Drugs for Psoriasis — MCQs
What is the primary condition for which calcitriol is used as a treatment?
What is the best range of UV light used for treatment of skin diseases?
All trans retinoic acid is used topically for -
PUVA therapy is used in all except:
Auspitz's sign is characteristically seen in
Treatment of choice for Pustular psoriasis is:
All of the following are true about "Imiquimod" except:
Which of the following is used in the treatment of Multiple Sclerosis:
Which of the following steroids possesses maximum glucocorticoid activity?
The Drug of choice for a pregnant woman in 2nd trimester with pustular psoriasis is:
Drugs for Psoriasis Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Explanation: Secondary hyperparathyroidism - Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1]. - In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2]. - Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2]. - This is the primary therapeutic indication for calcitriol in clinical practice. Lichen planus - This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes - Typically treated with corticosteroids or other immunosuppressants - Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism Pemphigus - Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes - Primary treatment involves immunosuppressants like corticosteroids, often in high doses - Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease Leprosy - Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae - Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine - Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Question 2: What is the best range of UV light used for treatment of skin diseases?
- A. 100 – 200 nm
- B. > 700 nm
- C. 400 – 700 nm
- D. 200 – 400 nm (Correct Answer)
Explanation: ***200 – 400 nm*** - This range encompasses **UVA (320-400 nm)** and **UVB (290-320 nm)**, which are the most commonly used portions of the **UV spectrum** for treating various skin conditions like psoriasis and eczema. - Specifically, **narrowband UVB (311-313 nm)** is highly effective due to its therapeutic benefits with reduced side effects compared to broadband UVB or UVA. *100 – 200 nm* - This range falls into the **vacuum UV (VUV)** spectrum, which is largely absorbed by air and is not practical for dermatological phototherapy due to its limited penetration and potential for significant cellular damage. - It is known for its germicidal properties but is not used for treating skin diseases in living tissue due to its **high energy** and **low penetration** depth. *> 700 nm* - Wavelengths above 700 nm fall into the **infrared (IR) spectrum** or visible light, which primarily produces heat and has different therapeutic applications. - While IR light can be used for therapies like **pain relief** and **wound healing**, it does not have the immunomodulatory effects on skin cells needed for conditions traditionally treated by UV. *400 – 700 nm* - This range represents the **visible light spectrum**, which is used in some dermatological treatments like **photodynamic therapy (PDT)** or for certain **pigmentary disorders**. - However, visible light does not possess the same **immunomodulatory** and **antiproliferative effects** on keratinocytes and T-cells that make UV light effective for conditions like psoriasis.
Question 3: All trans retinoic acid is used topically for -
- A. Lupus vulgaris
- B. Alopecia areata
- C. Acne vulgaris (Correct Answer)
- D. Androgenic alopecia
Explanation: ***Acne vulgaris*** - **All-trans retinoic acid (tretinoin)** is a topical retinoid that is highly effective in treating **acne vulgaris** by normalizing follicular keratinization, reducing sebum production, and possessing anti-inflammatory properties. - It helps in preventing the formation of new **comedones** and promoting the clearance of existing lesions. *Lupus vulgaris* - **Lupus vulgaris** is a cutaneous form of **tuberculosis**, typically treated with multidrug antitubercular therapy. - Retinoic acid is **not a primary treatment** for this condition. *Alopecia areata* - **Alopecia areata** is an autoimmune hair loss condition, often treated with **topical or intralesional corticosteroids**, or immunomodulators. - Topical retinoic acid is **not indicated** for its treatment. *Androgenic alopecia* - **Androgenic alopecia (male or female pattern baldness)** is primarily treated with **topical minoxidil** or **oral finasteride**. - While retinoids can stimulate hair growth, they are **not a first-line treatment** for androgenic alopecia and are sometimes used as an adjuvant to minoxidil.
Question 4: PUVA therapy is used in all except:
- A. Psoriasis
- B. Vitiligo
- C. Mycosis fungoides
- D. Melasma (Correct Answer)
Explanation: ***Melasma*** - **PUVA (Psoralen plus UVA) therapy** is contraindicated in melasma due to its potential to worsen hyperpigmentation and cause paradoxical darkening. - Melasma is best managed with topical agents like **hydroquinone**, **tretinoin**, and chemical peels, along with strict **sun protection**. *Psoriasis* - **PUVA therapy** is a well-established and effective treatment for moderate to severe psoriasis, especially for patients with widespread plaques. - It works by inhibiting DNA synthesis and cell proliferation in rapidly dividing keratinocytes, leading to a reduction in psoriatic lesions. *Vitiligo* - **PUVA therapy** is a common treatment for vitiligo, stimulating melanocyte activity and promoting repigmentation in affected areas. - Psoralen sensitizes melanocytes to UVA light, which then encourages melanin production. *Mycosis fungoides* - In its early stages, **mycosis fungoides**, a cutaneous T-cell lymphoma, can be effectively treated with **PUVA therapy**. - PUVA induces apoptosis of malignant T-cells in the skin, leading to remission of skin lesions.
