Treatment of Psoriasis
According to age, site, pattern and exposure sites:
-Steroids are not used in face or intertriginous areas due to atrophy , but we use pimecrolimus
-Suppurative care and emollients are important.
LOCALIZED PSORIASIS
Topical agents are first line of treatment.
1-Trunk and Extremities
a) Topical fluorinated glucocorticoids, e.g.betamethasone valerate. Glucocorticoid-impregnated tape useful for small plaques.
b) For small plaques (≤4 cm), triamcinolone, there will be hypopigmentation.
c)Topical anthralin preparations, but very irritant.
d) Vitamin D analogues, e. g. calcipotriene.
e) Topical pimecrolimus is effective in inverse psoriasis and seborrheic dermatitis–like psoriasis of the face and ear canals.
2-Scalp
-Mild:
Ketoconazole shampoos followed by betamethasone valerate.
-Severe:
Removal of scales from plaques before active treatment by 10%salicylic acid in mineral oil.
Then use clobetasol propionate, lotion.
But it is better to use systemic treatment for recurrence or ineffective.
3-Palms and Soles,Nails
a) Topical glucocorticoids
b) PUVA
c) Retinoids (acitretin >isotretinoin) orally
d) Combination of a and b.
According to age, site, pattern and exposure sites:
-Steroids are not used in face or intertriginous areas due to atrophy , but we use pimecrolimus
-Suppurative care and emollients are important.
LOCALIZED PSORIASIS
Topical agents are first line of treatment.
1-Trunk and Extremities
a) Topical fluorinated glucocorticoids, e.g.betamethasone valerate. Glucocorticoid-impregnated tape useful for small plaques.
b) For small plaques (≤4 cm), triamcinolone, there will be hypopigmentation.
c)Topical anthralin preparations, but very irritant.
d) Vitamin D analogues, e. g. calcipotriene.
e) Topical pimecrolimus is effective in inverse psoriasis and seborrheic dermatitis–like psoriasis of the face and ear canals.
2-Scalp
-Mild:
Ketoconazole shampoos followed by betamethasone valerate.
-Severe:
Removal of scales from plaques before active treatment by 10%salicylic acid in mineral oil.
Then use clobetasol propionate, lotion.
But it is better to use systemic treatment for recurrence or ineffective.
3-Palms and Soles,Nails
a) Topical glucocorticoids
b) PUVA
c) Retinoids (acitretin >isotretinoin) orally
d) Combination of a and b.
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GENERALIZED PSORIASIS
1-Acute, Guttate Psoriasis
a) First treat streptococcus infection with antibiotics.
b) Narrow band UVB irradiation most effective.
c) PUVA.
2-Generalized Plaque-Type Psoriasis
a) Narrow-Band UVB Phototherapy:
Effective only in psoriasis with very thin plaques
b) Oral PUVA Photochemotherapy
oral (8-MOP or 5-MOP) then exposure to UV radiation.
-Side effects: keratosis, Squamous cell carcinoma.
c)In patients with recalcitrant plaque-type psoriasis, acitretin (in males) or isotretinoin (in females) may be combined with other antipsoriatic therapy.
4-Methotrexate أهم واحد
Is the drug of choice and the most convenient treatment for generalized plaque type psoriasis.
Warning: Before starting ttt, check CBC, LFT and RFT because it is contraindicated in anemia or liver and renal diseases also in pregnancy.
After treatment do liver biopsy.
5-Cyclosporine
6-Monoclonal Antibodies and Fusion Proteins:
a) Alefacept
b) Efalizumab
7-Tumor necrosis factor (TNF) α antagonists, e.g.Infliximab.
GENERALIZED PUSTULAR PSORIASIS
(von Zumbusch)
-Patients Should be treated in specialized unit like that of burn cases,do isolation, fluid replacement, and repeated blood cultures which are necessary.
DOC is (acitretin, 50 mg/d).
1-Acute, Guttate Psoriasis
a) First treat streptococcus infection with antibiotics.
b) Narrow band UVB irradiation most effective.
c) PUVA.
