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?
Submission Instructions:
- APA style writing
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources (Within 5 years). Your initial post is worth 8 points.
Full Answer Section
Treatment Options:
Topical therapies:
- First-line: Corticosteroids (K.B.'s initial treatment), calcineurin inhibitors, vitamin D analogues, coal tar.
- Second-line: Combination therapies, retinoids.
Systemic therapies:
- Moderate/severe cases: Methotrexate, cyclosporine, acitretin, apremilast, biologics (e.g., adalimumab, ustekinumab).
Non-pharmacological options:
- Phototherapy: Ultraviolet light exposure can improve symptoms.
- Stress management: Techniques like yoga or meditation can be helpful.
- Skin care: Moisturizers and gentle cleansing routines are crucial.
- Support groups: Connecting with others with psoriasis can offer emotional support.
K.B.'s treatment approach:
Given K.B.'s previous response to topical corticosteroids and the limited nature of her initial flare-up, topical therapy remains a reasonable first-line approach. Options include:
- High-potency corticosteroids: Short-term use to control inflammation.
- Combination therapy: Combining corticosteroids with calcineurin inhibitors or vitamin D analogues.
- Coal tar: May be helpful for scalp involvement.
However, considering the widespread nature of this relapse, consultation with a dermatologist is crucial to assess if:
- Topical therapy alone is sufficient, or
- Systemic therapy or phototherapy is needed for better control.
Medication Review:
Medication review is crucial in K.B.'s case for several reasons:
- Drug interactions: Some medications can interact with psoriasis treatments, reducing their effectiveness or causing side effects.
- Triggering medications: Identifying and potentially adjusting medications that might be triggering K.B.'s flares.
- Comorbidities: Ensuring psoriasis treatments are compatible with any existing medical conditions K.B. may have.
Other Manifestations:
Psoriasis can also affect:
- Joints: Psoriatic arthritis causing pain, stiffness, and swelling.
- Nails: Pitting, thickening, and discoloration.
- Eyes: Conjunctivitis, blepharitis, and uveitis.
- Emotional well-being: Anxiety, depression, and social isolation due to the visible nature of the condition.
Remember: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a qualified healthcare professional for diagnosis and treatment of psoriasis.