Psoriasis John Sugrue

What is Psoriasis? Auto immune disease in which T cells are activated when they shouldn’t be. Causes swelling and increased skin tissue turnover (keratinocyte hyperproliferation) Normal skin takes 28-30 days to form. Patients with psoriasis form new skin cell within 3-4 days. New skin is being pushed upwards towards the surface up to 10x faster. https://www.psoriasis.com/what-is-psoriasis#video-box-what-is-psoriasis-101-video

Types of Psoriasis Plaque (80%-90%) Inverse Guttate Pustular Erythrodermic https://www.psoriasis.com/psoriasis-types-pictures

Plaque Psoriasis Most common Characterized by inflamed red lesions covered in silvery scaly skin. Often found on knees, elbows, scalp and lower back. https://www.psoriasis.com/psoriasis-types-pictures

Inverse Psoriasis Typically found in body folds, armpits, under the breasts, around the genitals and groin areas. Presents as red, smooth, shiny skin with minimal scaling. https://www.psoriasis.com/psoriasis-types-pictures

Guttate Psoriasis Presents as small pinkish red dots all over the body. Often symptoms are apparent early in the patients life. https://www.psoriasis.com/psoriasis-types-pictures

Pustular Psoriasis Presents as blisters containing noninfectious pus. Could be localized (commonly palms/soles of feet) Could be widespread throughout the body. https://www.psoriasis.com/psoriasis-types-pictures

Erythrodermic Psoriasis Covers most of the body’s surface area. Can present as bright red with some scaling. Skin often sheds in sheets https://www.psoriasis.com/psoriasis-types-pictures

General Treatment Principles Majority of patients with psoriasis have mild to moderate disease (5-10% BSA) which can be treated topically. Difference between topical formulations is very important as the potency differs between ointments and creams. Systemic treatment is usually reserved for more severe disease (>10% BSA) Menter A, et al. J Am Acad Dermatol. 2009 Sep;61(3):451-85.

Otezla (ampremilast) Systemic medication. FDA Approved for the treatment of moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. FDA approved for the treatment of active psoriatic arthritis. Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]

Treatment Algorithm

Mechanism of Action Inhibits phosphodiesterase 4 (PDE 4) resulting in increased intracellular cAMP. This in turn helps regulate inflammatory mediators Decreased expression of nitric oxide synthase, TNF-α, and IL-23 Increased expression of IL-10 Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]

Dosing Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]

Adverse Effects Unexplained weight loss, diarrhea, nausea, headache, upper respiratory infection, nasopharyngitis are most common. Other less common effects include depression, insomnia, loss of appetite, abdominal pain, sinusitis Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]

Is Otezla in the Psoriasis Guidelines? Otezla has not yet made its way into the psoriasis guidelines, but… It is safe to use with methotrexate as well as topical medications. Safety/efficacy has not been studied for patients under the age of 18. https://www.psoriasis.org/about-psoriasis/treatments/oral-treatments

Questions?

References What is Psoriasis?:ABBVIE INC. [Internet]. North Chicago (IL); 2015 [cited 2016 Aug 5] Available from: https://www.psoriasis.com/what-is-psoriasis#video-box-what-is-psoriasis-101-video. Psoriasis Types and Pictures: ABBVIE INC. [Internet]. Noth Chicago (IL); 2015 [cited 2016 Aug 5] Available from: https://www.psoriasis.com/psoriasis-types-pictures. Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB,et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009 Apr;60(4):643-59. Menter A, Korman NJ, Elmets CA, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 4. Guidelines of care for the management and treatment of psoriasis with traditional systemic agents. J Am Acad Dermatol. 2009 Sep;61(3):451-85. Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]