THE ROLE OF DRUGS IN THE INDUCTION AND/OR EXACERBATION OF PSORIASIS

8/11/2019 THE ROLE OF DRUGS IN THE INDUCTION AND/OR EXACERBATION OF PSORIASIS

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THE ROLE OF DRUGS IN THE INDUCTION

AND/OR EXACERBATION OF PSORIASIS

Oleh:

Zurniati AZ

PEMBIMBING:

dr. Dina Lidadari, Sp.KK

BAGIAN/SMF ILMU KESEHATAN KULIT DAN KELAMIN

FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA

BPK RSUD Dr. ZAINOEL ABIDIN

BANDA ACEH

(International Journal of Dermatology2010, page 13511361)


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Introduction

Drugs Exacerbation

induction

precipitation

psoriasis

May result in


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What is therapeutic agents that have been

associated with psoriasis?

NSAIDs

Theprecepitation or

exacerbation of

psoriasis

antimalarials

Beta adrenergicreceptor

blocking agents

lithium


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Various drugs involved in the induction/exacerbation of psoriasis


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lithium

Beta blockers

Miscellaneous

drugs

induce and trigger psoriasis with almost equal

frequency

Anti malarialsDo not induce psoriasis de novo, but only

trigger already existing psoriasis

This review highlighted the drugs which are involved in

triggering/exacerbating psoriasis and the mechanism of action of

each drug relating to the pathogenesis of psoriasis


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Beta blockers

noncardioselective cardioselective

propranolol

Include psoriasis

practolol

Cause psoriasiform

eruptions, exacerbation

of pre-existing psoriasis

Plaque psoriasis was transformed into pustular psoriasis as

consequence of therapy with -blocking agents


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Lithium

Induce a new onset of psoriasis; exacerbate pre-existingpsoriasis; or cause nail changes, psoriasis pustulosa, and

erytrhoderma

When psoriasis is induced by lithium, there is no longer latencyperiod (average 48 weeks)

The incidence of execerbating and inducing psoriasis due to

lithium treatment has been reported to range from 3.4-45%.


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Synthetic Antimalarial drugs SADs)

Antimalarials only trigger already existing psoriasis via a

pharmacologic mechanism, due to an alternation of the activity

of enzymes involved in the epidermal proliferation process.

Three indications for

the use of

antimalarials in

patients with

psoriasis

1. Treatment of psoriatic

arthropathy

2. Coexistent lupus

erythermatosus (LE)

3. Antimalarial prophylaxis for

travel to an endemic area


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NSAIDs

NSAIDs may provoke worsening of existing psoriasis.

Generalized pustular psoriasis developed in a patient treatedwith phenylbutazone

Topical application of indomethacin was reported to exacerbate

psoriasis in 14 of 20 patients.


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Miscellaneous drugs

IFN (, ), imiquimod,

cimetidine, and gemfibrozil

IFN Cutaneous adverse effects such as nonspecific erythema, hair loss,vasculitis, local ulcerations at the site of injection, and exacerbation

of psoriasis

The impact of IFN therapy in psoriasis induction/exacerbation is

still a subject of research and the exact mechanism of actions

remains obscure.


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Conclusion

Drugs that have been associated with the precipitation or exacerbation of psoriasis

include lithium, beta adrenergic receptor blocking agents, and antimalarials.

The withdrawal of corticosteroids has been reported to activate pustular pasoriasis.

NSAIDs such as

indomethacin, miscellaneous agents including tetracycline, have recently been

reported to exacerbate psoriasis

Clinical studies on adverse drug effects on psoriasis have been difficult to conduct.

The exacerbation and induction of the psoriasis attributed to a drug are coincidental

and not casual


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Derajat Gizi Buruk

1. Gizi buruk ringan

2. Gizi buruk sedang3. Gizi buruk berat (Marasmus, kwarsiorkor)

Telaah Jurnal

Pedoman Keterangan

Apakah penulis merumuskan

masalah dengan jelas?

Apakah signifikansinyadijelaskan (ruang lingkup,

tingkat keparahan,

relevansi)?

Jawaban: Ya, halaman 1351

(dalam introduction,

paragraf 1 alinea 12: in thisreview we have highlighted

the drugs which are involved

in triggering/exacerbating

psoriasis and the mechanism

of action of each drugrelating to the pathogenesis

of psoriasis)


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Pedoman Keterangan

Apakah orientasi

penelitian penulis(misalnya, interpretif, ilmu

kombinasi, kritis)?

jawaban: orientasi

penelitian (review) penulisadalah interpretif

Telaah Jurnal


15/18

Derajat Gizi Buruk



Pedoman Keterangan

Apakah ada dasar tujuan

untuk penalaran, atau

penulis hanyalah"membuktikan" apa yang

dia sudah percaya?

Jawaban: ya, dari isi

literatur review, tampak

bahwa penulis tidak hanyamemberikan penlaran

terhadap topik yang

diangkat tetapi juga

menjabarkan hubungan

sebab akibat.

Telaah Jurnal


16/18

Derajat Gizi Buruk



Pedoman Keterangan

Apakah review ini terorganisir secara

logis? Apakah itu menggunakan

analisis kritis yang sesuai dengan

literature yang ada?

Jawaban: ya, isi review tampak logis,

pertama penulis menjelaskan

pengenalan mengenai masalah yang

akan dibahas, selanjutnya penulis

menjabarkan masing-masing

masalah dan menggali hubungan

sebab akibat, selanjutnya penulis

menarik kesimpulan dari apa yang

telah dijabarkan.

Telaah Jurnal


17/18

Derajat Gizi Buruk



Pedoman Keterangan

Apakah literatur yang

digunakan sebagian besar

adalah literature terbaru?

Dan terutama berasal dari

literfatur baku dan hasil-

hasil penelitian?

Jawaban: tidak,pada

umumnya literatur yang

digunakan penulis berkisar

di bawah tahun 2000,

walaupun menggunakan

literatur baku, namun

masalah yang diangkat

kurang update karenadiambil dari hasil

penelitian yang telah lama

dilakukan.

Telaah Jurnal


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Thank You

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THE ROLE OF DRUGS IN THE INDUCTION AND/OR EXACERBATION OF PSORIASIS