifungal treatment options for both superficial and systemic fungal infections. It covers several classes of antifungals including azoles like fluconazole, itraconazole, and ketoconazole as well as other drugs like terbinafine, griseofulvin. It provides details on indications, pharmacokinetics, drug interactions, monitoring parameters, and adverse effects for common antifungal therapies.
This document provides information on the diagnosis and management of atopic dermatitis (AD). It begins by describing the characteristic features of AD including its typical onset in infancy or early childhood and association with asthma and allergic rhinitis. It then outlines the Hanifin and Rajka diagnostic criteria. Key aspects of the epidemiology, pathogenesis, and treatment approach according to severity are summarized. Treatment involves moisturizers and topical corticosteroids with systemic immunosuppressants or phototherapy for more severe cases.
Psoriasis is a chronic, non-contagious inflammatory disease of the skin characterized by red patches covered with silvery scales. It most commonly affects the elbows, knees, scalp, back and torso. Factors like genetics, infections, stress, and certain medications can trigger flare-ups. Treatment involves topical creams and ointments, phototherapy using UV light, or systemic medications in severe cases. Managing stress and keeping skin moisturized can also help control symptoms.
This document discusses psoriasis and scabies. Psoriasis is a chronic inflammatory skin disorder characterized by thickened, scaly plaques that affects 1.5-3% of the population worldwide. Scabies is a contagious skin infection caused by the mite Sarcoptes scabiei that causes intense itching. Treatment for psoriasis includes topical therapies like corticosteroids and vitamin D analogues, phototherapy, and systemic immunosuppressants. Scabies is transmitted through direct skin contact and presents as a pimple-like rash and sores from scratching.
learning objectives : Pathophysiology of Psoriasis
Common sites with pictures
Pharmacotherapy of Psoriasis
Local Drug therapy
Systemic Drug therapy
Biological therapy
Phototherapy
The document discusses several skin conditions and the role of physiotherapy in treating them. It describes conditions like acne, alopecia, psoriasis, vitiligo, and hyperhidrosis. For each condition, it discusses symptoms, types, potential causes, and treatment options including medications, phototherapy, and physiotherapy techniques. Physiotherapy can include ultraviolet radiation therapy, exercises to improve joint mobility and circulation, maintaining skin integrity and hygiene, and reducing friction. Ultraviolet radiation is used to treat several dermatological conditions like psoriasis and increase vitamin D production.
This document provides information on various dermatological conditions including:
- Pityriasis versicolor, describing presentation, diagnosis via KOH mount, and treatment with selenium sulfide or ketoconazole.
- Acne vulgaris, outlining exacerbating factors to avoid and medical management approaches for moderate and severe cases including topical and oral medications. Details are given on isotretinoin use and monitoring.
- Rosacea, defining diagnostic criteria and stages, differential diagnosis, and treatment approaches including lifestyle modifications and topical or oral antibiotics.
- Vitiligo, alopecia areata, scabies, lichen planus, and psoriasis, briefly covering presentation, diagnosis
- A 7-year-old boy presented with a new rash, fatigue, cough, and irritated lips. Examination found diffuse papular skin lesions, conjunctival injection, and cracked lips.
- This presentation is consistent with Stevens-Johnson syndrome (SJS), a severe mucocutaneous reaction typically caused by medications. SJS involves epidermal necrosis and detachment that ranges in severity.
- Management involves withdrawal of any offending medications, supportive care including wound care and fluid management, and possible immunosuppressants though evidence is limited. Prognosis depends on the severity and extent of skin and mucosal involvement.
Thyroid surgery involves rendering patients euthyroid with antithyroid drugs before operation and using potassium iodide to reduce thyroid size and vascularity. A subtotal thyroidectomy is performed, leaving a portion of one lobe. While complications are rare, 15% of patients become permanently hypothyroid and 5% remain thyrotoxic. Radioactive iodine treatment with 131I is also described, being effective in 75% of patients within 4-12 weeks but sometimes resulting in hypothyroidism. Hypothyroidism is then discussed, including its causes, features, and treatment with levothyroxine replacement.
