מהי פסוריאזיס - מצגת של דר. לי-און גלעד

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  • (, ...) " - " -,

  • " 300 " Corpus Hipocraticum. : PSORA= / : Lepra= / .:

  • : (Prevalence) - 2% " " - 4.6% . , 0.4%-0.7% . -: 120,000 2,000

  • : (Prevalence) , 20-30 50-60 : 27 29

  • : (Prevalence) : 0.5-1.1% 16 8-12.5 -

  • : (Prevalence)- 2/3 - 1/3 -- 5-8% ( ) : - 5% 5

  • : , NSAIDs, HIV () PR , , , , (Known Trigers):

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  • : : (APCs) T T :

  • T , TNFa - IFNg " " . " " T. :

  • - T, / ( ) . . .:

  • : :16% 50% 10% 70% (" ) 20%

  • : - 14 !

  • , , !:

  • : 68-89 - 6-10 91%

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  • Impact of Psoriasis vs Other Diseases on Patient-Reported Physical OutcomesRapp SR, et al. J Am Acad Dermatol. 1999;41:401-407.Ware JE Jr, et al. SF-36 Health Survey Manual and Interpretation Guide. The Health Institute; 1993.S F - 3 6 H E A L T H S U R V E YLower scores reflect worse patient-reported outcomes.Physical Component Summary Score (n=317)SF-36 ScorePsoriasis41Hypertension44Myocardial InfarctionCongestive Heart Failure35Diabetes42Depression45Arthritis43Cancer454342Chronic Lung Disease

  • Impact of Psoriasis vs Other Diseases on Patient-Reported Mental OutcomesRapp SR, et al. J Am Acad Dermatol. 1999;41:401-407.S F - 3 6 H E A L T H S U R V E YLower scores reflect worse patient-reported outcomes.Mental Component Summary Score (n=317)60403020100SF-36 ScoreChronic Lung Disease44Diabetes52CancerDepression35Psoriasis49Hypertension52Congestive Heart Failure50Myocardial Infarction524946Arthritis50

  • How do personality systems interact in patients with psoriasis, atopic dermatitis and urticaria? Bahmer JA, Kuhl J, Bahmer FA. Acta Derm Venereol. 2007;87(4):317-24

    ' . - , .

  • Role of depression in quality of life for patients with psoriasis Schmitt JM, Ford DE, Dermatology. 2007;215(1):17-27

    32% 16.5% !

  • Psoriasis has a major secondary impact on the lives of family members and partners A.M. Eghlileb, et al, Br J Dermatol 156;6:1245-1250, June 2007

    70% 57% 55% 44% , 37% , 37% 8%

  • : . 1/3 , ? /

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  • : D A :Climatotherapy UVBNB-UVBLaserPUVA :' ""'

  • : D , , A () Zorac , , , Pix, () , ' , ' , , , ...

  • : / D Rebound " Weekend therapy

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  • A 52-week safety study of a calcipotriol/betamethasone dipropionate two-compound product (Daivobet) in the treatment of psoriasis vulgaris.Kragballe K, et al. Br J Dermatol 2006; 154(6):1155-60634 , " 52 ' "

  • "

  • 2%

    EventDaivobet only(52 wks)

    n=207Daivobet/ Daivonex(alt. 4 wks)n=213Daivobet 4 wks/ Daivonex 48 wksn=206%%%Burning sensation1.43.84.9Erythema1.01.93.4Pruritus5.810.313.1Skin irritation0.02.83.4

  • EventDaivobet only(52 wks)n=207Daivobet/ Daivonex(alt. 4 wks; n=213)Daivobet 4 wks/ Daivonex 48 wks (n=206)n%n%n%Adrenal insufficiency00.000.010.5Cellulitis00.000.010.5Ecchymosis10.500.000.0Folliculitis20.910.500.0Furuncle00.020.900.0Hypertrichosis00.000.010.5Purpura10.500.010.5Rash, pustular00.010.500.0Skin atrophy41.910.521.0Skin depigmentation21.000.000.0Skin papilloma00.010.500.0Skin striae00.010.500.0Total # of adverse events1176Total # of pts (%)104.862.862.9

  • 4 weeks between visitsAverage drug consumption=17.3g/week in the Daivobetarm

    Chart2

    118.59999.3

    104.490.484.6

    111.385.986

    109.495.888.2

    111.493.885.9

    109.791.289.3

    106.594.891.1

    101.18892.3

    99.18993

    98.783.391.9

    95.883.588.7

    96.384.693

    99.793.189

    Daivobet/Calcipotriol (4/48)

    Daivobet/Calcipotriol (4/4 alt)

    Daivobet

    Visit

    Mean amount used (g)

    Slide 8

    VisitDaivobetDaivobet/Calcipotriol (4/4 alt)Daivobet/Calcipotriol (4/48)