Question 5: Auspitz's sign is characteristically seen in
- A. Plaque Psoriasis (Correct Answer)
- B. Inverse Psoriasis
- C. Pustular Psoriasis
- D. Lichen Planus (flat-topped, purple papules)
Explanation: ***Plaque Psoriasis*** - **Auspitz's sign** is the appearance of pinpoint bleeding after the removal of scales from a psoriatic plaque, a classic finding in **plaque psoriasis**. - This phenomenon is due to the thinning of the epidermis over elongated and dilated dermal papillae, making the superficial capillaries prone to rupture. *Pustular Psoriasis* - This form of psoriasis is characterized by the presence of sterile **pustules** on erythematous skin, either localized or generalized. - While it is a type of psoriasis, Auspitz's sign is not its characteristic feature; rather, the presence of pustules defines this variant. *Inverse Psoriasis* - Inverse psoriasis typically affects **skin folds** (e.g., axillae, groin, inframammary regions) and presents as smooth, erythematous patches without the characteristic scaling seen in plaque psoriasis. - Due to the absence of thick scales, Auspitz's sign is generally not observed in inverse psoriasis. *Lichen Planus (flat-topped, purple papules)* - Lichen planus is an inflammatory condition characterized by **pruritic, polygonal, planar, purple papules** and plaques, often with **Wickham's striae**. - It does not involve the epidermal scaling and capillary changes that lead to Auspitz's sign.
Question 6: Treatment of choice for Pustular psoriasis is:
- A. Methotrexate (Correct Answer)
- B. Psoralen - UV therapy
- C. Systemic steroid
- D. Estrogen
Explanation: ***Methotrexate*** - **Methotrexate** is a systemic immunosuppressant often considered the first-line treatment for severe forms of **pustular psoriasis** due to its efficacy in reducing inflammation and hyperproliferation of skin cells. - It works by inhibiting **dihydrofolate reductase**, thereby interfering with DNA synthesis and cell division, which is crucial in rapidly dividing cells like those found in psoriasis. *Psoralen - UV therapy* - **Psoralen and ultraviolet A (PUVA)** therapy can be used for chronic plaque psoriasis, but it is generally **contraindicated or used with extreme caution** in pustular psoriasis due to the risk of exacerbating the disease or causing irritation. - **UV light therapy** can sometimes trigger or worsen pustular flares, especially in acute generalized pustular psoriasis. *Systemic steroid* - While systemic steroids can provide temporary relief by addressing inflammation, their use in pustular psoriasis is generally **not recommended for long-term management** due to the high risk of severe rebound flares upon withdrawal. - Withdrawal of **systemic corticosteroids** can precipitate or worsen generalized pustular psoriasis, making them a less desirable long-term treatment option. *Estrogen* - **Estrogen** has no direct role in the treatment of psoriasis. Psoriasis is an inflammatory skin condition, and its pathophysiology is not directly influenced by estrogen levels. - Hormonal therapies are not indicated for the management of psoriasis, including its pustular forms.
Question 7: All of the following are true about "Imiquimod" except:
- A. Antitumor activity
- B. Indirect antiviral activity
- C. Direct antiviral activity (Correct Answer)
- D. It releases cytokines
Explanation: ***Direct antiviral activity*** - Imiquimod is a **Toll-like receptor 7 (TLR7) agonist** that primarily works by **stimulating the immune system** to produce cytokines, which then fight viral infections and cancerous cells. - It does not directly inhibit viral replication or destroy viral particles; its action is entirely **immune-mediated**. *Antitumor activity* - Imiquimod stimulates the local immune response, leading to the production of interferons and other cytokines that can inhibit the growth of **tumor cells**, such as in basal cell carcinoma. - This activity is **indirect**, as it relies on the host immune system rather than direct cytotoxic effects on cancer cells. *Indirect antiviral activity* - As a TLR7 agonist, imiquimod prompts immune cells to release significant amounts of **cytokines** like interferon-alpha, which have potent antiviral effects. - This **enhances the body's natural defense mechanisms** against viral infections, such as those causing genital warts. *It releases cytokines* - Imiquimod's mechanism of action involves binding to **Toll-like receptor 7 (TLR7)** on immune cells like macrophages and dendritic cells. - This binding triggers a signaling cascade that results in the robust production and release of various **pro-inflammatory and anti-viral cytokines**, including interferons and TNF-alpha.