Psoriasis is a chronic skin condition characterized by inflamed plaques and scales. It affects 1-3% of populations and has a genetic component. The causes involve an immune reaction and abnormal skin cell growth. Symptoms range from small red spots to widespread inflammation. Treatments include topical creams and light therapy. For severe cases, oral medications like retinoids, methotrexate and biologics may be used. Psoriasis has no cure and requires long-term management of symptoms.
Juvenile arthritis is a common condition in children that causes joint inflammation and pain. It can be classified as acute, sub-acute, or chronic based on the duration of symptoms. The most common type is juvenile idiopathic arthritis, which refers to conditions characterized by chronic joint inflammation. Treatment involves medications like NSAIDs and DMARDs to reduce inflammation and pain, physical or occupational therapy to maintain mobility, and surgery in severe cases to correct joint deformities. Nursing care focuses on alleviating pain, increasing mobility through exercise, promoting independence in self-care, and ensuring patients understand their condition and treatment plan.
Acne and rosacea are extremely common skin conditions that can have a significant psychological and social impact. Acne is caused by factors like blocked hair follicles, increased sebum production, inflammation, bacteria, and hormones. Rosacea has different clinical forms including papules/pustules and redness/telangiectasias. Both are managed with topical treatments like retinoids, antibiotics, and oral antibiotics/isotretinoin for more severe cases. Patients require long-term treatment to control symptoms.
Other cutaneous problems associated with viral infectionsdr maria saeed
This ppt include Pityriasis rosea,Papular pruritic gloves and socks syndrome,Torch infection,gianotti crosti syndrome,Measles from text book of Rook's dermatology
This document provides information on various dermatological topics discussed at an EADV pearls session in November 2018. It covers dermoscopy of pigmented and raised facial lesions, sexually transmitted diseases, rosacea, cutaneous lymphomas, hidradenitis suppurativa, pediatric dermatology, atopic dermatitis, hair loss, lichen planus, oral cavity cancers, nail disorders, and autoimmune vesicobullous disorders. Key points include dermoscopy increasing biopsies of pigmented facial lesions, features of different conditions, and treatment recommendations.
Psoriasis is a chronic skin condition characterized by excessive skin cell growth. It has both genetic and environmental triggers. The most common form, plaque psoriasis, presents as raised, red patches covered with silvery scales on the elbows, knees, scalp and other areas. Treatment depends on the severity but includes topical creams and ointments, phototherapy, oral medications and newer biologic therapies that target specific proteins involved in inflammation. While there is no cure for psoriasis, current treatments can effectively control symptoms and clear the skin lesions.
Dermatologic Emergencies - Dr. Sicilianobcooper876
This document summarizes an emergency medicine presentation on approaching undifferentiated skin lesions. It reviews dermatology basics for emergency physicians, including how to describe rashes and differentially diagnose the unknown lesion. A modified Lynch algorithm is presented to categorize rashes based on morphology, distribution, and whether the patient is sick or well-appearing. Two rare but important dermatologic emergencies are discussed in more detail - generalized pustular psoriasis and necrotizing soft tissue infections. The talk emphasizes recognizing toxic from non-toxic rashes and getting early specialist involvement and surgical intervention when needed.
Actinomycosis is caused by Actinomyces israelii, a gram-positive bacterium. It most commonly infects the cervicofacial region and presents with draining sinuses and indurated nodules. Diagnosis is made by microscopy showing branching filaments or culturing the bacteria. Treatment involves prolonged courses of penicillin or tetracyclines. Septicemia is the presence of bacteria and toxins in the blood, potentially leading to systemic inflammatory response syndrome and multi-organ failure. Both gram-positive and gram-negative bacteria can cause septicemia. Pyaemia involves disseminated bacterial emboli in multiple organs causing abscesses. Cancrum oris
1. Brown-Séquard syndrome was first described in 1850 based on observations of machete injuries in sugar cane farmers, with key features being ipsilateral motor paralysis and mixed sensory loss below the level of the spinal cord lesion.
2. Understanding the anatomy of ascending and descending spinal tracts is important for explaining the clinical features of Brown-Séquard syndrome and other spinal cord injuries.
