Mild-to-Moderate Psoriasis

by Koo; John Y.M.

• ISBN13: 9780849337239
• ISBN10: 0849337232
• Edition: 1st
• Format: Hardcover
• Copyright: 2006-08-21
• Publisher: CRC Press

Summary

A companion to Therapy of Moderate-to-Severe Psoriasis, Second Edition, this reference offers expert guidance on the management of psoriasis with chapters covering recent advances in combination therapy, topical corticosteroids, calcipotriene, and phototherapy. Offering a practical approach to the many forms of psoriasis, including those that are particularly difficult to treat-including palmar-plantar, scalp, inverse, and nail psoriasis-this source will serve as a must-have tool for every clinician caring for patients with these conditions.

Table of Contents

Preface	iii
Contributors	xiii
1. Therapy of Mild-to-Moderate Psoriasis—Introduction	1	(2)
Mark G. Lebwohl
2. General Approach to Psoriasis Treatment	3	(6)
Steven R. Feldman
Introduction	3	(2)
General Considerations in Treatment of Localized Psoriasis	5	(1)
Conclusions	6	(1)
Reference	7	(2)
3. The Koo–Menter Psoriasis Instrument for Identifying Candidate Patients for Systemic Therapy	9	(20)
John Y.M. Koo, Jonathan W. Kowalski, Mark G. Lebwohl, Chris M. Kozma, and Alan Menter
Introduction	9	(1)
Overview	10	(1)
Components of the Koo–Menter Psoriasis Instrument	10	(4)
Background on the PQOL-12	14	(1)
Application of the Original PQOL	14	(1)
Development of the PQOL-12	15	(1)
Study 1: Multicentered Office-Based Study	15	(9)
Study 2: Using Data from the Randomized Clinical Trial	24	(2)
Minimally Important Difference	26	(1)
Test–Retest Reliability of the POOL-12	26	(1)
Calculating the POOL-12 Score Within the KMPI	26	(1)
Discussion on KMPI	27	(1)
Conclusion	27	(1)
References	28	(1)
4. General Guidelines for Administration of Topical Agents in the Treatment of Mild-to-Moderate Psoriasis	29	(12)
Jashin J. Wu and Gerald D. Weinstein
Factors of Psoriasis	30	(2)
Medications	32	(6)
References	38	(3)
5. Topical Corticosteroids	41	(18)
Jason Givan, Daniel Pearce, and Steven R. Feldman
Introduction	41	(1)
Rationale for Psoriasis Therapy	42	(1)
Mechanism of Action and Biologic Potency	42	(2)
Delivery and Physiologic Potency	44	(2)
Adherence	46	(2)
Lessons from Skin Cap®	48	(1)
Efficacy	49	(1)
Safety	50	(1)
Safer Topical Corticosteroids: Are They Possible?	51	(1)
Cost Considerations	52	(1)
Practical Use of Topical Corticosteroids	52	(1)
Steroid Alternatives: Complementary, Not Really Alternatives	53	(1)
Summary	54	(1)
References	55	(4)
6. Vitamin D3 Analogs	59	(16)
Chai Sue Lee and John Y.M. Koo
Chemistry and Mechanism of Action	60	(1)
Calcipotriene Monotherapy	61	(1)
Calcipotriene in Children	61	(1)
Calcipotriene vs. Other Topical Agents	62	(1)
Combination Therapy	63	(1)
Calcipotriene and Topical Steroids	63	(1)
Calcipotriene and Tazarotene	64	(1)
Calcipotriene and Phototherapy	64	(1)
Calcipotriene and Systemic Agents	65	(1)
Adverse Effects	66	(3)
Calcipotriene Application in Psoriasis	69	(1)
Conclusions	70	(1)
References	70	(5)
7. Fixed-Dose Corticosteroid/Calcipotriene Combination Therapy	75	(16)
Chai Sue Lee and John Y.M. Koo
Combination Corticosteroid/Calcipotriene Therapy	76	(1)
Clinical Trials and Analyses of Fixed-Combination Formulation of Betamethasone Dipropionate/Calcipotriene	77	(1)
The Fixed-Dose Combination Is More Effective Than Steroid or Calcipotriene Monotherapy	77	(1)
The Fixed-Dose Combination b.i.d. Achieves Greater PASI Reduction Within One Week vs. Steroid Monotherapy	77	(1)
Once-Daily Fixed-Dose Combination Is Safe and Effective	78	(2)
Once-Daily Fixed-Dose Combination Is as Safe and Effective as b.i.d. Therapy	80	(1)
Once-Daily Fixed-Dose Therapy Achieves Higher Clearance and Fewer Adverse Events vs. Monotherapy	81	(1)
Once-Daily Fixed-Dose Therapy Is Effective for Patients with Mild, Moderate, and Severe Psoriasis	81	(1)
Investigators and Patients' Assessments of Once-Daily Fixed-Dosed Therapy Agree	82	(1)
Long-Term, Once-Daily Fixed-Dose Therapy Is Safe and Effective	83	(1)
Potential Benefits of Fixed-Dose Combination Therapy	84	(2)
In Combination with Biologics	86	(1)
In Combination with Other Systemic Agents	87	(1)
Potential Effects on Compliance	87	(1)
Conclusions	87	(1)
References	88	(3)
8. Tazarotene	91	(14)
Chai Sue Lee and John Y.M. Koo
Chemistry and Mechanism of Action	91	(2)
Tazarotene Monotherapy	93	(1)
