ANSWER
First Case Study: K.B. – Psoriasis Control
1. Typical Psoriasis Triggers and Clinical Forms
Systemic inflammation and hyperproliferation of keratinocytes define the chronic autoimmune illness known as psoriasis. Typical stimuli include:
Environmental Considerations: Stress, frigidity, and smoking.
Streptococcal infections can set up guttate psoriasis.
Medications: antimalarials, lithium, and beta-blockers.
Skin trauma from cuts, burns, or bug bites—the Koebner Phenomenon.
Lifestyles: obesity and alcohol intake.
Psoriasis of clinical forms consist in:
Most prevalent; marked by elevated, inflammatory lesions covered in silvery scales, plaque psoriasis
Often brought on by infections, guttate psoriasis are tiny, droplet-like lesions.
Smooth, crimson lesions in skin creases define inverse psoriasis.
White pustules encircled by irritated skin define pustular psoriasis.
Often a medical emergency, Erythrodermic Psoriasis cause extreme, generalised redness and scaling.
2. Psoriasis: Treatment Strategies
Treatment is based on the patient’s medical background and disease degree.
Pharmacological remedies:
For mild to severe cases, high-potency corticosteroids and vitamin D analogues (e.g., calcipotriol) topically treat.
Systematic Therapies:
For either mild or severe cases, non-biologics include methotrexate, cyclosporine, and acitretin.
For severe cases, biologics include tumour necrosis factor (TNF) inhibitors (e.g., adalimumab), IL-12/23 inhibitors (e.g., ustekinumab), and IL-17 inhibitors (e.g., secukinumab) show promise.
PUVA therapy or narrow-band UVB therapy.
Given K.B.’s severe and recurring plaque psoriasis, a systemic treatment with biologics or phototherapy mixed with topical medicines for localised regions would be most appropriate. For moderate to severe psoriasis especially, biologics aiming at IL-17 or IL-23 pathways are quite successful.
Non-Pharmaceutical Suggestions:
Regular application of emollients helps to lower dryness and scaling.
Stress Management: Counselling or yoga.
Dietary Changes: Anti-inflammatory diets heavy in omega-3 fatty acids.
Reducing alcohol intake, quitting smoking, and avoiding skin damage are among the triggers to avoid.
3. Value of Medicinal Review and Reconciliation
Knowing K.B.’s present prescriptions is vital since:
Some medications—such as lithium or beta-blockers—can aggravate psoriasis.
Systemic psoriasis therapies may interact with concurrent drugs.
For example, methotrexate needs to be watched for hepatotoxicity; biologics raise infection risks, hence a careful screening for contraindications is very important.
4. Other Psoriasis’ Expressions
Psoriasis can show up non-skinally as well as systemically:
Psoriatic arthritis causes swollen joints.
Pitting, onycholysis, and discoloration—nail changes.
Risks for Cardiovascular Problems: Higher chance of heart disease.
Psychological effects include anxiety, depression, and lowered quality of life.
Case Study 2: C.J. – Eye and Ear Expressions
One diagnoses for an eye condition.
C.J.’s presentation suggests that bacterial conjunctivitis is most likely diagnosis. This is reinforced by:
Stuck yellowish discharge covering the eyes in crust form.
conjunctival erythema in both directions.
Vision returns to normal upon cleaning, therefore excluding significant eye damage.
Recent onset without systemic symptoms points to localised bacterial involvement.
2. Likely Aetiology
Considering: bacterial infection is most likely the cause given:
Typical of bacterial conjunctivitis is a purulent discharge.
Lack of systematic viral symptoms—that is, fever or upper respiratory tract problems.
Given discharge and ear complaints, allergic conjunctivitis is less likely.
Other aetiologies (e.g., gonococcal or trachoma) are unlikely without a history of high-risk sexual activity or travel to endemic locations.
For bacterial conjunctivitis, the therapeutic approach is:
Broad-spectrum antibiotics including polymyxin B/trimethoprim drops or erythromycin or polymyxin B eye drops.
Hygiene: Frequent hand washing helps stop spread by preventing eye-touching.
Warm compresses help to ease discharge and irritation.
Regarding the related tympanic membrane findings and ear pain:
Prescription oral antibiotics like amoxicillin-clavulanate help with otitis media management.
Over-the-counter painkillers such as ibuprofen.
4. Integration of Case Results
A careful review guarantees appropriate control and helps to prevent complications:
Should symptoms continue despite therapy, additional investigation for resistant bacteria or other underlying causes—such as sinus infections—is advised.
Should symptoms aggravate, referral to an ophthalmologist or ENT expert could be required.
While encouraging recovery and avoiding complications, by addressing both case studies with thorough treatment plans patient outcomes can be maximised.
Citations
Armstrong, A. W., and associates 2020 Updates on Psoriasis therapy. Journal of the American Academy of Dermatology.
Azari, A. A. & Barney, N. P. 2013. Review of systematic literature on conjunctivitis. J AMA.
QUESTION
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.
Submission Instructions:
- You must complete both case studies.
- Your initial post should be at least 500 words per case study, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points