3. Injuries can disrupt motor or sensory tracts differently, causing varying neurological deficits depending on whether the lesion involves upper or lower motor neurons.
The document discusses several inflammatory arthropathies known as spondylarthropathies. They are commonly associated with the HLA B27 gene and involve entheses, synovium, and the spine. Major types include ankylosing spondylitis, psoriatic arthropathy, reactive arthritis, and enteropathic arthritis. They often present with enthesitis, uveitis, and spondylitis and are treated with NSAIDs, DMARDs, anti-TNF drugs, or surgery depending on the specific condition and symptoms.
Lung cancer is classified into two main types - non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). NSCLC makes up about 80% of cases and can be further divided into squamous cell carcinoma, adenocarcinoma, and large cell carcinoma. SCLC accounts for 10-15% of lung cancers and grows more quickly. The main symptoms are cough, chest pain, and coughing up blood. Risk factors include smoking, asbestos exposure, and radiation exposure. Diagnosis involves tests such as sputum analysis, biopsies, CT scans, and PET scans to determine the cancer type and stage. Treatment options depend on the cancer type and stage but may include surgery, chemotherapy
Eczema herpeticum is a potentially life-threatening herpes infection that occurs when herpes simplex virus infects disrupted skin in patients with pre-existing skin conditions like eczema or atopic dermatitis. It presents with clusters of vesicles and punched-out erosions that spread and become hemorrhagic and crusted. Diagnosis involves identifying characteristic lesions along with fever and pain, and can be confirmed with tests like Tzanck smear, viral culture, or antibody testing. Aggressive treatment with IV acyclovir is required to prevent complications like herpes keratitis, which can lead to blindness. Early recognition and effective antiviral therapy are important given the potential severity of eczema her
The vagus nerve connects organs in the neck and below to the brainstem. It has both sensory and motor functions and helps control the heart rate, digestion, and other involuntary processes. Stimulation of the vagus nerve has been shown to reduce seizures, experimental pain, and inflammation, and may help treat conditions like epilepsy, obesity, and heart disease. Damage to the vagus nerve or its connections in the brainstem can impact swallowing, heart rate variability, and level of consciousness.
Poor water and sanitation are responsible for a huge global burden of disease, with contaminated water alone contributing to about 2.4 million preventable deaths per year, mainly in children. While progress has been made in increasing access to safe water and improved sanitation, current rates of progress will not meet the Millennium Development Goal targets. Water and sanitation remain a low priority on international development agendas despite their importance for health and achieving the MDGs. Coordinated efforts are still needed to address this critical issue.
This document discusses medical student electives in developing countries. It notes potential benefits like exposure to rare diseases and personal growth, but also flags ethical issues. Electives could exploit local health systems and raise false expectations. They may perpetuate neo-colonial practices by benefiting students and health systems in wealthy countries more than local populations. The document also examines how non-governmental organizations can undermine public health systems and calls for electives to minimize harm, respect local needs, and establish long-term exchange programs to provide mutual benefit.
This document provides an overview of global health by defining key terms, outlining major players and organizations, and summarizing the history and evolution of the field from 1945 to the present day. It describes how global health has shifted from a focus on infectious disease control to addressing social determinants of health and health issues that transcend national borders. Major milestones discussed include the founding of the UN and WHO, the Alma-Ata Declaration, structural adjustment policies, the Millennium Declaration and MDGs, debt relief campaigns, and the establishment of the Global Fund. The summary highlights the ongoing tension between disease-specific and comprehensive primary healthcare approaches.
The document discusses how international organizations like the WTO and treaties it has established like TRIPS and GATS impact healthcare. The WTO aims to liberalize trade and its dispute process enforces agreements. TRIPS established intellectual property standards that require drug patenting, raising prices. Some countries like Brazil and South Africa have issued compulsory licenses to produce cheaper generics, facing opposition from pharmaceutical companies but helping improve access to treatment.
Global health examines influences on health across borders, including issues like globalization, poverty, and human rights. It draws from multiple disciplines. Globalization refers to reducing barriers between countries, leading to increased trade, investment, and communication. This has effects like economic growth but also rising inequalities. Agreements like TRIPS have increased pharmaceutical patent protection globally, raising concerns about access to medicines, especially in developing countries. Networks of both commercial and civil society actors have been important in debates over balancing intellectual property with public health.
