13.02.26 Psoriasis clinic


    • Topical

    • Phototherapy

      • Psoralen + UVA (PUVA)

    • Methotrexate

    • Cyclosporine

    • Retinoids

      • Acitretin

    • Biologicals

      • Anti-TNF

        • Etanercept

        • Infliximab

        • Golimumab

      • Anti-IL-12/23

        • Ustekinumab

PASI score - Out of 72

Side-effects of biologicals

    • Malignancy

      • Lymphomas

      • Possibly melanomas

    • NOT benign tumours

    • Infection

      • cf Surgery

Side-effects of other systemics

    • MTX

      • Liver fibrosis

        • cf Alcohol contraindicated

      • Skin lymphoma

      • Reactivation of latent TB

        • Check specifically for symptoms + do CXR before starting

    • Risk of downward trend in lymphocytes

    • Cyclosporine => Renal damage

Pityriasis rosea

    • URTI may precede all other symptoms in as many as 69% of patients

    • A single, 2- to 10-cm oval red "herald" patch appears, classically on the abdomen

      • May occur in a 'hidden' position and not be noticed

    • 7-14 days after the herald patch, large patches of pink or red, flaky, oval-shaped rash appear on the torso

    • In 6% of cases an inverse distribution may occur, with rash mostly on the extremities

    • The more numerous oval patches generally spread widely across the chest first, following the rib-line in a characteristic "christmas-tree" distribution

    • Small, circular patches may appear on the back and neck several days later

    • It is unusual for lesions to form on the face, but they may appear on the cheeks or at the hairline

    • About one in four people with PR suffer from mild to severe symptomatic itching

    • The rash may be accompanied by low-grade fever, headache, nausea and fatigue

Erythema multiforme

    • Skin condition of unknown cause

    • Possibly mediated by deposition of immune complex (mostly IgM) in the superficial microvasculature of the skin and oral mucous membrane that usually follows an infection or drug exposure

    • Common disorder; Peak incidence in the second and third decades of life

    • Presentation

      • Mild, self-limited rash to severe, life-threatening erythema multiforme major that also involves mucous membranes

        • May be related to Stevens–Johnson syndrome

      • Often takes on the classical "target lesion" appearance, with a pink-red ring around a pale center

      • Resolution within 7–10 days is the norm

    • Causes

      • Bacteria

        • BCG vaccination, haemolytic Streptococci, legionellosis, leprosy, Neisseria meningitidis, Mycobacterium, Pneumococcus, Salmonella, Staph, Mycoplasma pneumoniae, Chlamydia

      • Fungal

      • Parasitic

        • Trichomonas species, Toxoplasma gondii

      • Viral

        • Especially Herpes simplex

      • Drug reactions

        • Antibiotics (including sulphonamides, penicillin), anticonvulsants (phenytoin, barbiturates), aspirin, antituberculoids, allopurinol

      • Physical factors

        • Radiotherapy, cold, sunlight

      • Others

        • Collagen diseases, vasculitides, non-Hodgkin lymphoma, leukaemia, multiple myeloma, myeloid metaplasia, polycythemia

Post-inflammatory change

Ehlers–Danlos syndrome

    • Group of inherited connective tissue disorders caused by a defect in the synthesis of collagen (Type I or III)

    • Severity of the mutation can vary from mild to life-threatening

    • There is no cure, and treatment is supportive

      • Close monitoring of the digestive, excretory and particularly the cardiovascular systems

      • Physical therapy, bracing, and corrective surgery may help with the frequent injuries and pain that tend to develop in certain types of EDS


    • Hydroxychloroquine

      • SLE

      • RA

      • Sjögren's

      • Porphyria cutanea tarda

    • Mycophenolate mofetil

      • For eczema, not psoriasis

    • Stopping and starting biologicals can => anti-drug antibodies

      • But must stop 1 month pre-surgery due to infection risk

    • DLQU index

    • Link between psoriasis + metabolic syndrome/weight gain