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PsoriasisMxNICE
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> NICE guidelines 2012 ''Management of chronic plaque psoriasis'' regular emollients - reduce scale and pruritus 1st - potent corticosteroid od plus vitamin D analogue od (separately, one in morning, other in evening) for up to 4/52 2nd - vit D analogue bd for another 4/52 3rd - potent corticosteroid bd or coal tar od-bd short-acting dithranol can also be used ''topical steroids in psoriasis'' may lead to skin atrophy, striae and rebound symptoms systemic side-effects may be seen if used on large areas (> 10%BSA) 4 week break before starting another course only use potent corticosteroids for 8/52 or very potent ones for 4/52 without 4/52 break initially maintenance - 1-2/52 / month use for flexural or facial mild steroid for od or bd for 2/52) ''vitamin D analogues'' calcipotriol (Dovonex), calcitriol and tacalcitol reducing cell division and differentiation adverse effects are uncommon may be used long-term (unlike steroids) do not smell or stain (unlike coal tar or dithranol) reduce scale and thickness of plaques but not erythema avoid in pregnancy maximum weekly amount for adults is 100g ''Scalp psoriasis'' potent topical corticosteroids od 4/52 then try different formulation (shampoo/mousse) or topical agent to remove scale (salicylic acid, emollients and oils) before steroid ''Secondary care management'' ''Phototherapy'' narrow band ultraviolet B light is treatment of choice. (3 times a week) photochemotherapy is also used - psoralen + ultraviolet A light (PUVA) adverse effects: skin ageing, squamous cell cancer (not melanoma) ''Systemic therapy'' 1st - oral methotrexate - esp good if also joint disease ciclosporin systemic retinoids biological agents: infliximab, etanercept and adalimumab ustekinumab (IL-12 and IL-23 blocker) is showing promise in early trials ''Mechanism of action of commonly used drugs'' coal tar: probably inhibit DNA synthesis calcipotriol: vitamin D analogue which reduces epidermal proliferation and restores a normal horny layer dithranol: inhibits DNA synthesis, wash off after 30 mins, SE: burning, staining
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