Migration of health care workers has both positive and negative effects on health. It reduces the availability of health services in source countries while increasing access in destination countries. This unequal distribution of health workers is driven by push factors like low pay and poor working conditions in source countries and pull factors like higher wages in destination countries. As a result, source countries experience worse health outcomes due to lack of health workers, while destination countries receive an indirect subsidy through the receipt and employment of trained medical professionals from poorer nations. Proposed policy responses aim to strengthen health systems in source countries, implement ethical recruitment practices, and foster partnerships between nations to promote more equitable health worker distribution.
Global institutions play major roles in health financing and policy. The key players discussed are the World Health Organization (WHO), World Bank, International Monetary Fund (IMF), and World Trade Organization (WTO). The WHO is the UN agency for health, working with 192 member states. The World Bank aims to reduce poverty through loans and policy advice to developing countries. The IMF promotes international monetary cooperation and provides temporary financial assistance. The WTO, formed in 1995, ensures trade flows freely through treaties and enforcement mechanisms, which some criticize can undermine public health systems.
Haemochromatosis is an autosomal recessive condition characterized by excessive iron accumulation in the body. It affects around 0.5% of Caucasians and usually presents in the 40s-50s with a triad of pigmentation, diabetes mellitus, and hepatomegaly. Diagnosis involves blood tests showing elevated serum iron, transferrin saturation over 50%, and elevated serum ferritin. Liver biopsy can confirm iron deposition and damage. Treatment aims to reduce iron stores through weekly venesection of 1 unit of blood for 6-12 months followed by maintenance venesection.
Ascites is an abnormal collection of fluid in the peritoneal cavity, commonly caused by portal hypertension due to cirrhosis. It results from sodium and water retention triggered by vasodilation and activation of the renin-angiotensin system, as well as increased hydrostatic pressure and transudation of fluid from the liver and spleen into the peritoneal cavity. Hypoalbuminemia due to decreased liver function also contributes by reducing plasma oncotic pressure. Spironolactone is used as treatment as it is an aldosterone antagonist. Management involves dietary sodium restriction, diuretics, stopping alcohol, monitoring for complications, and procedures such as paracentesis or shunts.
The liver has two lobes, separated by veins, and is divided into sections supplied by individual blood vessels. Blood flows through hepatic arteries and portal veins into sinusoids, where waste is filtered by Kupffer cells in the space of Disse before draining into hepatic veins. The liver performs many functions including synthesizing proteins, metabolizing carbohydrates and lipids, and detoxifying hormones and drugs. Liver function can be assessed through blood tests of enzymes and proteins.
Antidepressants such as SSRIs, TCAs, and MAOIs work by increasing levels of serotonin, norepinephrine, or both in the brain. SSRIs are generally first-line treatment and safer in overdose than TCAs, but TCAs may be better for severe depression. Both classes of drugs can cause side effects like dry mouth, nausea, and sexual dysfunction. Antidepressants may take 10-20 days to work and should be continued for at least 6 months after symptoms improve to prevent relapse. Combining certain antidepressants can be dangerous due to increased serotonin levels.
Gout is caused by deposition of uric acid crystals in the joints, which leads to acute inflammation. It typically presents as sudden severe pain, swelling and redness in one joint, most commonly the big toe. Diagnosis is made based on symptoms and identification of crystals in joint fluid under polarized microscopy. Treatment involves medications to reduce symptoms during acute attacks as well as long-term drugs like allopurinol or probenecid to lower uric acid levels and prevent future episodes. Without treatment, gout can progress to a chronic stage with multiple joint involvement and growth of tophi deposits in the tissues.
Review of orthopaedic services: Prepared for the Auditor General for Scotland...meducationdotnet
1. Orthopaedics is a large specialty that treats musculoskeletal conditions through surgery, medication, and rehabilitation. It accounts for a significant portion of NHS spending and activity in Scotland.
