Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19

1238 Psoriasis

➣Lichen planus

➣Pityriasis rubra pilaris – often islands of normal skin, palmoplan-

tar hyperkeratosis

management

What to Do First

■Assess the extent of the disease

■Assess the affect of the disease on the patient’s life circumstances

General Measures

■Topical therapy for limited disease

■Phototherapy

■Systemic therapy for extensive disease or disease that interferes with

daily activities or employment

specific therapy

Topical Therapy

■Corticosteroids

➣Wide range of potencies and vehicles

➣Select a potency and vehicle for the specific site

■Tars – adjunctive therapy, messy

■Anthralin – difficult to use, should be handled by a dermatologist

■Calcipotriene (Dovonex)

➣Available as an ointment, cream or scalp solution

➣May use in combination with a superpotent corticosteroid – use

the calcipotriene bid on Monday through Friday and the super-

potent corticosteroid on Saturday and Sunday

■Retinoids (Tazarotene)

➣Available as a gel or cream

Phototherapy

■UVB phototherapy – heliotherapy or home or office UVB

➣May be delivered daily at home or 3–5 times per week in an office

➣Enhanced by tar application (Goeckerman therapy)

➣Side effects

Short term – burns, time away from work

Long-term – skin cancer risk

➣Contraindications

Inability to stand

Presence of skin cancers or a genetic predisposition – e.g., xero-

derma pigmentosa