2-Generalized Plaque-Type Psoriasis
a) Narrow-Band UVB Phototherapy:
Effective only in psoriasis with very thin plaques
b) Oral PUVA Photochemotherapy
oral (8-MOP or 5-MOP) then exposure to UV radiation.
-Side effects: keratosis, Squamous cell carcinoma.
c)In patients with recalcitrant plaque-type psoriasis, acitretin (in males) or isotretinoin (in females) may be combined with other antipsoriatic therapy.
4-Methotrexate أهم واحد
Is the drug of choice and the most convenient treatment for generalized plaque type psoriasis.
Warning: Before starting ttt, check CBC, LFT and RFT because it is contraindicated in anemia or liver and renal diseases also in pregnancy.
After treatment do liver biopsy.
5-Cyclosporine
6-Monoclonal Antibodies and Fusion Proteins:
a) Alefacept
b) Efalizumab
7-Tumor necrosis factor (TNF) α antagonists, e.g.Infliximab.
GENERALIZED PUSTULAR PSORIASIS
(von Zumbusch)
-Patients Should be treated in specialized unit like that of burn cases,do isolation, fluid replacement, and repeated blood cultures which are necessary.
DOC is (acitretin, 50 mg/d).
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بإختصار:
Isolated localized chronic stable psoriasis 👉🏻T.glucocorticoids.
Generalized plaque type psoriasis 👉🏻Methotrexate.
Inverse psoriasis 👉🏻T.pimecrolimus.
GENERALIZED PUSTULAR PSORIASIS👉🏻Acitretin.
Isolated localized chronic stable psoriasis 👉🏻T.glucocorticoids.
Generalized plaque type psoriasis 👉🏻Methotrexate.
Inverse psoriasis 👉🏻T.pimecrolimus.
GENERALIZED PUSTULAR PSORIASIS👉🏻Acitretin.
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BCC👉🏻 Mohs surgery
SCC👉🏻 Surgery
M.melanoma👉🏻 Surgical excision
SCC👉🏻 Surgery
M.melanoma👉🏻 Surgical excision
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Quick notes:
Asboe Hansen's sign
Pressure over the surface of a bulla by the finger leads to peripheral bilster spreading.
Pemphigus vulgaris.
Fixed drug eruption:
Fixed to the drug and fixed to the same site.
-Characteristic early lesion is a sharply demarcated macule hours after
ingestion of the offending drug. Initially erythema, then dusky red to violaceous.
-Most common causative drug is Tetracyclines.
-Most common site involved is Genital skin.
-After healing leads to hyperpigmentation.
Treatment of Urticaria and Angioedema:
Chronic urticaria👉🏻Antihistamines
Acute urticaria with angioedema👉🏻Prednisone
Hereditary angioedema👉🏻Danazol
Severe angioedema 👉🏻Adrenaline life saving
Chronic idiopathic or autoimmune urticaria👉🏻 Cyclosporine "When systemic Glucocorticoids contraindicated or side effects.
Asboe Hansen's sign
Pressure over the surface of a bulla by the finger leads to peripheral bilster spreading.
Pemphigus vulgaris.
Fixed drug eruption:
Fixed to the drug and fixed to the same site.
-Characteristic early lesion is a sharply demarcated macule hours after
ingestion of the offending drug. Initially erythema, then dusky red to violaceous.
-Most common causative drug is Tetracyclines.
-Most common site involved is Genital skin.
-After healing leads to hyperpigmentation.
Treatment of Urticaria and Angioedema:
Chronic urticaria👉🏻Antihistamines
Acute urticaria with angioedema👉🏻Prednisone
Hereditary angioedema👉🏻Danazol
Severe angioedema 👉🏻Adrenaline life saving
Chronic idiopathic or autoimmune urticaria👉🏻 Cyclosporine "When systemic Glucocorticoids contraindicated or side effects.
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LEPROSY"Hansen disease"
Cause: M. leprae
Transmission: Uncertain; possibl transmission includes nasal droplet infection.
