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What are the other treamtent options for psoriasis?
- balneotherapy
- tacrolimus
- pimecrolimus
- mycopehnolate mofetil
- sulfasalazine
- 6-Thioguanine
- hydroxyurea
- azathioprine
- leflunomide
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What is balneotherapy?
- exposure to sea salt
- daily sunbathing
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What is tacrolimus?
immunosuppressive agent taken PO for recalcitrant plaque-type psoriasis
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What is pimecrolimus?
immunosuprresive agent for atopic dermatitis dosed topically BID
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What is mycophenolate mofetil?
anti-rejection medication dosed orally QID
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What is sulfasalazine?
- used in IBS, RA dosed orally
- less effective than MTX, PUVA, or acitretin
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What is 6-thioguanine?
antimetabolite used in leukemia dosed twice a week with less hepatic toxicity than MTX
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What is hydroxyurea?
antimetabolite for various malignancies dosed orally per day that has less hepatic toxicity and less effective than MTX
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What is azathioprine?
- a purine antimetabolite indicated to prevent rejection of renal transplant
- dosed 75-150 mg PO daily
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What is leflunomide?
- a pyrimidine synthesis inhibitor for RA
- dosed 20 mg PO daily after 100 mg daily x3 days load
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What are the goals of psoriasis therapy?
- reduce or clear signs
- increase QOL
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What determines PASI?
- BSA involved
- degree of erythema, induration, and scaling
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What 4 sections is the body broken down into to determine PASI?
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What is the range of PASI?
0-72
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What % reduction is usually significant in clincial trials when monitoring disease severity?
50%
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What are the PASI values for mild, moderate, and severe psoriasis?
- mild <12
- mod 12-18
- severe >18
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What needs to be taken into consideration when developing a treatment plan?
- extent and site of disease involvement
- age
- concurrent diseases
- mild-mod <20% BSA
- severe >20%
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What are the treatment options for psoriasis on the scalp?
topical steroid, calcipotriene solution, coal tar shampoo
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What are the treatment options for psoriasis in nails?
- topical steroid under nail
- systemic therapy
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What are the treatment options for psoriasis on genitalia?
- low-potent corticosteroid lotion
- topical calcipotriene
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What are the treatment options for psoriasis on the palms and soles?
- high-potent steroid
- MTX
- or acitretin
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What areas are ointments used for?
- hands
- feet
- trunk
- places with little hair
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What areas are creams used for?
- facial
- axilla
- groin
- smooth or hairy skin
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What areas are gels used for?
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What areas are lotions used for?
- face
- scalp
- axilla
- groin
- ear canal
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What are condsidered 1st line therapies for vulgaris?
- topical steroids
- calcipotriene
- UVB
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What are considered 1st line therapies for guttate?
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What are considered 1st line therapies for erythrodermic?
- systemic retinoids
- immunomodulatory agents
- MTX
- cyclosporine
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What are considered 1st line therapies for pustular?
- coal tar
- systemic retinoids
- immunomodulatory agents
- MTX
- cyclosporine
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What are considered 1st line therapies for arthritis?
- NSAID +/- immunomodulatory agents
- MTX
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