MODULE 15 REVIEW

ACNE VULGARIS &

PSORIASIS

SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

REVIEW

MODULE 15
ACNE VULGARIS

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH SJAH

DEFINITION

ACNE VULGARIS ETIOLOGY STATISTICS

DEFINITION • a common, usually self-limiting
EPIDEMIOLOGY 85% of Teenagers
disease involving inflammation of
ETIOLOGY the sebaceous follicles of the face PATHOPHYSIOLOGY
and upper trunk
S/SX
EPIDEMIOLOGY Men>Women
DIAGNOSIS
PATHOPHYSIOLOGY
TREATMENT GOALS
S/SX Urban>Rural
NON-PHARMACOLOGIC
TXT
DIAGNOSIS
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
 acce vulgaris ETIOLOGY

DEFINITION CAUSES EPIDEMIOLOGY

1. Increased Sebum Production

.
ETIOLOGY Puberty High Humidity
PATHOPHYSIOLOGY

S/SX
EPIDEMIOLOGY
DIAGNOSIS
Pregnancy Milk Products
PATHOPHYSIOLOGY
TREATMENT GOALS

S/SX
NON-PHARMACOLOGIC
Occlusive TXT
DIAGNOSIS Clothing
Cosmetics
PHARMACOLOGIC TXT
TREATMENT GOALS
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

ETIOLOGY ETIOLOGY

2. Retention Hyperkeratosis 3. Cutibacterium acnes formerly known as

EPIDEMIOLOGY EPIDEMIOLOGY
Propionibacterium acnes
PATHOPHYSIOLOGY PATHOPHYSIOLOGY

S/SX S/SX

DIAGNOSIS DIAGNOSIS

TREATMENT GOALS TREATMENT GOALS

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT PHARMACOLOGIC TXT

REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

ETIOLOGY ETIOLOGY

EPIDEMIOLOGY EPIDEMIOLOGY

PATHOPHYSIOLOGY PATHOPHYSIOLOGY

S/SX S/SX

DIAGNOSIS DIAGNOSIS

TREATMENT GOALS TREATMENT GOALS

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT PHARMACOLOGIC TXT

REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
 ETIOLOGY EPIDEMIOLOGY

EPIDEMIOLOGY PATHOPHYSIOLOGY CLINICAL DESCRIPTION

CLINICAL
FEATURES
PATHOPHYSIOLOGY
PRESENTATION

S/SX
LOCATION Face, neck, chest, upper
DIAGNOSIS back, and shoulders
DIAGNOSIS
TREATMENT GOALS
SX Usually Asymptomatic
TREATMENT GOALS
NON-PHARMACOLOGIC Pruritus/Pain if large, tender
TXT
NON-PHARMACOLOGIC lesions are present
TXT
PHARMACOLOGIC TXT

PHARMACOLOGIC TXT
REFERENCES

REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

EPIDEMIOLOGY EPIDEMIOLOGY

PATHOPHYSIOLOGY PATHOPHYSIOLOGY

CLINICAL CLINICAL
PRESENTATION PRESENTATION

DIAGNOSIS DIAGNOSIS

TREATMENT GOALS TREATMENT GOALS

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT PHARMACOLOGIC TXT

REFERENCES REFERENCES

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

EPIDEMIOLOGY EPIDEMIOLOGY

PATHOPHYSIOLOGY PATHOPHYSIOLOGY

CLINICAL CLINICAL
PRESENTATION PRESENTATION

DIAGNOSIS DIAGNOSIS

TREATMENT GOALS TREATMENT GOALS

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT PHARMACOLOGIC TXT

REFERENCES REFERENCES

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
 S/SX DIAGNOSIS

DIAGNOSIS Reduce the # and severity of lesions TREATMENT GOALS • Avoid aggravating factors
NON-PHARMACOLOGIC • Maintain a balanced diet
TREATMENT GOALS
Slow Disease Progression TXT
• Control Stress
NON-PHARMACOLOGIC
TXT
PHARMACOLOGIC TXT • Gentle Cleansing 2-3x daily
Limit disease duration • Do not scrub your face
REFERENCES
PHARMACOLOGIC TXT
• Sulfur, Resorcinol or Salicylic acid
Prevent formation of new lesion
REFERENCES
medicated soaps (little value)
Prevent scarring and hyperpigmentation • Mild comedonal acne: pumice,
polyethylene or aluminum oxide

