60.3 🩺 內科專科考前版

60.3.0.1 📌 䞀頁重點

  • 22E: dupilumab AD revolution / TYK2 (deucravacitinib) for psoriasis / abrocitinib JAK
  • Taiwan: 健保 biologics 限制條件 + step therapy

60.3.0.2 💊 進階

60.3.0.2.1 AD Biologic Use
  • Dupilumab 適甚moderate-severe + topical 倱敗
  • Lebrikizumab/tralokinumab 替代遞項
  • JAK (abrocitinib, upadacitinib) caveat感染、cardiovascular、cancer warning
  • Topical ruxolitinib for non-immunocomp
60.3.0.2.2 Psoriasis Step Therapy (台灣健保)
  • Phototherapy / MTX → biologicsTNF-α firstIL-17/23 埌
  • Switch criteriaresponse < PASI 75 at 24 wk
60.3.0.2.3 矎容甚 Isotretinoin Pearls
  • iPledge or local equivalent
  • 監枬 lipid + LFT q 1-2 mo
  • Avoid donate blood × 1 mo post-stop

60.3.0.3 🌟 Pearls (8)

  1. Dupilumab age 6 months+ for AD
  2. PsA early treatment improves joint + skin outcomes
  3. Sweet syndrome / pyoderma gangrenosum in IBD/leukemia
  4. Hidradenitis suppurativa = 慢性 axillae/groin → adalimumab/secukinumab
  5. Eczema herpeticum = AD + HSV → IV acyclovir
  6. Erythrodermic psoriasis ICU
  7. Scabies in nursing home = norwegian (crusted) variant
  8. Tinea capitis in children → oral terbinafine䞍胜單 topical

60.3.0.4 📍 Taiwan

  • 健保 biologics 條件嚎栌PsO PASI > 10
  • AD biologic dupilumab 健保有條件
  • Acne isotretinoin 自費為䞻 (健保限定 nodular cystic)

60.3.0.5 🎓 內專重點

  1. AD biologics 階梯
  2. Psoriasis biologics 機蜉
  3. Skin infections empiric
  4. Isotretinoin pearls

⚠ AI 草皿。