Quick revision table- Treatment for Psoriasis

Treatment ladder for psoriasis

Treatment chart for psoriasis

Topical If < 10% Body surface involved	Systemic If > 10% Body surface involved	Phototherapy
1) Steroids Often first-line therapy in Mild to moderate psoriasis. 2) Calcipotriol (Drug of choice)-MCQ 3) Coal Tar Goeckerman regimen- MCQ typically involves receiving ultraviolet (UV) light treatment and applying a prescription coal tar mixture to the psoriasis. The coal tar mixture usually remains on the skin for several hours) 4) Anthralin Ingram regimen MCQ -Ingram regimen involves a similar process. Instead of coal tar, a psoriasis medicine called anthralin (which comes from coal tar) is applied to the skin. After receiving a UVB or UVA light treatment, the anthralin is applied. Sometimes, the body is wrapped in a plastic dressing. The anthralin usually remains on the skin for 2 to 4 hours. 5) Tacrolimus Specially for Flexural and facial psoriasis 6) Tazarotene- Not used much due to irritation	1) Methotrexate (MTX) MTX is administered weekly, usually as a single oral dose  a) DOC for Erythrodermic psoriasis- MCQ  b) DOC  for psoriatic arthritis- MCQ  c) 2nd choice drug for Pustular psoriasis Side effects: Hepatotoxic, Bone marrow suppression, Nausea 2) Acitretin a) DOC for Pustular psoriasis- MCQ b) 2nd line choice for Erythrodermic psoriasis Side effects: Dyslipidemia, Liver abnormalities- This was recently asked in JIPMER 3) Cyclosporine (calcineurin inhibitor) 3 mg/kg/day- MCQ DOC for severe erythrodermic psoriasis (Fastest drug to act)- MCQ Very useful for Impetigo herpetiformis Side effects: nephrotoxic 4) Systemic Steroids -DOC for Impetigo herpetiformis in India- Commonest question asked in psoriasis chapter (other drugs for impetigo herpetiformis are cyclosporine and biologics) - Also the DOC for psoriatic erythroderma in pregnancy 6) Biologics ·         Useful for severe psoriasis not responding to conventional medications ·         Also for arthritis mutilans  a. Etanercept Target: TNF-α Molecule: Human fusion protein - DOC for arthritis mutilans- MCQ  b. Infliximab Target: TNF-α Molecule: Chimeric antibody c. Adalimumab Target: TNF-α Molecule: Human antibody d. Ustekinumab - MCQ Target: IL-12/23 Molecule: Human antibody 6) Fumaric acid	· PUVA (Psoralens+ UVA) · UVB (both narrow band and broad band UVB) PUVA had the highest percentage of patients with clearance (70%), followed by UVB (67.9%) Usually phototherapy is offered first to patients of psoriasis (> 10% body surface area). If not possible or contraindicated, other systemic medicines like acitretin, cyclosporine, MTX  are offered.

Topical

If < 10% Body surface involved

Systemic

If > 10% Body surface involved

Phototherapy

1) Steroids

Often first-line therapy in Mild to moderate psoriasis.

2) Calcipotriol (Drug of choice)-MCQ

3) Coal Tar

Goeckerman regimen- MCQ

typically involves receiving ultraviolet (UV) light treatment and applying a prescription coal tar mixture to the psoriasis. The coal tar mixture usually remains on the skin for several hours)

4) Anthralin

Ingram regimen MCQ

-Ingram regimen involves a similar process. Instead of coal tar, a psoriasis medicine called anthralin (which comes from coal tar) is applied to the skin. After receiving a UVB or UVA light treatment, the anthralin is applied. Sometimes, the body is wrapped in a plastic dressing. The anthralin usually remains on the skin for 2 to 4 hours.

5) Tacrolimus

Specially for Flexural and facial psoriasis

6) Tazarotene- Not used much due to irritation

1) Methotrexate (MTX)

MTX is administered weekly, usually as a single oral dose

 a) DOC for Erythrodermic psoriasis- MCQ

 b) DOC  for psoriatic arthritis- MCQ

 c) 2nd choice drug for Pustular psoriasis

Side effects: Hepatotoxic, Bone marrow suppression, Nausea

2) Acitretin

a) DOC for Pustular psoriasis- MCQ

b) 2nd line choice for Erythrodermic psoriasis

Side effects: Dyslipidemia, Liver abnormalities- This was recently asked in JIPMER

3) Cyclosporine (calcineurin inhibitor)

3 mg/kg/day- MCQ

DOC for severe erythrodermic psoriasis (Fastest drug to act)- MCQ

Very useful for Impetigo herpetiformis

Side effects: nephrotoxic

4) Systemic Steroids

-DOC for Impetigo herpetiformis in India- Commonest question asked in psoriasis chapter (other drugs for impetigo herpetiformis are cyclosporine and biologics)

- Also the DOC for psoriatic erythroderma in pregnancy

6) Biologics

·         Useful for severe psoriasis not responding to conventional medications

·         Also for arthritis mutilans

 a. Etanercept

Target: TNF-α

Molecule: Human fusion protein

- DOC for arthritis mutilans- MCQ

 b. Infliximab

Target: TNF-α

Molecule: Chimeric antibody

c. Adalimumab

Target: TNF-α

Molecule: Human antibody

d. Ustekinumab - MCQ

Target: IL-12/23

Molecule: Human antibody

6) Fumaric acid

· PUVA (Psoralens+ UVA)

· UVB (both narrow band and broad band UVB)

PUVA had the highest percentage of patients with clearance (70%), followed by UVB (67.9%)

Usually phototherapy is offered first to patients of psoriasis (> 10% body surface area). If not possible or contraindicated, other systemic medicines like acitretin, cyclosporine, MTX  are offered.