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?
Sensory Function:
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.
Full Answer Section
Psoriasis Types:
- Plaque Psoriasis (most common): Thick, red, scaly patches on the skin. K.B. has this type.
- Guttate Psoriasis: Small, red, teardrop-shaped lesions often triggered by a streptococcal infection.
- Inverse Psoriasis: Smooth, red, inflamed patches in skin folds (groin, armpits, genitals).
- Pustular Psoriasis: White pustules on red, inflamed skin.
- Erythrodermic Psoriasis: Widespread, red, scaling that covers most of the body.
Treatment Options for K.B.'s Relapse:
- Topical Corticosteroids: First-line treatment; effective for mild to moderate psoriasis. K.B. previously responded well, so a mid-potency steroid cream/ointment might be appropriate due to the larger affected area.
- Topical Vitamin D Analogs: Can be used alone or combined with corticosteroids.
- Topical Calcineurin Inhibitors: Immunomodulators for moderate psoriasis.
- Phototherapy (Light Therapy): Ultraviolet B (UVB) light therapy can be effective for moderate to severe psoriasis.
- Oral or Injectable Medications: For severe psoriasis or when topical treatments are ineffective. Options include methotrexate, cyclosporine, and biologic drugs.
Non-Pharmacological Options:
- Moisturizers: Regular use helps hydrate the skin and reduce itching.
- Sunlight Exposure (with caution): Moderate sun exposure can improve psoriasis symptoms, but sunburn can worsen them.
- Stress Management: Techniques like yoga or meditation can help manage stress, a potential trigger.
- Weight Loss (if overweight): Can improve psoriasis severity.
Medication Review Importance:
- Drug Interactions: Some medications can worsen psoriasis or interact with psoriasis treatments.
- Contraindications: Certain medications might not be suitable for K.B. due to underlying health conditions.
Additional Manifestations of Psoriasis:
- Psoriatic Arthritis (joint pain and inflammation)
- Nail Psoriasis (pitting, discoloration, separation of nails)
- Psoriatic Eye Disease (conjunctivitis, blepharitis)
Case 2: C.J. (Eye Infection)
Diagnosis:
Based on the symptoms (crusty discharge, redness, blurry vision), C.J. most likely has
acute bacterial conjunctivitis. This is a common eye infection caused by bacteria.
Rationale:
- Viral conjunctivitis typically presents with watery discharge, not yellowish and thick like C.J.'s.
- Allergic conjunctivitis usually doesn't cause blurry vision or throbbing ear pain.
- Gonococcal and chlamydial conjunctivitis, transmitted through sexual contact, wouldn't typically cause ear pain.
- Trachoma is a chronic bacterial infection more common in developing countries.
Probable Etiology:
Without further information, pinpointing the exact bacteria is difficult. Common culprits include Staphylococcus aureus and Haemophilus influenzae.
Treatment Approach:
- Antibiotic Eye Drops: These are the first-line treatment for bacterial conjunctivitis.
- Warm Compresses: Soak a clean washcloth in warm water and apply to closed eyelids to loosen discharge.
- Pain relievers: Over-the-counter pain relievers like ibuprofen can help with discomfort.
Important Note:
This information is for educational purposes only and should not be interpreted as medical advice. Please consult a licensed physician for diagnosis and treatment of any medical condition.