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

DIAGNOSIS TREATMENT GOALS

NON-PRESCRIPTION TOPICAL MEDICATION
NON-PHARMACOLOGIC DRUG MOA SAFETY/SIDE
TREATMENT GOALS
TXT EFFECTS/MONITORING
•Maintenance Therapy for Acne:
BENZOYL • decomposes to SIDE EFFECTS
GENERAL • Topical retinoids (adapalene, tazarotene, or PHARMACOLOGIC TXT PEROXIDE release oxygen • Stinging or burning sensation
PRINCIPLE (2.5%-10%) • increases the
tretinoin) are commonly recommended. turnover rate of
• Contact dermatitis (2.5% of users)
REFERENCES
PHARMACOLOGIC TXT • Topical azelaic acid is an alternative. epithelial cell NOTE
• Initiate maintenance after a 12-week induction, • Effect should be noted w/in 2 weeks but
REFERENCES can be up to 6-8 weeks
lasting for 3 to 4 months. • Can cause discoloration of clothing
• Longer duration may be necessary to prevent material or hair
relapse. APPLICATION
• Long-term antibiotic therapy is not • Apply at night, left on for 15-20mins to
test sensitivity then washed off
recommended to minimize antibiotic resistance. • Apply once daily
• If drying, redness or peeling does not
occur in 3 days, increase to 2x daily

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

NON-PRESCRIPTION TOPICAL MEDICATION PRESCRIPTION MEDICATIONS: Topical
NON-PHARMACOLOGIC NON-PHARMACOLOGIC DRUG MOA SAFETY/SIDE
TXT DRUG MOA TXT EFFECTS/MONITORING
TRETINOIN • increases the SIDE EFFECTS
PHARMACOLOGIC TXT SALICYCLIC ACID • increases the turnover rate of PHARMACOLOGIC TXT (vitamin A turnover rate of • Excessive irritation, erythema, peeling
acid, trans- nonadhering • Increased risk of severe sunburn
(0.5%-2.0%) epithelial cell retinoic horny cells in the
REFERENCES • Promote penetration of other REFERENCES
acid, Retin- follicular canal, NOTE
acne products A) which results in
• May cause initial exacerbation of the
comedo clearing
and inhibits new acne (pustular flare) at 2 to 4 weeks,
comedo but usually by 8 weeks, the patient will
SULFUR (3%-8%) • Keratolytic agent and has development. see marked improvement.
SULFUR (3%-8%) W/ antibacterial actions
RESORCINOL (2%) • Acnegenic in the long run APPLICATION
• Apply at night, every other day or daily
• Use gel form for dry skin
• Applied 30mins after washing

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
TREATMENT GOALS TREATMENT GOALS
PRESCRIPTION MEDICATIONS: Topical PRESCRIPTION MEDICATIONS: Topical
NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT DRUG SAFETY/SIDE EFFECTS/MONITORING TXT DRUG SAFETY/SIDE EFFECTS/MONITORING

PHARMACOLOGIC TXT ADAPALENE SIDE EFFECTS PHARMACOLOGIC TXT TAZAROTENE SIDE EFFECTS
(Differin) • Excessive irritation, erythema, peeling (Tazorax) • Itching, burning, stinging
REFERENCES • Increased risk of severe sunburn REFERENCES CONTRAINDICATIONS
• Pregnancy
NOTE APPLICATION
• Less potential for photosensitivity. • Apply at night, daily
• Results should be noticed in 8-12 weeks
AZELAIC ACID
APPLICATION SIDE EFFECTS
• Apply at night, every other day or daily • Burning, stinging and tingling
• Use gel form for dry skin APPLICATION
• Applied 30mins after washing • Apply 2x daily
• Improvement w/in 4 weeks

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

PRESCRIPTION MEDICATIONS: Topical PRESCRIPTION MEDICATIONS: Oral
NON-PHARMACOLOGIC NON-PHARMACOLOGIC Antibiotics/Anti-infectives
TXT DRUG SAFETY/SIDE EFFECTS/MONITORING TXT DRUG SAFETY/SIDE EFFECTS/MONITORING
PHARMACOLOGIC TXT TOPICAL SIDE EFFECTS PHARMACOLOGIC TXT TETRACYCLINE SIDE EFFECTS
ANTIBIOTICS: • Itching, burning, stinging • upset stomach, vaginal moniliasis, and
REFERENCES erythromycin REFERENCES
(Eryderm),
photosensitivity
NOTES NOTES
clindamycin • Tetracycline: yellow staining of the skin
(Cleocin-T) and • Taken at empty stomach
• Clindamycin: Potential risk of pseudomembranous • Initial dose is 250 mg, two to four times daily,
tetracycline.
colitis
gradually reduced to a maintenance dose of about
250 mg per day
APPLICATION
• applied directly to acne site ERYTHROMYCIN SIDE EFFECTS
• gastrointestinal distress
NOTES
• Initial doses range from 500 to 2000 mg per day in divided
doses. A maintenance dose ranges from 250 to 500 mg
per day

