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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 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

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