2. Waiting times for orthopaedic services have reduced in recent years through changes to service delivery and additional funded activity. However, further improvements to meet 18-week referral targets will be challenging to sustain.
3. There is variation in orthopaedic efficiency across Scotland that is not fully explained by resources or procedures. The report finds opportunities to use existing resources more efficiently through measures like increasing day surgery and reducing hospital length of stay.
This document discusses the use of muscle relaxants in anesthesia and the potential role of sugammadex as a reversal agent. It provides background on why muscle relaxants are used, types of muscle relaxants, and current problems with reversal agents. It then summarizes research on sugammadex, which appears to be a more effective reversal agent than anticholinesterases, allowing faster recovery from neuromuscular blockade. Sugammadex may allow safer use of muscle relaxants and replace agents like suxamethonium, but economic factors will also influence its adoption.
This document contains a series of slides related to ophthalmology. It tests the reader's knowledge on topics like visual acuity measurements, refractive errors, eye abnormalities, causes of vision loss, and eye examination techniques. The slides include images showing conditions like cataracts, glaucoma, retinal detachments, and more. Key details are provided about diagnoses, symptoms, investigations, and treatments.
1. Block 18 Week 7: Psoriasis
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Psoriasis
Chronic T-cell-mediated autoimmune disease
Histology
Inflammatory T-cell infiltratedirected againstoneor more antigens
Abnormal proliferation and differentiation
Vascular proliferation
Epidemiology
Psoriasisiscommon
o prevalence 1-3% (Faroes 5%)
Polygenic with different genes important in different individuals (monozygotic twin
concordance~74%)
Association with IBD
May demonstrate Koebner (isomorphic) phenomenon (>40% of cases)
Age of onset has 2 peaks
5-10 years females;15-19years males
o Genetic influence
6th-7th decade (male=female)
o No genetic influence
Association between IBD and Psoriasis
Clinical Studies (Yates, VM et al 1982,Keohane, S et al 1998)
o most refer to Crohn’s
o psoriasisin Crohn’s ranges from4-12% (1.1-3% in controls)
Genetic studies
o HLA - Cw6, DR7
o genome scans - 16q
Antigen persistence
2. Block 18 Week 7: Psoriasis
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o In all cases,except one patient with Crohn’s disease,onset of psoriasis preceded onset of
abdominal diseaseby at least1 year
Genetic
o FH of psoriasisin 1stdegree relatives
o 5/84 IBD patients; 2/110 non-IBD patients
Emotional stress of severe IBD
Triggers
Trauma (Koebner) - In 38-76% of patients
Infection
o Throat infection (guttate) (tonsillectomy usually makes no difference)
o HIV
o Eg HHV?
Hormone
o Puberty
o pregnancy
UV light
o Sunburn
o iatrogenic
Emotional stress
Alcohol
Drugs
o Li+
o Beta blockers
o Antimalarials
o Can usevibramycin and minocin less effective
o Tetracyclines
o Terbinafine
o NSAIDS
o 187 more including CORTICOSTEROIDS
Types of Psoriasis
Flexural
Guttate
Localised pustular (PPP)
Unstable- Generalised pustular,Erthyrodermic
Nail
Hand
Joint
acral
Psoriasis Vulgaris
Well demarcated salmon-pink plaques with silvery whitescale - Auspitz sign
Elbows
Knees & shins
Scalp
Buttocks
Umbilicus
Nails (50%)
genitals
3. Block 18 Week 7: Psoriasis
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Psoriasis (flexural)
Commoner in adults
Partof psoriasisvulgarisor isolated (inverse) psoriasis
?Koebner to infection or seborrhoeic dermatitis
Therefore need to excludeinfection
Colour is typical
Scalingmay be absent
Flexural and Extensor Psoriasis
Flexural psoriasis often occurs in association with extensor
psoriasis
May fissure
Secondary infection is COMMON and hard to spot
Treatment
Consider,exclude or treat infection, especially C.albicans
Topical steroids (includingcombinations) aremainstay
Eosin & Brilliantgreen
Systemics may be needed