Types:
Tuberculoid: Well-defined, hypopigmented, slightly scaling, anesthetic macules and plaques on skin.
Borderline: Geographic shaped plaque on the skin with raised red indurated margins and central clearing. There is extension of the infection indicated by the erythematous papules beyond the margins.With anesthetic sensation.
Lepromatous: Macules, papules, nodules, plaques.Thickened on face leonine facies. Lesions not hypoaesthetic but glove and stocking anaesthesia, trophic ulcers of periphery, muscle paralysis. Nasal crusting and epistaxes. Saddle nose, Keratitis, Infertility.
MANAGEMENT:
DOC: Dapsone.
Cause: M. leprae
Transmission: Uncertain; possibl transmission includes nasal droplet infection.
Types:
Tuberculoid: Well-defined, hypopigmented, slightly scaling, anesthetic macules and plaques on skin.
Borderline: Geographic shaped plaque on the skin with raised red indurated margins and central clearing. There is extension of the infection indicated by the erythematous papules beyond the margins.With anesthetic sensation.
Lepromatous: Macules, papules, nodules, plaques.Thickened on face leonine facies. Lesions not hypoaesthetic but glove and stocking anaesthesia, trophic ulcers of periphery, muscle paralysis. Nasal crusting and epistaxes. Saddle nose, Keratitis, Infertility.
MANAGEMENT:
DOC: Dapsone.
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Forwarded from المكتبة الطبية الإلكترونية م 5
كتابة طالب من العام الماضي
للدكتور عادل "العملي"
وبعض أسألة التقييم
⬇️⬇️
للدكتور عادل "العملي"
وبعض أسألة التقييم
⬇️⬇️
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إختبار الجلدية النظري النصفي-الدفعة 20-2022
-For each question is one minute!
1-Dislodging of epidermis by lateral finger pressure in the vicinity of lesions, which leads to an erosion. Pressure on bulla leads to lateral extension of blister.
A) The talk here is about?
-Nikolsky Sign.
B) Name one important drug that is used for treatment of the disease that is associated with this clinical sign?
-Prednisone "Glucocorticoids".
2-An infant patient admitted to you presented with erythema and yellow-orange scales and crusts on the scalp. With eczematous scaling dermatitis lesions distributed on the trunk and arms.
A) What is the diagnosis?
-Seborrheic dermatitis "Cradle cap".
B) What is the treatment?
-Ketoconazole shampoo 2%.
3-A child presented with discrete solid skin-coloured papules, 1-2 mm in diameter with central umblication on the chest and abdomen. The lesions are with erythematous halo is undergoing spontaneous regression,(self-limited disease).
A) What is your diagnosis?
-Molluscum contagiosum.
B) Type one important way of transmission.
-Skin-skin contact.
4-A fine delicate destruction of the lesions or diseased and abnormal tissue with shedding of the viruses.
A) What is this method of treatment?
-Cryosurgery "Cryotherapy".
B) Give one important disease treated by means of this way.
-Warts, Also Molluscum contagiosum.
5-An adult female patient presented to you with burning sensation, itching, pain, tingling and associated with a group of vesicles on an erythematous base. And it is as recurrent symptoms from time to time with menstrual cycle.
A) What is your professional diagnosis?
-Herpes simplex virus infection.
B) Name one important differential diagnosis comes as this presentation?
-Impetigo.
6)An Epidermal dermatophytosis, often associated with dermatophytic folliculitis.It ccurs when an inflammatory dermatophytosis is mistaken for psoriasis or an eczematous dermatitis. Lesions are usually aymptomatic but may be very pruritic or even painful. Characterized by active lesions in periphery with central clearing.
A) What is this?
-Tinea incognito ,Tinea corporis or cruris.
B)One important method of diagnosis?
-KOH microscopy.
7-A female patient recently had given a birth presented with multiple, pink-brown, soft barely visible papules on the labia. And on clinical examination of her new baby was found to have similar skin lesions on his body similar to those lesions of his mother.
A)What's the diagnosis?