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

PRESCRIPTION MEDICATIONS: Oral PRESCRIPTION MEDICATIONS
NON-PHARMACOLOGIC Antibiotics/Anti-infectives NON-PHARMACOLOGIC
TXT DRUG SAFETY/SIDE EFFECTS/MONITORING TXT DRUG SAFETY/SIDE EFFECTS/MONITORING

PHARMACOLOGIC TXT Minocycline PHARMACOLOGIC TXT ORAL SIDE EFFECTS

SIDE EFFECTS
(Minocin) or • dizziness or vertigo and headache, discoloration of ISOTRETINOIN • Mucocutaneous dryness. Cheilitis (i.e.,
REFERENCES doxycycline REFERENCES (Accutane) inflammation of the lips), dryness of the nasal
skin and visceral tissue, and drug-induced lupus
(Vibramycin) mucosa, and facial dermatitis
erythematosus
• elevated serum triglycerides and cholesterol

NOTES NOTES
• 50 to 200 mg per day • daily dose of 0.5 mg/kg and increased to 1 mg/ kg
• CAN BE TAKEN WITH FOOD given in two divided doses with food for the usual
duration of 20 we

CONTRAINDCATIONS
• potent teratogen and should not be given to
pregnant women

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
TREATMENT GOALS TREATMENT GOALS
PRESCRIPTION MEDICATIONS: Antiandrogens PRESCRIPTION MEDICATIONS: Antiandrogens
NON-PHARMACOLOGIC and hormones NON-PHARMACOLOGIC and hormones
TXT DRUG SAFETY/SIDE EFFECTS/MONITORING TXT DRUG SAFETY/SIDE EFFECTS/MONITORING
PHARMACOLOGIC TXT PHARMACOLOGIC TXT
Estrogens • decrease sebum production Corticosteroids NOTES
• Prednisone: 20 mg per day or higher may be
REFERENCES through an antiandrogenic effect. REFERENCES used for a short period to quickly improve
acne for important events like a wedding
Norgestimate + • For moderate acne
ethinyl estradiol • FDA approved for acne

SPIRONOLACT
ONE

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

DIAGNOSIS DIAGNOSIS

TREATMENT GOALS •Comedonal Noninflammatory Acne: TREATMENT GOALS •Severe Papulopustular or Moderate Nodular Acne:
• Topical agents targeting increased keratinization are • Oral isotretinoin monotherapy is the first choice.
recommended. • Alternatives include systemic antibiotics with adapalene,
GENERAL GENERAL
• Topical retinoids, especially adapalene, are the drugs of choice.
PRINCIPLE PRINCIPLE fixed-dose combination of adapalene and benzoyl
• Benzoyl peroxide or azelaic acid can be considered.
•Mild to Moderate Papulopustular Inflammatory Acne: peroxide, or combination with azelaic acid.
PHARMACOLOGIC TXT • Priority is to reduce P. acnes population. PHARMACOLOGIC TXT • Oral antiandrogens with oral antibiotics or topical
• First-choice therapies include fixed-dose combinations of treatments are considered if limitations exist.
REFERENCES adapalene and benzoyl peroxide or topical clindamycin and REFERENCES •Nodular or Conglobate Acne:
benzoyl peroxide. • Monotherapy with oral isotretinoin is the first choice.
• Alternatives include different topical retinoid with antimicrobial • Alternatives include systemic antibiotics with azelaic acid.
agent, with or without benzoyl peroxide. • Consider oral antiandrogens with oral antibiotics or
• Azelaic acid or benzoyl peroxide can be recommended.
systemic antibiotics with adapalene, benzoyl peroxide, or
• In more widespread disease, systemic antibiotic with adapalene
is recommended. adapalene-benzoyl peroxide combination if limitations
exist.

