Page 58 - LECTURE NOTES

Urea 10% cream or ointment as an emulsifier, aqueous cream in folds. - Treat any

super infection with betadine or antibiotics if necessary.
Vitamin D3 analogues: Calcitriol and Calcipotriol, act by regulating keratinocyte

proliferation and maturation.
Retinoids Tazarotene, available in 0.05% and 0.1% gels, is a topical retinoid for the

treatment of psoriasis; can regulate keratinocyte proliferation and maturation. Main side
effect is irritation. Special precaution: women of child-bearing age.

PUVA photo chemotherapy -also known as PUVA, a photosensitizing drug methoxsalen
(8-methoxypsoralens) is given orally, followed by ultraviolet A (UVA) irradiation to treat

patients with more extensive disease. UVA irradiation utilizes light with wavelengths

320-400 nm. PUVA, decreases cellular proliferation by interfering with DNA synthesis,
and also induces a localized immunosuppression by its action on T lymphocytes.

Therapy usually is given 2-3 times per week on an outpatient basis, with maintenance
treatments every 2-4 weeks until remission. Adverse effects of PUVA therapy include

nausea, pruritus, and burning. Long-term complications include increased risks of photo
damage and skin cancer. PUVA has been combined with oral retinoid derivatives to

decrease the cumulative dose of UVA radiation to the skin.

Systemic therapy

In severe cases, retinoids, methotrexate, cyclosporine, and hydroxyurea may be used.
Systemic corticosteroids are generally contraindicated, and they can exacerbate a very

severe type of psoriasis called pustular psoriasis, which has a high rate of mortality

3.13. Exfoliative Dermatitis Erythroderma Syndrome “Skin Failure”

The exfoliative erythroderma syndrome (EES) is a serious, at times life-threatening
reaction pattern of the skin characterized by generalized and uniform redness and

scaling Involving practically the entire skin (>90% surface) and associated with
systemic “toxicity,” generalized lymphadenopathy, and fever. In the acute and sub

acute phases, there is rapid onset of generalized vivid red erythema and fine branny

scales; the patient feels hot and cold, shivers, and has fever. In the chronic EES, the

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