1. Psoriasis
John Sugrue

2. 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 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.

3. Types of Psoriasis Plaque (80%-90%) Inverse Guttate Pustular
Erythrodermic

4. Plaque Psoriasis Most common
Characterized by inflamed red lesions covered in silvery scaly skin.
Often found on knees, elbows, scalp and lower back.

5. 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.

6. Guttate Psoriasis
Presents as small pinkish red dots all over the body.
Often symptoms are apparent early in the patients life.

7. Pustular Psoriasis Presents as blisters containing noninfectious pus.
Could be localized (commonly palms/soles of feet)
Could be widespread throughout the body.

8. Erythrodermic Psoriasis
Covers most of the body’s surface area.
Can present as bright red with some scaling.
Skin often sheds in sheets

9. 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 Sep;61(3):

10. 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]

11. Treatment Algorithm

12. 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]

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

14. 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]

15. 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.

16. Questions?

17. References
What is Psoriasis?:ABBVIE INC. [Internet]. North Chicago (IL); 2015 [cited 2016 Aug 5] Available from: Psoriasis Types and Pictures: ABBVIE INC. [Internet]. Noth Chicago (IL); 2015 [cited 2016 Aug 5] Available from: 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 Apr;60(4): 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 Sep;61(3): Otezla. In: Lexi-Drugs [database on the Internet] Hudson (OH): Lexicomp Inc.: 2016 [cited 2016 Aug 5]