    1.599.399118.5

    2.584.690.4104.4

    3.58685.9111.3

    4.588.295.8109.4

    5.585.993.8111.4

    6.589.391.2109.7

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    Slide 8

    99.399118.5

    84.690.4104.4

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    88.295.8109.4

    85.993.8111.4

    89.391.2109.7

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    Daivobet

    Daivobet/Calcipotriol (4/4 alt)

    Daivobet/Calcipotriol (4/48)

    Visit

    Mean amount used (g)

  • '

  • " " " - " (%5
  • Disease severityAcute treatment:Daivobet ODTreatment of flare-up:Daivobet ODStabilisation and maintenance:Daivobet OD as requiredStabilisation and maintenance:Daivobet OD as required

  • : Mild1% HydrocortizoneMethylprednisolone

    ModerateClobetasone butirate(Eumovate)Fluocinolone acetonide (Dermalar)Betamethasone valerate (Betacorten)Diflucortolon valerate cr. (Neriderm Cr.)Desonide 0.1% (Locatop Cr.)PotentDiflucortolon valerate ung. (Neriderm)Halcinonide (Halciderm)Fluocortolone valerate (Ultralan)Momethasone fluorate (Elocom)Fluticasone propionate (Cutivate)Very potentDiflucortolon valerate fatty oint (Neriderm) Betamethasone dipropionate (Dicorten) (Diprolene)Clobetasole dipropionate (Dermovate) ("", "")

  • : ("", "") - , !

  • : : " " => Rebound

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  • A () ZoracTazarotene 0.1% gel in the treatment of fingernail psoriasis: a double-blind, randomized, vehicle-controlled study Scher RK, Stiller M, Zhu YICutis. 2001 Nov;68(5):355-8.Links

    tazarotene 0.1% gel can significantly reduce onycholysis (in occluded and nonoccluded nails) and pitting (in occluded nails) and is well tolerated in the treatment of nail psoriasis

  • Tazarotene 0.1% gel for psoriasis of the fingernails and toenails: an open, prospective study L.Bianchi et al, British Journal of Dermatology 2003; 149: 193227 12 ' 0.1%

  • Tazarotene 0.1% gel for psoriasis of the fingernails and toenails: an open, prospective study L.Bianchi et al, British Journal of Dermatology 2003; 149: 193227

  • UVB 290-320 nmPUVA 320-400 nmNB UVB 311 nmLaser 308nmLaser585nm

  • Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trialSchiener R et al Arch Dermatol. 2007 May;143(5):586-96 1241 , 4 , 4 , 8 UVB, PUVA , UVB (TW-UVB), UVB (SW-UVB) Bath Puva, UVB-SW - UVB UVB-TW

  • A Pragmatic Randomized Controlled Trial on the Effectiveness of Highly Concentrated Saline Spa Water Baths Followed by UVB Compared to UVB Only in Moderate to Severe Psoriasis.Brockow T, et al, J Altern Complement Med. 2007 Sep;13(7):725-32

    The study indicates that HC-SSW-UVB are superior to routine UVB at the end of a 6-week treatment course

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  • The percentage of patients achieving PASI 75 after 1 month and remission time after climatotherapy at the Dead Sea.Harari M, et al, Int J Dermatol. 2007 Oct;46(10):1087-1091.95.5% - PASI 4 100% PASI 50, 75.9% PASI 75 23.1 33.6

  • Copyright 2007 BMJ Publishing Group Ltd.Weatherhead, S. et al. BMJ 2007;334:1218-1220Treatment advice to be given before conceptionin patients with psoriasis

  • Anti neoplasticMethotrexateImmunosuppressiveCyclosporineMycophenolateCorticosteroidsMethotrexateMetabolic stabilizationRetinoidsNeotigasonTigasonRoaccutaneFumaric acid derivativesFumaderm , , , , , , , , , , , , ,

  • American Academy of Dermatology recommendations for liver biopsy in patients with psoriasis receiving long-term methotrexate1. In patients without risk factors for liver damage, perform first liver biopsy after cumulative dose of 10-15 g MTX 2. Provided no significant abnormalities are found, repeat liver biopsy after each additional 15 g MTX3. When cumulative dose > 40 g, perform biopsy after each additional 10 g MTX4. In patients with risk factors for liver damage, perform liver biopsy within 2-4 months of starting MTX and after each additional 05-10 g thereafter

  • Replacement of routine liver biopsy by procollagen III aminopeptide for monitoring patients with psoriasis receiving long-term methotrexate: a multicentre audit and health economic analysis.Chalmers, R.J.G., Kirby, B., Smith, A., Burrows, P., Little, R., Horan, M., Hextall, J.M., Smith, C.H., Klaber, M. & Rogers, S.British Journal of Dermatology 152 (3), 444-450.

  • Biochemical and biophysical assessment of MTX-induced liver fibrosis in psoriasis patients: Fibrotest predicts the presence and Fibroscans predicts the absence of signicant liver fibrosisMaartje A. M. Berends, et al, Liver International 2007 27;5:639-645

    Fibrotest accurately predicted the