1. PSORIASIS Ben Basger Basgers Pharmacy North Bondi Pharmacy Practice, The University of Sydney

2. Psoriasis - references Co-morbidities in patients with psoriasis - The American Journal of Medicine (2009) 122, 1150.e1- 1150.e9 Diagnosis of psoriasis and psoriatic arthritis in adults: summary of SIGN guidance - BMJ 2010;341:c5623 doi: 10.1136/bmj.c5623

3. Psoriasis eTG34, 2011 Psoriasis is a disease of the skin characterised by erythema and scale Psoriasis is chronic, recurrent and benign Treatment can control the disease in most cases Psychological effects can be disproportional Stress may aggravate the disorder Certain drugs may aggravate the disorder Treatments are not curative Treatment is based on location, severity, clinical response, adverse effects, cost and time commitments

5. Psoriasis eTG34, 2011 Psoriasis is strongly familial The presentation is variable and the clinical manifestations numerous, from mild presentation in one site to total skin involvement with pustulation and constitutional symptoms Approximately one third of patients have arthritis Psoriasis is activated by specific trigger factors such as infection, stress, trauma, drugs Two peaks of onset; 16-22 yrs (more severe disease) and 57-60 yrs – milder; family history may be absent

6. Psoriasis – treatment of different types Type of psoriasisTreatment options Plaque – mild to moderateTars, topical corticosteroids, calcipotriol, dithranol FlexuralMild-moderate topical corticosteroids PalmoplantarTars, topical corticosteroids, keratolytics, systemic therapy ScalpTar shampoo, topical corticosteroid lotions

9. Psoriasis – topical therapies eTG34, 2011 Emollients – scaling, irritation Keratolytic – salicylic acid Topical corticosteroids – anti-inflammatory, anti-mitotic Tars – anti-inflammatory and antipruritic Calcipotriol – regulates proliferation and differentiation of keratinocytes Dithranol – antiproliferative effect

10. Psoriasis – systemic therapy eTG34, 2011 Methotrexate – slows epidermal cell proliferation; immunosuppressant Acitretin – proliferation and differentiation of keratinocytes; anti-inflammatory Cyclosporin – immunosuppressant Biological therapies e.g. Adalimumab PHOTOTHERAPY/PUVA

16. Psoriatic arthritis eTG34, 2011 Typically presents in young to middle aged adults May involve hands and feet; spine; sacroiliac joints; a variable number or peripheral joints (oligo- or polyarticular) TREATMENT – oral NSAIDs, oral corticosteroids, DMAARDs, TNFα inhibitors