Psoriasis Case Study No. 1
1. The most common causes of psoriasis and an explanation of the many clinical types:
Stress, skin damage, infections (such as streptococcal throat infection), certain drugs (such as beta-blockers and lithium), and environmental changes are common psoriasis triggers. Psoriasis is classified into several clinical forms, the most frequent of which are plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Plaque psoriasis is distinguished by high, red spots covered with silvery scales. Guttate psoriasis manifests as tiny, dot-like lesions frequently caused by streptococcal infections. Inverse psoriasis presents as smooth, red lesions in skin creases. Pus-filled blisters on the skin distinguish pustular psoriasis, whereas erythrodermic psoriasis is characterized by widespread inflammation and skin exfoliation.
2. Different types of psoriasis treatments and the best method for K.B. :
Topical therapies (e.g., corticosteroids, vitamin D analogs), phototherapy (e.g., UVB, PUVA), systemic drugs (e.g., methotrexate, biologics), and oral retinoids are all choices for treating psoriasis. In the case of K.B.’s recurrence episode involving generalized plaque psoriasis, topical therapy and phototherapy would be the best approach. For the affected areas, high-potency corticosteroids, to which K.B. initially responded effectively, can be administered. Phototherapy, particularly UVB therapy, can target more expansive areas of involvement. Non-pharmacological alternatives and advice include frequent skin moisturization, avoiding triggers, controlling stress, and leading a healthy lifestyle.
3. The importance of medication review and reconciliation for K.B.: Medication review and reconciliation are critical since certain drugs might aggravate or provoke psoriasis. Any medicines that K.B. takes must be identified to examine their potential impact on her psoriasis. Beta-blockers and lithium, for example, are known to aggravate psoriasis symptoms. A medication evaluation allows healthcare providers to identify possible culprits and make necessary changes to K.B.’s treatment plan.
4. Other psoriasis manifestations: Psoriasis can appear in ways other than skin sores. Psoriasis patients may endure joint discomfort and swelling, known as psoriatic arthritis. Pitting, discoloration, and detachment from the nail bed are all possible nail alterations. Psoriasis can cause scaling and itching on the scalp. Individuals with psoriasis may also experience psychological and emotional effects such as low self-esteem, sadness, and anxiety.
Case Study 2: Eye Disease
1. C.J.’s eye problem is diagnosed:
C.J.’s diagnosis would be conjunctivitis with otitis media based on the clinical signs (yellowish discharge, bilateral conjunctival erythema, throbbing pain, and opaque, bulging, and red tympanic membrane). Conjunctivitis is an inflammation of the conjunctiva characterized by bilateral conjunctival erythema and discharge. Otitis medium, an infection of the middle ear, is characterized by throbbing pain and a red, bulging tympanic membrane. The two disorders are frequently linked in cases of viral or bacterial infections that can damage both the eyes and hearing.
2. Probable etiology of the eye affection: It is impossible to definitively define the etiology of C.J.’s eye ailment with the facts provided. However, taking into account
The most likely cause of the symptoms of yellowish discharge and conjunctival erythema, as well as the presence of otitis media, is a bacterial infection. Bacterial conjunctivitis is distinguished by purulent discharge and redness, and it may be associated with otitis media due to the disease spreading from the nasopharynx to the middle ear.
3. The best treatment approach for C.J.’s condition: Antibiotics would be the best therapeutic approach for C.J.’s disease because a bacterial infection is the most likely etiology. Topical antibiotic eye drops, or ointments such as fluoroquinolones or macrolides might be administered to treat bacterial conjunctivitis. Antibiotics administered systemically may also be indicated for the accompanying otitis media. An ophthalmologist or primary care physician should be consulted for a complete evaluation and suitable therapy.
1. Griffiths, C. E., Barker, J. N., and Bleiker, T. (2016). Rook’s Dermatology Textbook. John Wiley & Sons, Inc.
2. Mente, A., and K. Manmohan (2019). StatPearls [Internet]. Psoriasis. StatisticsPearls Publishing.
3. S. Michael, M. Moore, C. Maranzano, A. Hanlon, D. S. Dizon, and J. Ochoa (2020). A Review of Psoriasis. Dermatology and Therapy, vol. 10, no. 4, pp. 569-585.
(2019) American Academy of Ophthalmology. Preferred Practice Pattern® for Conjunctivitis. URL: https://www.aao.org/preferred-practice-pattern/conjunctivitis-ppp-updated-2019
K.B. is a 40-year-old white female with a 5-year history of psoriasis. She has scheduled an appointment with her dermatologist due to another relapse of psoriasis. This is her third flare-up since a definitive diagnosis was made. This outbreak of plaque psoriasis is generalized and involves large regions on the arms, legs, elbows, knees, abdomen, scalp, and groin. K.B. was diagnosed with limited plaque-type psoriasis at age 35 and initially responded well to topical treatment with high-potency corticosteroids. She has been in remission for 18 months. Until now, lesions have been confined to small regions on the elbows and lower legs.
Case Study Questions
Name the most common triggers for psoriasis and explain the different clinical types.
There are several types of treatments for psoriasis, explain the different types and indicate which would be the most appropriate approach to treat this relapse episode for K.B. Also include non-pharmacological options and recommendations.
Included in question 2
A medication review and reconciliation are always important in all patient, describe and specify why in this particular case is important to know what medications the patient is taking?
What others manifestation could present a patient with Psoriasis?
C.J. is a 27-year-old male who started to present crusty and yellowish discharged on his eyes 24 hours ago. At the beginning he thought that washing his eyes vigorously the discharge will go away but by the contrary increased producing a blurry vision specially in the morning. Once he clears his eyes of the sticky discharge her visual acuity was normal again. Also, he has been feeling throbbing pain on his left ear. His eyes became red today, so he decided to consult to get evaluated. On his physical assessment you found a yellowish discharge and bilateral conjunctival erythema. His throat and lungs are normal, his left ear canal is within normal limits, but the tympanic membrane is opaque, bulging and red.
Case Study Questions
Based on the clinical manifestations presented on the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rational.
With no further information would you be able to name the probable etiology of the eye affection presented? Viral, bacterial, allergic, gonococcal, trachoma. Why and why not.
Based on your answer to the previous question regarding the etiology of the eye affection, which would be the best therapeutic approach to C.J problem.
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