PSORIASIS VULGARIS PATIENT DEMOGRAPHICS NAME mahadevappa naik SEX

PSORIASIS VULGARIS PATIENT DEMOGRAPHICS: NAME: - mahadevappa naik SEX: - male AGE: - 60 yrs CHIEF COMPLAINTS: c/o, exacerbations of skin lesions since one and half month. HISTORY OF PRESENT ILLNESS: The exacerbation of skin lesions was insidious in onset, progressive gradually. Initially the lesions were red colored. The lesions are present on forearm , lower legs progressed to trunk, and associated with scaling and itching of grade-II. PAST MEDICAL HISTORY: k/c/o: - psoriasis vulgaris. PERSONAL HISTORY: alcoholic since 30 years.

• LABORATORY INVESTIGATIONS: 4/6/2013 BILURUBIN TOTAL 1. 2 mg/dl BILURUBIN CONJUGATED 0. 8 mg/dl SGOT 55 U/L ALP 221 U/L COMPLETE BLOOD COUNT: ESR: - 65 mm/hr URINE: ALBUMIN Present RBC’s 1. 5 - 2/ hbf

GENERAL PHYSICAL EXAMINATION: Itching – grade 2 Sleep- disturbed b/l pedal edema present Cutaneous exacerbation: - multiple, well defined, extending from lower one third of leg to ankle joint. • Erythematous hyper pigmented plaques with silvery white colour loosely adherent scales present. • Scalp scaling present • Subungual hyperkeratosis present on toe nails • • • SOAP FORMAT SUBJECTIVE DATA: - here is a 60 yrs old male patient hospitalized with complaints of exacerbations of skin lesions since one and a half month.

• OBJECTIVE DATA: • The ESR values are increased- it indicates infection • The total bilurubin and conjugated bilurubin values are increased – this indicates biliary flow obstruction. • The SGOT and ALP values are increased – this indicates biliary obstruction. • USG abdomen: • Presence of gall bladder stones. • Skin biopsy is also done. • DIAGNOSIS: • By observing all the subjective and objective evidences the patient was diagnosed with psoriasis vulgaris.

• ASSESSMENT: • Problem list: • 1. skin lesions: - the activated T cells secrete various cytokines, interferon Alfa and interleukin-2. this stimulates the local keratinocytes and neutrophils to produce TNF- Alfa and interleukin-8, as a result there will be T cell production and activation and the psoriatic epidermal cells proliferate. • 2. psoriasis: - it is a chronic inflammatory skin disorder characterized by recurrent exacerbations and remissions of thickened erythematous and scaling plaques.

PROBLEM GOALS OF THERAPY DRUGS AND MOA psoriasis 1. Achieve resolution of lesions Emollients- liquid paraffin: - they hydrate the stratum corneum and minimize water evaporation. They eliminate scaling. UV- B exposure DOSAGE 290 - 320 nm Keratolytics- salicylic acid- they cause disruption in corneocyte- 2 - 10% gel corneocyte adhesion and removes scales. Corticosteroids: clobetasol- they halt synthesis of DNA in epidermal cells. It also lowers amount of 0. 05% gel inflammatory mediators.

• THERAPY: S. NO TRADE NAME GENERIC NAME DOSE AND REGIMEN 4/6 5/6 6/6 7/6 8/6 1. Tab. Atarax Hydroxyzine 25 mg 0 -0 -1 y Y Y 2. Tenovate ointment Clobetasol propionate 1 -1 -1 Y Y Y 3. Liquid paraffin 1 -1 -1 Y Y Y 4. Narrow band UV spectrum 290 - 320 nm X Y X 5. t. Bact ointment 1 -0 -0 X X Y mupirocin

• DRUGS AND THEIR MECHANISM OF ACTION: • 1. hydroxyzine- they are H-1 blockers. They block histamine induced itching, wheal and flare ( triple response ). • 2. clobetasol- they suppress allergic phenomenon. They block accumulation of inflammatory mediators. • 3. liquid paraffin- they hydrate stratum corneum and minimize water evaporation. They prevent scaling and itching. • 4. mupirocin: - they inhibit bacterial protein synthesis by blocking production of t- RNA.

• • • DISCHARGE DRUGS: 1. tab. Atarax 25 mg 0 -0 -1 2. tenovate ointment 1 -1 -1 3. liquid paraffin Follow up after 7 days • DRUG INTERACTIONS: • No drug interactions found. • SUSPECTED ADR: • Dizziness- it may be due to the drug Atarax.

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