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There are many therapeutic options in psoriasis to be chosen according to the extent and severity of disease Certain drugs, such as -blockers, antimalarials, statins, and lithium, may flare or worsen psoriasis

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For many patients, the easiest regimen is to use a highpotency to ultra-high-potency topical corticosteroid cream or ointment It is best to restrict the ultra-high-potency corticosteroids to 2 3 weeks of twice-daily use and then use them in a pulse fashion three or four times on weekends or switch to a midpotency corticosteroid Topical corticosteroids rarely induce a lasting remission They may induce tachyphylaxis or cause psoriasis to become unstable Additional measures are therefore commonly added to topical corticosteroid therapy Calcipotriene ointment 0005%, a vitamin D analog, is used twice daily for plaque psoriasis Initially, patients are treated with twice-daily corticosteroids plus calcipotriene twice daily This rapidly clears the lesions Calcipotriene is then used alone once daily and with the corticosteroid once daily for several weeks Eventually, the topical corticosteroids are stopped, and once- or twice-daily calcipotriene is continued longterm Calcipotriene usually cannot be applied to the groin or on the face because of irritation Treatment of extensive psoriasis with calcipotriene may result in hypercalcemia Calcipotriene is incompatible with many topical corticosteroids (but not halobetasol), so if used concurrently it must be applied at a different time Tar preparations such as Fototar cream, LCD (liquor carbonis detergens) 10% in Nutraderm lotion, alone or mixed directly with triamcinolone 01%, are useful adjuncts when applied twice daily Occlusion alone has been shown to clear isolated plaques in 30 40% of patients Occlusive hydrocolloid dressings such as thin DuoDerm are placed on the lesions and left undisturbed for as long as possible (a minimum of 5 days, up to 7 days) and then replaced Responses may be seen within several weeks For the scalp, start with a tar shampoo, used daily if possible For thick scales, use 6% salicylic acid gel (eg, Keralyt), P & S solution (phenol, mineral oil, and glycerin), or fluocinolone acetonide 001% in oil (Derma-Smoothe/ FS) under a shower cap at night, and shampoo in the morning In order of increasing potency, triamcinolone 01%, or fluocinolone, betamethasone dipropionate, fluocinonide or amcinonide, and clobetasol are available in solution form for use on the scalp twice daily For psoriasis in the body folds, treatment is difficult, since potent.

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Schapira AH Restless legs syndrome: an update on treatment options Drugs 2004;64(2):149 58 [PMID: 14717617] Winkelman JW et al Efficacy and safety of pramipexole in restless legs syndrome Neurology 2006 Sep 26;67(6):1034 9 [PMID: 16931507]

Multiple motor and phonic tics Symptoms begin before age 21 years Tics occur frequently for at least 1 year Tics vary in number, frequency, and nature over time

In this metabolic disorder, abnormal movement and posture may occur with or without coexisting signs of liver involvement It is discussed in 15

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