Integumentary Function

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Integumentary Function:
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.

Sample Solution

Integumentary Function: K.B.’s Psoriasis Case

1. Triggers and Clinical Types of Psoriasis:

Common triggers:

  • Stress
  • Skin injury (cuts, scrapes)
  • Infections (streptococcal)
  • Certain medications (beta-blockers, lithium)
  • Alcohol and smoking
  • Changes in weather

Clinical types:

  • Plaque psoriasis (most common): Thick, red, scaly patches on skin.
  • Guttate psoriasis: Small, teardrop-shaped lesions often triggered by infections.
  • Inverse psoriasis: Smooth, red, inflamed areas in skin folds (groin, armpits).
  • Pustular psoriasis: Small, white pustules on red, inflamed skin.
  • Erythrodermic psoriasis: Severe inflammation affecting most of the body.

2. Treatment Approach for K.B.’s Relapse:

Considering K.B.’s history and current presentation:

  • Topical corticosteroids: May not be sufficient due to generalized nature of outbreak.
  • Systemic medications:
    • Methotrexate: Can be effective for widespread psoriasis.
    • Cyclosporine: Powerful option, but requires close monitoring.
    • Biologics (e.g., adalimumab): Target specific immune pathways, highly effective but expensive.
  • Phototherapy: Ultraviolet light therapy can be helpful.
  • Non-pharmacological options:
    • Moisturizers: Keep skin hydrated and reduce itching.
    • Sunlight exposure (controlled): Can improve symptoms in some cases.
    • Stress management: Reducing stress can help prevent flare-ups.

Medication review is important in K.B.’s case because:

  • Some medications can worsen psoriasis (e.g., beta-blockers).
  • Interactions between medications and psoriasis treatments can occur.
  • Underlying health conditions (e.g., liver disease) can influence treatment options.

3. Other Manifestations of Psoriasis:

  • Psoriatic arthritis: Joint pain, swelling, and stiffness.
  • Nail changes: Thickening, pitting, and discoloration.
  • Eye involvement (rare): Conjunctivitis, blepharitis.

Sensory Function: C.J.’s Eye Condition

1. Diagnosis:

Based on the presentation (crusting discharge, conjunctival erythema, otalgia, otitis media), the most likely diagnosis is acute bacterial conjunctivitis (ABC) with otitis media.

Rationale:

  • Yellowish discharge, redness, and pain suggest inflammation and infection.
  • Bilateral conjunctival involvement points towards infectious cause.
  • Concurrent ear infection strengthens suspicion of bacterial etiology.

2. Determining Etiology:

Without further information (e.g., culture), pinpointing the exact bacterial cause (viral, bacterial, etc.) is impossible. However, the presence of otitis media suggests bacterial involvement is more likely.

3. Therapeutic Approach:

  • Topical antibiotics: Eye drops or ointment to target bacterial conjunctivitis.
  • Oral antibiotics: May be needed for otitis media if symptoms persist.
  • Warm compresses: Can help relieve discomfort and promote drainage.
  • Pain relievers: For symptom management.

Important note: This information is for educational purposes only and should not be used for diagnosis or treatment. Please consult a qualified healthcare professional for any medical concerns.

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