Guttate Psoriasis
Children and young adults
Infection related
o Especially streptococcal sorethroat
o ?tonsillectomy of littlevalue
50% clear and 50% are recurrent or progress to chronic Psoriasis
vulgaris
Localised Pustular Psoriasis
Palmoplantar pustulosis
Pink & scaly areas studded with pustules
In all stages
o Yellow
o Brown & flat
o detaching
Itchy and/or sore
Chronic and resistantto treatment
o Best evidence for RE-PUVA
Adults female>male
Especially smokers
4. Block 18 Week 7: Psoriasis
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Unstable Psoriasis
Previously stablepsoriasisthathas become erythrodermic or generalised pustular (GPP) as a resultof:
- Irritanttreatments
- Corticosteroids or other drugs
- Infection
- Pregnancy
- UV
- Unknown factors in many cases especially of GPP
GPP can occur in patients with no previous history of psoriasis
Adults
Erythema
Pustules
Systemic symptoms
Relapses occur
Management
Admission
Supportive therapy and remove trigger
factors
Emollients
Retinoid
Methotrexate iv
Complications
Hypothermia
Malabsorption
Protein and iron loss
Oedema
Heart failure
Nail Psoriasis
Partof all types in up to 50% or more
May be isolated finding
Often associated with PsA and dactylitis
Always check mycology before givingoral terbinafineas itexacerbates
psoriasisaswell as causingTEN
Hyperkeratotic hand & foot Psoriasis
Thick, fissuringhyperkeratotic plaques on palms and sole
o Thenar and hypothenar
o Possibly no psoriasiselsewhere
Can be hard to treat
o Fissures
Lassar’s pasteor superglue
o Emollient
o May be responseto topical tar,retinoid or dithranol aloneor in
combination (steroids)
o Topical PUVA +/- retinoid
Psoriatic arthropathy
Deforming inflammatory arthropathy develops in up to 23% of psoriasis patients
May predate psoriasis
Not related to skin severity
NSAIDS and corticosteroidscan exacerbatethe skin disease
5. Block 18 Week 7: Psoriasis
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Management
Patient Advice
Incurable
Chronic/recurrent
Not an infection
Not contagious
Not a genetic defect
Drugs and other trigger factors
What do patients want to achieve from
treatment
Do they wish systemic
Will they put creams on
Topical
Emollients
Occlusion
Tar
Dithranol
Retinoids
Steroids
Vitamin D
Topical: choice drug(s) and vehicle
Child or adult
Body site
Tolerability to the patient
Likelihood of compliance
Corticosteroids
Block the effect of T-cell mediators of inflammation atthe receptor level
o Therefore there may be a rebound inflammation when they are
withdrawn
o Most other therapies down regulate T-cells and induceapoptosis so
that remission is longer lasting
Useful atflexures, scalp and ?nails?
Useful in combination
Some dermatologists never use any corticosteroids
Tar
“complex mixtures”
o Crude------highly refined
o Cruder the better
Availablein creams and ointments as well as solution for bathing
Combinations with corticosteroid and or salicylic acid available
o Alphosyl
o CTS10% in Eumovate
o Betnovate 25% in CTP
Anti-inflammatory,antipruritic and antiseptic
Complications
o Contact dermatitis
o Folliculitis
o No clear evidence of carcinogenicity buttheoretically possible
Dithranol
Synthetic anthralin
Ideal vehicleis Lassar’s paste
o Short contact creams and micronised preparationsarefar easier to use at home but less
effective
Complications
o Irritancy.Unsuitablefor multiplesmall plaques.
o Stains everything in sightincludingbath enamel
6. Block 18 Week 7: Psoriasis
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Tazarotene
Retinoid
Very irritantin somepeople
Useful in hand psoriasis
Vitamin D analogues
Effects on cell division and differentiation.Therefore antiproliferativein psoriasis.
Mild-moderate psoriasis
Safe and well tolerated. Little stainingetc
Calcipotriol
Tacalcitol
Calcitriol
Used alone or in combination with emollientor corticosteroid
o Eg Calcipotriol o.n.Eumovate o.m.
o Dovobet
Better compliancethan separate preparations
Especially importantas patients can overusesteroids in psoriasis
Alternating Vit D analogues as for emollients,appears to maintain efficacy.
