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 Dermatology 2010, page 1351 1361) Drugs Exacerbation induction precipitation psoriasis May result in What is therapeutic agents that have been associated with psoriasis? NSAIDs The precepitation or exacerbation of psoriasis antimalarials Beta adrenergic receptor blocking agents lithium Various drugs involved in the induction/exacerbation of psoriasis lithium Beta blockers Miscellaneous drugs induce and trigger psoriasis with almost equal frequency Anti malarials Do 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
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 Lithium Induce a new onset of psoriasis; exacerbate pre-existing psoriasis; or cause nail changes, psoriasis pustulosa, and erytrhoderma When psoriasis is induced by lithium, there is no longer latency period (average 48 weeks) The incidence of execerbating and inducing psoriasis due to lithium treatment has been reported to range from 3.4-45%. 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 NSAIDs NSAIDs may provoke worsening of existing psoriasis. Generalized pustular psoriasis developed in a patient treated with phenylbutazone Topical application of indomethacin was reported to exacerbate psoriasis in 14 of 20 patients. 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. 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 Derajat Gizi Buruk 1. Gizi buruk ringan 2. Gizi buruk sedang 3. Gizi buruk berat (Marasmus, kwarsiorkor) Telaah Jurnal Pedoman Keterangan Apakah penulis merumuskan masalah dengan jelas? Apakah signifikansinya dijelaskan (ruang lingkup, tingkat keparahan, relevansi)? Jawaban: Ya, halaman 1351 (dalam introduction, paragraf 1 alinea 12: in this review we have highlighted the drugs which are involved in triggering/exacerbating psoriasis and the mechanism of action of each drug relating to the pathogenesis of psoriasis) Pedoman Keterangan Apakah orientasi penelitian penulis (misalnya, interpretif, ilmu kombinasi, kritis)? jawaban: orientasi penelitian (review) penulis adalah interpretif Telaah Jurnal Derajat Gizi Buruk 1. Gizi buruk ringan 2. Gizi buruk sedang 3. Gizi buruk berat (Marasmus, kwarsiorkor) 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 hanya memberikan penlaran terhadap topik yang diangkat tetapi juga menjabarkan hubungan sebab akibat. Telaah Jurnal Derajat Gizi Buruk 1. Gizi buruk ringan 2. Gizi buruk sedang 3. Gizi buruk berat (Marasmus, kwarsiorkor) 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 Derajat Gizi Buruk 1. Gizi buruk ringan 2. Gizi buruk sedang 3. Gizi buruk berat (Marasmus, kwarsiorkor) 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 karena diambil dari hasil penelitian yang telah lama dilakukan. Telaah Jurnal Thank You