Psoriasis Vulgaris

Emollients

• Minimize the symptoms of itching and tenderness
• Help prevent irritation and thus the potential for
• Subsequent Koebnerization

Tar

Antiproliferative effect

2% or 3% crude coal tar

• Alternative is 4 to 10% LCD
• (liquor carbonis detergens, a tar distillate)

Anthralin

May restore normal epidermal

• proliferation and keratinization
• Stains clothes, irritant

Salicylic acid

• Keratolytic agent
• Adjuvant to other topicals

Topical corticosteroids

• Mainstay of topical treatment especially for plaque psoriasis
• Antiinflammatory, antiproliferative, and immunosuppressive actions
• Can be used as monotherapy 1-2 times daily or combined with other topical agents

Topical vitamin D analogues

• Inhibition of keratinocyte proliferation and enhancement of keratinocyte differentiation
• Calcipotriene, Calcitriol, Tacalcitol, Maxacalcitol, Becocalcidiol

• Topical retinoids
• Tazarotene (0.05% / 0.1%)
• Act by normalizing abnormal keratinocyte differentiation, diminishing hyperproliferation, and by decreasing expression of inflammatory markers
• Calcineurin inhibitors
• Tacrolimus/ Pimecrolimus
• Act by blocking the synthesis of numerous inflammatory cytokines
• Facial & intertriginous psoriasis

Indication

• Generalized psoriasis unresponsive to topicals.
• Narrow band UVB is not only more effective than broad band UVB but also leads to rapid clearance of lesions.

Dosage :

• Initial dosing according to skin type (130-400 mJ/cm2) or MED (50% of MED)[ MED = Minimal erythema dose]
• Subsequent dosage increase by 15-65 mJ/cm2 or ≤10% of initial MED
• Treatment 3-5 times/week

Methotrexate

Indication: Severe, recalcitrant, disabling psoriasis that is not adequately responsive to other forms of therapy.

Dosing: Weekly single oral dose Total dose should not ordinarily exceed 30 mg/wk

A test dose of 2.5-5 mg is recommended

Folate supplementation: Cyclosporine, Acitretin