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS
• Contact patients within 2 to 3 weeks after
NON-PHARMACOLOGIC
TXT the start of therapy to assess progress
• Lesion counts should decrease by 10% to
EVALUATION OF OUTCOME
15% within 4 to 8 weeks or by more than
REFERENCES 50% within 2 to 4 months. MODULE 15
PSORIASIS
• Inflammatory lesions should resolve within
a few weeks,
• Comedones should resolve by 3 to 4
months.
• If anxiety or depression is present at the
outset, control or improvement should be
achieved within 2 to 4 months

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH SJAH

 SCALY DERMATOSES
REVIEW DEFINITION
• diseases affecting the outer
ETIOLOGY layer of skin

EPIDEMIOLOGY

PATHOPHYSIOLOGY

S/SX

DIAGNOSIS
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

DEFINITION

PSORIASIS ETIOLOGY STATISTICS

DEFINITION • a chronic inflammatory disease EPIDEMIOLOGY 125M
characterized by recurrent
ETIOLOGY
exacerbations and remissions of PATHOPHYSIOLOGY

EPIDEMIOLOGY
thickened, erythematous, and S/SX Developing Countries
scaling plaques. DIAGNOSIS
PATHOPHYSIOLOGY
TREATMENT GOALS
S/SX
15-25y/o
NON-PHARMACOLOGIC
TXT
DIAGNOSIS
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

ETIOLOGY

DEFINITION • Genetics EPIDEMIOLOGY

ETIOLOGY
• Immune PATHOPHYSIOLOGY

Dysfunction S/SX
EPIDEMIOLOGY
• Environmental DIAGNOSIS

PATHOPHYSIOLOGY
Triggers TREATMENT GOALS

S/SX
• Keratinocyte NON-PHARMACOLOGIC
TXT
DIAGNOSIS
Proliferation PHARMACOLOGIC TXT
TREATMENT GOALS
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
 ETIOLOGY EPIDEMIOLOGY

EPIDEMIOLOGY PATHOPHYSIOLOGY

CLINICAL
PATHOPHYSIOLOGY
PRESENTATION

S/SX
DIAGNOSIS

DIAGNOSIS
TREATMENT GOALS

TREATMENT GOALS
NON-PHARMACOLOGIC
TXT
NON-PHARMACOLOGIC
TXT
PHARMACOLOGIC TXT

PHARMACOLOGIC TXT
REFERENCES

REFERENCES MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

EPIDEMIOLOGY
S/SX

PATHOPHYSIOLOGY
DIAGNOSIS
Minimize or eliminate skin
CLINICAL
TREATMENT GOALS lesions, alleviate pruritus
PRESENTATION
NON-PHARMACOLOGIC
DIAGNOSIS TXT
Reduce frequency flare-ups
TREATMENT GOALS PHARMACOLOGIC TXT

NON-PHARMACOLOGIC REFERENCES
TXT Avoid adverse treatment effects
PHARMACOLOGIC TXT

REFERENCES

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

DIAGNOSIS DIAGNOSIS

Reduce Stress Level UV Light Therapy

TREATMENT GOALS TREATMENT GOALS

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT Soak in lukewarm water PHARMACOLOGIC TXT

REFERENCES REFERENCES

Smoking Cessation

Overweight/Obese:
weight loss

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
 S/SX S/SX

DIAGNOSIS DIAGNOSIS

TREATMENT TREATMENT
ALGORITHM ALGORITHM

NON-PHARMACOLOGIC NON-PHARMACOLOGIC
TXT TXT

PHARMACOLOGIC TXT PHARMACOLOGIC TXT

REFERENCES REFERENCES

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

TOPICAL PSORIASIS TREATMENT TOPICAL PSORIASIS TREATMENT
NON-PHARMACOLOGIC DRUG COMMENTS NON-PHARMACOLOGIC DRUG COMMENTS
TXT TXT

STEROIDS Use high-potency steroids only short-term due to Tazarotene (Tazorac) Long term treatment of psoriasis
PHARMACOLOGIC TXT PHARMACOLOGIC TXT
the risk of side effects. They can be used as - a topical retinoid +
monotherapy or with other therapies. halobetasol (Duobrii)
REFERENCES REFERENCES

Coal tar products, Coal tar products are messy, time-consuming,

including DHS Tar, and can stain clothing and bedding, but some
Lonil-T, Psoriasin, and patients experience relief at a reasonable cost.
Pentrax Gold,
combined with Do not use salicylic acid products with other
salicylic acid salicylates, as systemic absorption can occur.
(Tarsum), are
available over the These products can cause skin irritation and
counter (OTC). photosensitivity.