-Condylomata acuminata.
B) What is the treatment?
-Cryosurgery "Podophyllin",Electrocautery.
8-A highly contagious primary viral infection that infects 98% of adult populations.That is characterized by successive crops of pruritic vesicles that evolve to pustules, crusts, and at times, scars and often accompanied by mild constitutional symptoms as headache&fever.When occurring in adulthood may be complicated by pneumonia and encephalitis.
A) What is the disease?
-Chickenpox "Varicella".
B) Mention one important way of transmission.
-Airborne droplets.
9-A 30-year-old male patient presented with multiple large scaling plaques on the trunk, buttock, and legs. The lesions were round or polycyclic and confluent forming geographic patterns. The patient was taking a drug and after a period of treatment he has undergone a liver biopsy.
A) What is the drug the patient taken?
-Methotrexate.
B) What is the disease presented?
-Psoriasis "Chronic stable plaque type ".
10-A 56-year-old male patient presented with a generalized highly pruritic eruption. The patient had previously been diagnosed as having atopic dermatitis, scabies, and allergic contact dermatitis and had responded only poorly to topical glucocorticoids.In fact, this particular eruption occurred after he had spent a vacation "Holiday" on Alhodidah where his meals consisted of seafood and white bread.
A) What is the diagnosis?
-Dermatitis herpetiformis.
B) What would you advise this patient?
-Follow a "gluten" and iodides free diet.
Best wishes.✨
✒️-Mohammad Aldailami
-For each question is one minute!
1-Dislodging of epidermis by lateral finger pressure in the vicinity of lesions, which leads to an erosion. Pressure on bulla leads to lateral extension of blister.
A) The talk here is about?
-Nikolsky Sign.
B) Name one important drug that is used for treatment of the disease that is associated with this clinical sign?
-Prednisone "Glucocorticoids".
2-An infant patient admitted to you presented with erythema and yellow-orange scales and crusts on the scalp. With eczematous scaling dermatitis lesions distributed on the trunk and arms.
A) What is the diagnosis?
-Seborrheic dermatitis "Cradle cap".
B) What is the treatment?
-Ketoconazole shampoo 2%.
3-A child presented with discrete solid skin-coloured papules, 1-2 mm in diameter with central umblication on the chest and abdomen. The lesions are with erythematous halo is undergoing spontaneous regression,(self-limited disease).
A) What is your diagnosis?
-Molluscum contagiosum.
B) Type one important way of transmission.
-Skin-skin contact.
4-A fine delicate destruction of the lesions or diseased and abnormal tissue with shedding of the viruses.
A) What is this method of treatment?
-Cryosurgery "Cryotherapy".
B) Give one important disease treated by means of this way.
-Warts, Also Molluscum contagiosum.
5-An adult female patient presented to you with burning sensation, itching, pain, tingling and associated with a group of vesicles on an erythematous base. And it is as recurrent symptoms from time to time with menstrual cycle.
A) What is your professional diagnosis?
-Herpes simplex virus infection.
B) Name one important differential diagnosis comes as this presentation?
-Impetigo.
6)An Epidermal dermatophytosis, often associated with dermatophytic folliculitis.It ccurs when an inflammatory dermatophytosis is mistaken for psoriasis or an eczematous dermatitis. Lesions are usually aymptomatic but may be very pruritic or even painful. Characterized by active lesions in periphery with central clearing.
A) What is this?
-Tinea incognito ,Tinea corporis or cruris.
B)One important method of diagnosis?
-KOH microscopy.
7-A female patient recently had given a birth presented with multiple, pink-brown, soft barely visible papules on the labia. And on clinical examination of her new baby was found to have similar skin lesions on his body similar to those lesions of his mother.
A)What's the diagnosis?
-Condylomata acuminata.
B) What is the treatment?
-Cryosurgery "Podophyllin",Electrocautery.
8-A highly contagious primary viral infection that infects 98% of adult populations.That is characterized by successive crops of pruritic vesicles that evolve to pustules, crusts, and at times, scars and often accompanied by mild constitutional symptoms as headache&fever.When occurring in adulthood may be complicated by pneumonia and encephalitis.
