Integumentary Function

Full Answer Section

• • Weather: Cold and dry weather can worsen symptoms.
  • Alcohol and Smoking: These lifestyle factors can contribute to flares.
• Clinical Types of Psoriasis:
  • Plaque Psoriasis (Psoriasis Vulgaris): The most common type, characterized by raised, red patches covered with silvery scales.
  • Guttate Psoriasis: Small, drop-shaped lesions, often triggered by streptococcal infections.
  • Inverse Psoriasis: Occurs in skin folds (e.g., armpits, groin), presenting as smooth, red lesions.
  • Pustular Psoriasis: Characterized by pus-filled blisters, which can be localized or generalized.
  • Erythrodermic Psoriasis: A severe form involving widespread redness and shedding of the skin.
  • Psoriatic Arthritis: Inflammation of the joints associated with psoriasis.

2. Treatment Types and Appropriate Approach for K.B.:

• Treatment Types:
  • Topical Corticosteroids: First-line therapy for mild to moderate psoriasis.
  • Topical Calcineurin Inhibitors (Tacrolimus, Pimecrolimus): Useful for sensitive areas (e.g., face, groin).
  • Vitamin D Analogs (Calcipotriene, Calcitriol): Slow down skin cell growth.
  • Retinoids (Tazarotene): Normalize skin cell growth.
  • Phototherapy (UVB, PUVA): Uses ultraviolet light to slow skin cell growth.
  • Systemic Medications (Methotrexate, Cyclosporine, Apremilast): For moderate to severe psoriasis.
  • Biologics (TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors): Target specific components of the immune system.
• Appropriate Approach for K.B.:
  • Given the generalized nature of her relapse and the involvement of multiple body regions, topical treatments alone are likely insufficient.
  • A combination of therapies is recommended.
  • Systemic therapy should be considered. Methotrexate or Apremilast are good options.
  • Biologic therapy might also be appropriate, due to the generalization of the outbreaks.
  • Phototherapy could be used in conjunction with systemic medications.
  • Topical corticosteroids can still be used for targeted areas.
• Non-Pharmacological Options and Recommendations:
  • Moisturizers: Frequent use of emollients to hydrate the skin and reduce scaling.
  • Stress Management: Techniques such as yoga, meditation, or counseling.
  • Oatmeal Baths: Soothe irritated skin.
  • Healthy Diet: A balanced diet rich in fruits, vegetables, and omega-3 fatty acids.
  • Avoid Triggers: Identifying and avoiding known triggers.
  • Sunlight (with caution): Controlled exposure to sunlight can be beneficial.

4. Medication Review and Reconciliation:

• Importance:
  • Certain medications can trigger or exacerbate psoriasis (e.g., beta-blockers, lithium).
  • Drug interactions can occur between psoriasis treatments and other medications.
  • Systemic psoriasis medications can have significant side effects, requiring careful monitoring and consideration of other medications the patient is taking.
  • It is important to know if the medications that the patient is currently taking, may be contributing to the relapse.

5. Other Manifestations of Psoriasis:

• Nail Psoriasis: Pitting, ridging, thickening, or separation of the nails.
• Psoriatic Arthritis: Joint pain, stiffness, and swelling.
• Scalp Psoriasis: Scaly, red patches on the scalp.
• Oral Psoriasis: White or red patches in the mouth.
• Eye Involvement: Uveitis, conjunctivitis.
• Emotional and Psychological Impact: Depression, anxiety, and reduced quality of life.

Sample Answer

Let's break down K.B.'s psoriasis case and the associated questions.

1. Common Triggers and Clinical Types of Psoriasis:

• Common Triggers:
  • Stress: Emotional stress is a significant trigger for many individuals.
  • Infections: Streptococcal infections (e.g., strep throat) are known triggers.
  • Skin Injury: Trauma to the skin (Koebner phenomenon) can induce psoriasis lesions.
  • Certain Medications: Beta-blockers, lithium, and antimalarial drugs can exacerbate psoriasis.