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13. SYSTEMIC THERAPY Methotrexate have been used in treating extensive psoriasis that fails to respond to other forms of therapy. Should monitor hepatic, haematopoietic and renal systems. Reinforce women of childbearing age that retinoids and methotrexate are teratogenic; women must be using birth control. Oral retinoids (synthetic derivatives of Vitamin A and its metabolite, Vitamin A acid) Hydroxyurea (Hydrea). Monitor signs ands symptoms of bone marrow depression. PHOTOTHERAPY A treatment for severely debilitating psoriasis is psoralen and ultraviolet A (PUVA) therapy, which involves taking a photosensitizing drug (usually 8-methoxypsoralen) in a standard dose with subsequent exposure to long-wave ultraviolet light when peak drug plasma levels are obtained. UVB light is also used to treat generalized plaque. Advise patient to wear goggles to prevent cataracts and follow up with periodic eye exams. Should wear sunscreen and sunglasses. Contraceptives should be used since teratogenic effect has not been established yet.

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