A) What is the disease?
-Chickenpox "Varicella".
B) Mention one important way of transmission.
-Airborne droplets.
9-A 30-year-old male patient presented with multiple large scaling plaques on the trunk, buttock, and legs. The lesions were round or polycyclic and confluent forming geographic patterns. The patient was taking a drug and after a period of treatment he has undergone a liver biopsy.
A) What is the drug the patient taken?
-Methotrexate.
B) What is the disease presented?
-Psoriasis "Chronic stable plaque type ".
10-A 56-year-old male patient presented with a generalized highly pruritic eruption. The patient had previously been diagnosed as having atopic dermatitis, scabies, and allergic contact dermatitis and had responded only poorly to topical glucocorticoids.In fact, this particular eruption occurred after he had spent a vacation "Holiday" on Alhodidah where his meals consisted of seafood and white bread.
A) What is the diagnosis?
-Dermatitis herpetiformis.
B) What would you advise this patient?
-Follow a "gluten" and iodides free diet.
Best wishes.✨
✒️-Mohammad Aldailami
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الدفعة الـ 20
إختبار الجلدية النظري النصفي-الدفعة 20-2022 -For each question is one minute! 1-Dislodging of epidermis by lateral finger pressure in the vicinity of lesions, which leads to an erosion. Pressure on bulla leads to lateral extension of blister. A) The talk…
تقريباً يشبه إختبار السنة السابقة، بعض الأسئلة "الحالات" كانين نماذج MCQ's سابقة من اللي في المجموعة أو من هذولاء.
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الدفعة الـ 20
إختبار الجلدية النظري النصفي-الدفعة 20-2022 -For each question is one minute! 1-Dislodging of epidermis by lateral finger pressure in the vicinity of lesions, which leads to an erosion. Pressure on bulla leads to lateral extension of blister. A) The talk…
السؤال رقم 6
الحالة أن الشخص اصيب
ب epidermal dermatophytosis
بغض النظر عن نوعها
Tinea corporis, pedis or cruris
المهم في الامر ان تشخيصها حصل
غلط على انها psoriasis
(يعني عالجوها ب corticosteroid)
وبالتالي عيحصل كمضاعفات للتشخيص الغلط tinea incognito
مش ضروري يذكر corticosteroid
بطريقة مباشرة
يعني السؤال كان هادف سرعة
التفكير رغم الأجواء الطيبة 😅
الحالة أن الشخص اصيب
ب epidermal dermatophytosis
بغض النظر عن نوعها
Tinea corporis, pedis or cruris
المهم في الامر ان تشخيصها حصل
غلط على انها psoriasis
(يعني عالجوها ب corticosteroid)
وبالتالي عيحصل كمضاعفات للتشخيص الغلط tinea incognito
مش ضروري يذكر corticosteroid
بطريقة مباشرة
يعني السؤال كان هادف سرعة
التفكير رغم الأجواء الطيبة 😅
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الدفعة الـ 20
السؤال رقم 6 الحالة أن الشخص اصيب ب epidermal dermatophytosis بغض النظر عن نوعها Tinea corporis, pedis or cruris المهم في الامر ان تشخيصها حصل غلط على انها psoriasis (يعني عالجوها ب corticosteroid) وبالتالي عيحصل كمضاعفات للتشخيص الغلط tinea incognito…
ما ذكر Glucocorticoids، قال هم بيغلطوا ويشخصوها Psoriasis!
مابش في السؤال treatment ولا تطرق له. 🌝
الصح الأغلب Tinea infection ، والكل صح.
والله أعلم.
مابش في السؤال treatment ولا تطرق له. 🌝
الصح الأغلب Tinea infection ، والكل صح.
والله أعلم.
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In Trotter’s method patient is made to sit, leaning a little forward over a basin to spit any blood and breathe quietly from the mouth. Cold compresses should be applied to the nose to cause reflex vasoconstriction.