Tazarotene vs. Topical Steroids	93	(1)
Combination Therapy	94	(1)
Tazarotene and Topical Steroids	94	(2)
Tazarotene and Topical Steroid-Induced Skin Atrophy	96	(1)
Tazarotene Chemical Compatibility with a Topical Steroid	96	(1)
Tazarotene and Calcipotriene	97	(1)
Tazarotene and UVB Phototherapy	97	(1)
Tazarotene and PUVA Phototherapy	98	(1)
Tazarotene and Nail Psoriasis	99	(1)
Tazarotene Application in Psoriasis	99	(1)
Side Effects	100	(1)
Conclusions	101	(1)
References	101	(4)
9. Topical Calcineurin Inhibitors	105	(10)
Patricia Tinio and Mark G. Lebwohl
Mechanism of Action	107	(1)
Clinical Properties	107	(4)
References	111	(4)
10. Treatment of Mild-to-Moderate Psoriasis with Coal Tar, Anthralin, Salicylic Acid, and Lactic Acid	115	(10)
Priya Sivanesan and John Y.M. Koo
Coal Tar	115	(4)
Anthralin	119	(2)
Salicylic Acid	121	(1)
Lactic Acid	122	(1)
Conclusion	122	(1)
References	122	(3)
11. Phototherapy and Laser for the Treatment of Mild-to-Moderate Psoriasis	125	(22)
Holly A. Kerr, Henry W. Lim, and Jennifer Trepte
Introduction	125	(1)
Mechanism of Action	126	(1)
Ultraviolet B	126	(5)
Psoralen and UVA	131	(6)
Targeted (Localized) Phototherapy	137	(4)
Ultraviolet A1	141	(1)
Conclusion	142	(1)
References	143	(4)
12. Combination Therapy	147	(16)
Wendy Myers, Jennifer Tan, and Alice B. Gottlieb
The Rationale for Combination Therapy	147	(1)
Phototherapy Combinations	148	(2)
UV Phototherapy and Topical Medications	150	(4)
Combining Systemic Agents with Topical Therapies in the Treatment of Mild-to-Moderate Psoriasis	154	(4)
Future Therapies for the Combination Treatment of Mild-to-Moderate Psoriasis	158	(1)
References	159	(4)
13. Topical Sequential Therapy of Psoriasis	163	(10)
John Y.M. Koo and Shanthi M. Colaco
Introduction	163	(1)
Topical Sequential Therapy: Calcipotriene and Halobetasol Propionate	164	(3)
Optimal Timing to Proceed Down Sequential Therapy Scheme	167	(1)
Sequential Therapy as a Flexible Therapeutic Strategy	168	(1)
Sequential Therapy with New Topical Steroid Formulations	168	(1)
Topical Sequential Therapy Possibilities Beyond Calcipotriene	169	(1)
References	170	(3)
14. New Developments in Topical Psoriasis Therapy	173	(10)
Chai Sue Lee, John Y.M. Koo, and Shanthi M. Colaco
Introduction	173	(1)
Clobetasol Propionate Spray (Clobex Spray)	174	(1)
Clobetasol Propionate Shampoo (Clobex Shampoo)	175	(1)
Clobetasol Proprionate Lotion (Clobex Lotion)	176	(1)
Hydrogel Patch	176	(5)
Conclusions	181	(1)
References	181	(2)
15. Palmoplantar Psoriasis	183	(12)
Brian Bonish and Kenneth B. Gordon
Treatment	185	(1)
Topical Therapy	185	(3)
Phototherapy	188	(1)
Systemic Therapy	189	(1)
Biologic Therapies	190	(1)
Summary: A Treatment Approach for Therapy of Palmoplantar Psoriasis	190	(2)
Conclusion	192	(1)
References	192	(3)
16. Scalp Psoriasis	195	(12)
Peter C.M. van de Kerkhof, Marloes M. Kleinpenning, and Rianne M.J.P. Gerritsen
Introduction	195	(1)
Epidemiology	195	(1)
Clinical Morphology	196	(1)
Differential Diagnosis	197	(1)
General Therapeutic Aspects	197	(1)
Shampoos	198	(1)
Descaling of the Scalp	199	(1)
Coal Tar and Dithranol	199	(1)
Imidazole Antifungals	199	(1)
Topical Corticosteroids	200	(1)
Vitamin D3 Analogs	201	(1)
Phototherapy	202	(1)
Systemic Treatments	202	(1)
Treatment Strategies in Scalp Psoriasis	202	(1)
Conclusion	203	(1)
References	203	(4)
17. Inverse Psoriasis	207	(14)
Robert A. Lee and Abby S. van Voorhees
Introduction	207	(1)
Epidemiology	207	(1)
Clinical Presentation	208	(1)
Etiology	209	(1)
Differential Diagnosis	209	(1)
Management	210	(7)
Conclusion	217	(1)
References	217	(4)
18. Psoriasis of the Nails	221	(22)
Maithily A. Nandedkar-Thomas and Richard K. Scher
Introduction	221	(1)
Manifestations of Nail Psoriasis	222	(4)
Association with Psoriatic Arthritis	226	(2)
Associated Genetic Haplotypes	228	(1)
Nail Psoriasis: Childhood vs. Adult Onset	228	(1)
Diagnostic Challenge: Isolated Nail Psoriasis and Its Impersonators	229	(2)
Diagnostic Procedure: The Nail Biopsy	231	(1)
Measurement of Severity: The Nail Psoriasis Severity Index	231	(1)
Treatment Options and Complications from Therapy	231	(6)
References	237	(6)
19. Summary of Therapeutic Options for Mild-to-Moderate Psoriasis	243	(20)
Cindy Berthelot, Jennifer Clay Cather, and Alan Menter
Introduction	243	(2)
Topical Therapies	245	(11)
Phototherapy	256	(1)
Summary	257	(1)
References	257	(6)
Index	263