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

TOPICAL PSORIASIS TREATMENT SYSTEMIC PSORIASIS TREATMENT
NON-PHARMACOLOGIC DRUG COMMENTS NON-PHARMACOLOGIC DRUG COMMENTS
TXT TXT

Anthralin (Dritho- Keratolytic containing salicylic acid with irritant Acitretin BOXED WARNING
PHARMACOLOGIC TXT PHARMACOLOGIC TXT
Creme HP. Zithranol) potential. Contact time is tolerable up to 30 hepatotoxicity and pregnancy
minutes. (Soriatane)
REFERENCES REFERENCES Tablet DOSE
25-50mg

Calcipotriene SIDE EFFECTS

CONTRAINDICATION
dryness of the eyes, nasal and oral mucosa,
Hypercalcemia
+ betamethasone chapped lips, brittle nails, and burning skin
Do not apply to face, axillae or groin

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH
TREATMENT GOALS TREATMENT GOALS
SYSTEMIC PSORIASIS TREATMENT SYSTEMIC PSORIASIS TREATMENT: IMMUNOSUPPRESIVE
NON-PHARMACOLOGIC NON-PHARMACOLOGIC
AGENTS
DRUG COMMENTS
TXT TXT DRUG COMMENTS

PHARMACOLOGIC TXT Apremilast WARNINGS PHARMACOLOGIC TXT

Weight loss, depression and suicidal ideation cyclosporine SIDE EFFECTS
(Otezia) Tablet (Gengraf), Nephrotoxicity, Hyperkalemia and HTN
REFERENCES REFERENCES azathioprine
SIDE EFFECTS
Diarrhea, N/V, Headache (Imuran), and
hydroxyurea (Droxia)
WARNINGS
Methotrexate
Hepatotoxicity
FDA pregnancy category X

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

SYSTEMIC PSORIASIS TREATMENT: BIOLOGIC RESPONSE SYSTEMIC PSORIASIS TREATMENT: BIOLOGIC RESPONSE
NON-PHARMACOLOGIC
MODIFIER NON-PHARMACOLOGIC
MODIFIER
TXT DRUG COMMENTS TXT DRUG COMMENTS

PHARMACOLOGIC TXT adalimumab SIDE EFFECTS: URTIs, HA, Rash PHARMACOLOGIC TXT infliximab SIDE EFFECTS: HA, Fever, Rash URTIs
(Humira), DOSE: 40mg SC every other week (Remicade) DOSE: 5 mg/kg as an IV infusion at weeks 0,
REFERENCES Plaque Psoriasis: Initial: 80mg followed by REFERENCES 2, and 6, then every 8 weeks thereafter
40mg every other week
ustekinumab SIDE EFFECTS: HA, URTIs
alefacept (Amevive) SIDE EFFECTS: Flu-like sx, HA (Stelara) DOSE:
DOSE: 15mg IM once weekly for 12 weeks 100kg>: 45 mg initially and 4 weeks later,
followed by 45 mg every 12 weeks
etanercept (Enbrel) SIDE EFFECTS: GI infections, HA, N/V 100kg<: 90 mg initially and 4 weeks later,
infliximab DOSE: 50mg SC once weekly followed by 90 mg every 12 weeks.
(Remicade), and
ustekinumab
(Stelara)

MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH

TREATMENT GOALS TREATMENT GOALS

SYSTEMIC PSORIASIS TREATMENT
NON-PHARMACOLOGIC
TXT
DRUG COMMENTS NON-PHARMACOLOGIC
TXT
• A positive response
PHARMACOLOGIC TXT Brodalumab BOXED WARNING EVALUATION OF OUTCOME
involves normalization of
(Siliq), Brodalumab: suicidal ideation

REFERENCES Guselkumab SIDE EFFECTS

REFERENCES involved areas of skin, as
(Tremfya),
measured by reduced
Diarrhea, URTIs
Ixekizumab (Taltz),
Risankizumab WARNINGS
(Skyrizi),
Secukinumab
Hepatotoxicity
FDA pregnancy category X erythema and scaling, as
(Cosentyx),
Tildrakizumab well as reduction of
(Ilumya),
Ustekinumab plaque elevation
(Stelara)
MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH MODULE 15 ACNE VULGARIS & PSORIASIS CLINPHAR2. SJAH