Question 8: Which of the following is used in the treatment of Multiple Sclerosis:
- A. Interferon Alpha
- B. Infliximab
- C. Interferon gamma
- D. Interferon Beta (Correct Answer)
Explanation: ***Interferon Beta*** - **Interferon beta** is a disease-modifying therapy commonly used for **relapsing-remitting multiple sclerosis (RRMS)** to reduce the frequency and severity of relapses. - It works by modulating the immune system, decreasing inflammation and preventing demyelination in the central nervous system. *Interferon Alpha* - **Interferon alpha** is primarily used in the treatment of certain **cancers** (e.g., leukemia, melanoma) and **viral infections** (e.g., chronic hepatitis B and C). - It does not have a recognized role in the standard treatment protocols for multiple sclerosis. *Infliximab* - **Infliximab** is a **monoclonal antibody** that targets **tumor necrosis factor-alpha (TNF-α)** and is used in the treatment of inflammatory conditions like rheumatoid arthritis, Crohn's disease, and ulcerative colitis. - While TNF-α plays a role in inflammation, **anti-TNF therapy** has been shown to potentially worsen MS and is generally contraindicated. *Interferon gamma* - **Interferon gamma** is a pro-inflammatory cytokine that can exacerbate MS symptoms and **increase disease activity**. - It is **not used** in the treatment of multiple sclerosis and in fact, some studies suggest it may be detrimental.
Question 9: Which of the following steroids possesses maximum glucocorticoid activity?
- A. Prednisolone
- B. Aldosterone
- C. Dexamethasone (Correct Answer)
- D. Cortisol
Explanation: ***Dexamethasone*** - **Dexamethasone** is a synthetic glucocorticoid with high potency, making it one of the steroids with the **maximum glucocorticoid activity** [1], [2]. - It exhibits a much longer duration of action and significantly greater anti-inflammatory effects compared to natural glucocorticoids like cortisol [2]. *Prednisolone* - **Prednisolone** is a synthetic glucocorticoid that has approximately four times the anti-inflammatory potency of cortisol [1]. - While potent, it does not reach the glucocorticoid activity levels of dexamethasone. *Cortisol* - **Cortisol** is the body's primary natural glucocorticoid, involved in stress response and metabolism [2]. - Its glucocorticoid activity serves as a baseline for comparing the potencies of other synthetic corticosteroids [2]. *Aldosterone* - **Aldosterone** is primarily a mineralocorticoid, not a glucocorticoid, with its main role being the regulation of electrolyte and water balance [2]. - It possesses minimal to no glucocorticoid activity.
Question 10: The Drug of choice for a pregnant woman in 2nd trimester with pustular psoriasis is:
- A. Prednisolone (Correct Answer)
- B. Acitretin
- C. Methotrexate
- D. Dapsone
Explanation: ***Prednisolone*** - **Systemic corticosteroids** such as prednisolone are considered **safe and effective** for treating severe pustular psoriasis during pregnancy and represent the **best option among the choices provided**. - Pustular psoriasis is a severe systemic condition that can be associated with fever, malaise, and potential complications, necessitating **systemic therapy** rather than topical treatment alone. - While **cyclosporine** is often considered the preferred first-line agent for severe pustular psoriasis in pregnancy in current practice, it is not listed among the options here, making prednisolone the most appropriate choice. - Prednisolone **crosses the placenta minimally** (converted to less active prednisolone by placental 11β-HSD2 enzyme) and has a well-established safety profile in pregnancy. *Acitretin* - **Acitretin** is a systemic **retinoid** that is **highly teratogenic** and can cause severe birth defects including craniofacial, cardiac, thymic, and CNS abnormalities. - It is **absolutely contraindicated in pregnancy** (FDA Category X) and must be avoided for at least 2-3 years before conception due to its long half-life and storage in adipose tissue. *Methotrexate* - **Methotrexate** is an **antimetabolite** and **folate antagonist** that is a potent teratogen, particularly during the first trimester. - It can cause **aminopterin syndrome** (neural tube defects, craniofacial abnormalities, limb defects) and is **absolutely contraindicated in pregnancy** (FDA Category X). - Women on methotrexate must use effective contraception and discontinue the drug at least 3 months before attempting conception. *Dapsone* - **Dapsone** has anti-inflammatory properties and is used in some dermatological conditions, but it is **not indicated for pustular psoriasis**. - Risks in pregnancy include **hemolytic anemia** (particularly in G6PD-deficient individuals), methemoglobinemia in the newborn, and potential neonatal hyperbilirubinemia. - It is **not a first-line or appropriate treatment** for pustular psoriasis in pregnancy.
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