Psoriasis Case Study: K.B.

1. Triggers and Psoriasis Types:

Common Triggers for Psoriasis:

• Stress
• Skin injury (sunburn, cuts, scrapes)
• Certain medications (beta-blockers, lithium)
• Throat infections (strep throat)
• Excessive alcohol consumption
• Smoking

Clinical Types of Psoriasis:

• Plaque Psoriasis (most common): Thick, red, scaly patches on the skin (like K.B.’s case).
• Guttate Psoriasis: Small, red, teardrop-shaped lesions often triggered by a strep throat infection.
• Inverse Psoriasis: Smooth, red, inflamed patches in skin folds (armpits, groin).
• Pustular Psoriasis: White pustules on red, inflamed skin.
• Erythrodermic Psoriasis: Widespread reddening, peeling, and burning of the skin.
• Psoriatic Arthritis: Psoriasis with joint pain, swelling, and stiffness.

2. Treatment for K.B.’s Relapse:

Treatment Options:

• Topical medications: First-line treatment for mild to moderate psoriasis. K.B. previously responded well to high-potency corticosteroids, but due to the generalized nature of this relapse, a different approach might be considered. Options include:
  • Corticosteroids: Reduce inflammation and itching. (Short-term use due to side effects)
  • Vitamin D analogues: Slows skin cell growth.
  • Tazarotene: Retinoid that promotes normalization of skin cell growth.
  • Calcineurin inhibitors: Suppress immune system activity in the skin. (Not ideal for long-term use)
• Phototherapy: Ultraviolet light therapy can slow skin cell growth.
• Systemic medications: For severe psoriasis or cases not responding to topical treatments. Options include:
  • Methotrexate: Suppresses the immune system.
  • Cyclosporine: Suppresses the immune system. (Strong medication with side effects)
  • Biologics: Target specific parts of the immune system involved in psoriasis.

Most Appropriate Approach for K.B.:

Given K.B.’s previous response to topical corticosteroids and the widespread nature of this relapse, the dermatologist might recommend a combination approach. This could involve:

• Mid-potency topical corticosteroids: For targeted areas.
• Calcineurin inhibitors or Vitamin D analogues: For broader coverage.
• Phototherapy: Depending on the severity.

Non-pharmacological options:

• Moisturizers: Soothe dry, itchy skin.
• Stress management: Stress reduction techniques can help manage flares.
• Maintaining a healthy weight: Obesity can worsen psoriasis.

Medication Review:

A medication review is crucial to identify any medications that might be triggering the relapse or interact with psoriasis treatments. This is particularly important for K.B. as she might be taking medications for other conditions.

3. Other Psoriasis Manifestations:

Psoriasis can manifest beyond skin lesions. Potential complications include:

• Psoriatic arthritis: Joint pain, swelling, and stiffness.
• Nail psoriasis: Pitting, discoloration, and crumbling of nails.
• Increased risk of cardiovascular disease and depression.

Eye Case Study: C.J.

Diagnosis:

Based on the clinical manifestations, C.J. most likely has acute bacterial conjunctivitis. This is supported by:

• Yellowish discharge (pus) – a hallmark of bacterial infection.
• Bilateral conjunctival erythema (redness) – inflammation of the conjunctiva (lining of the eyelids and eyeball).
• Throbbing ear pain – suggests a possible bacterial upper respiratory infection (URI) that spread to the eye.

Etiology:

Without further information, pinpointing the exact bacterial cause is difficult. Common culprits for bacterial conjunctivitis include:

• Staphylococcus aureus
• Streptococcus pneumoniae
• Haemophilus influenzae

Treatment:

Given the suspected bacterial cause, the best therapeutic approach is likely:

• Topical antibiotic eye drops: Target the specific bacteria causing the infection.
• Warm compresses: Soothe discomfort.

Viral conjunctivitis is less likely due to the presence of pus (more common with bacteria). Allergic conjunctivitis typically wouldn’t cause a throbbing earache. Gonococcal and chlamydial conjunctivitis are sexually transmitted infections (STIs) with different presentations. Trachoma is a chronic bacterial infection more common in developing countries.

Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a licensed physician for diagnosis and treatment.