Light therapy
UVB TL01
8-12 week courses 3 times per week
Complications includeburning
The long term skin cancer risk is notknown
o Effective as is PUVA which is associated with BCC,SCC, MM
Dead sea
PUVA
Topical;hands and feet especially
Systemic
o 8-MOP, 5-MOP (can causenausea)
o Tablets are unlicensed
Cancer risk increases remarkably after upper level
Complications
Pigmentation, burning, itch,lentigines,malignancies
Contraindications
Photoaggravated diseases or drugs
Skin cancers and previous radiotherapy
Immunosuppression eg posttransplant
Severe renal,cardiac or liver disease
Pregnancy
children
Systemic drugs
Indications
Psoriasisnotrespondingto other treatment
Other treatments not tolerated
Special sites
7. Block 18 Week 7: Psoriasis
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Methotrexate
Antimetabolite. Inhibits dihydrofolatereductase
Anti-inflammatory
Once WEEKLY treatment
Test dose 2.5mg
Maximal benefit begins at 4-8 weeks
Monitor
initially weekly then
2-3 monthly
U+E
LFT
FBC
PIIIP
Maintenance dose 5-
25mg
Contraindications
BM suppression
Infection
UC
Alcoholism
Pregnancy, lactation
Diabetes mellitus and
cirrhosis risk
Side effects
Nausea
Cheilitis
Pulmonary/hepatic
fibrosis
Skin necrosis
Drug interactions
(especially thosewith
renal effects)
Ciclosporin
• 3.5-5mg/Kg/day
• Not for long term use becauseof renal damage and hypertension.
Contraindications
Renal dysfunction
Uncontrolled
hypertension
Malignancy
Infection
Pregnancy and
lactation
Interactions
NSAIDS
Erythromycin
Grapefruitjuice
anticonvulsants
Side effects
Tremor
Headache
Hypertrichosis
Gum hypertrophy
Hypertension
Nephrotoxicity
malignancy
Hydroxyurea
500-1500mgdaily
Start dose 500mg
Slow clinical response
Side effects
Bone marrow suppression
Photosensitiveexacerbation.Dermatomyositis-like
Acitretin
• Useful in Ps vulgarisand pustular/ generalised
• Combination with UV
• Similar sideeffects to roaccutanebut desquammation more sever. Also persists in fatfor 2 years
therefore contraception for 2 years
Side effects
Bone marrow suppression
Photosensitiveexacerbation.Dermatomyositis-like
Infliximab
Anti-TNF monclonal antibodies
8. Block 18 Week 7: Psoriasis
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Nails
Very difficultto treat
Can be socially and practically disablingtherefore ?systemics?
Topical treatments littleuse.
Intralesional steroid?
Keep nails SHORT
Nail varnish ( even for men)
Scalp
There is no pointin putting an activetreatment onto thick scale.Therefore:
SA 10% in EO for 1 month
Ung cocois co
Dovonex
Combinations
Coal tar pomade
Dithranol0.25%pomade
Guttate
May be self-limitingand need no treatment in children
Outpatient tar treatments eg Alphosyl may be all thatis needed
UV is highly effective
Children
Complianceis better and other factors eg alcohol arenot a problem
Avoid UV
Early inpatienttreatment
o Providerapid treatment without hazardous therapies
o Improve patient understanding for treatment of a lifelongdisease
Seborrhoeic dermatitis
Scaly,red, non-itchy, greasy-lookingrash
o Hairline
o Glabella,eyebrows
o Chin
o Occasionally flexures
Secondary infection is common in flexures
Seems to be caused by yeasts (Malassezia
furfur) in susceptibleindividuals
?part of a psoriasisspectrumor not?
Seborrhoeic Psoriasis or “Sebopsoriasis”
Coincidence of 2 chronic diseases?
Both worsen with stress and illness
Both worsen in early HIV
Scalp psoriasiscan improvewith Nizoral
Both associated with IBD
Seb derm worse in PD
General treatment
Suppression not cure
Medicated shampoo includingNizoral
Ketoconazole cream
o Sulphur and salicylic acid
Topical steroid and combined
UV phototherapy
Check for and treat infection