Psoriasis case study

This case study relates to a 47-year-old male patient, Mr GM, with severe psoriasis. The patient has been suffering with psoriasis on and off for 2 years, mostly in the form of widespread irritation. However, over the last few months the occurrence of the dry, scaly, shiny red lesions has become more regular and has spread across his body, after being initially confined to his elbows, knees and lower back. 

Tracy Gamier and Gary Moss Case study level 1 - Cold sores 294 Case study level 2 -Severe acne 295 Case study level 3 - Acute cellulitis 297 Case study level Ma - Atopic eczema 298 Case study level Mb - Psoriasis 301... 

Acitretin (Soriatane), a metabolite of the aromatic retinoid etretinate, is quite effective in the treatment of psoriasis, especially pustular forms. It is given orally at a dosage of 25-50 mg/d. Adverse effects attributable to acitretin therapy are similar to those seen with isotretinoin and resemble hypervitaminosis A. Elevations in cholesterol and triglycerides may be noted with acitretin, and hepatotoxicity with liver enzyme elevations has been reported. Acitretin is more teratogenic than isotretinoin in the animal species studied to date, which is of special concern in view of the drug s prolonged elimination time (more than 3 months) after chronic administration. In cases where etretinate is formed by concomitant administration of acitretin and ethanol, etretinate may be found in plasma and subcutaneous fat for many years. 

A dose-escalation study in 35 patients with psoriasis confirmed that constitutional symptoms in response to denileukin diftitox were dose-related and less frequent at lower doses (below 5 micrograms/kg/day) (17). There was only one case of mild vascular leak syndrome. Skin reactions compatible with delayed hypersensitivity reactions were noted in three patients, including one case of exfoliative dermatitis. 

Our measurements indicate that the cyclic AMP/cyclic GMP ratio in psoriatic lesions is reduced.1 The level of cyclic GMP is consistently increasedl whereas depending on the study, the level of cyclic AMP is either slightly increased,19 normal 9 or modestly reduced.1 Perhaps the most important observation is that whereas most metabolic parameters in psoriasis are unequivocally elevated20,21 as the case with any acti-... 

How common is psoriasis Estimates of the prevalence of psoriasis in the population at large vary from 0.2 to 4% (Table 1). Bereston and Cecclini (B9) and Sutton (S29) based their data on a study of Army personnel therefore, the mean age of the population studied was low and all were men. This no doubt explains the low frequencies since most studies indicate that the mean age of onset of psoriasis is in the twenties and about four years later in men than in women (Table 2). Lane and Crawford (Ll) actually reported an incidence rather than a prevalence figure for psoriasis since they were reporting the percentage of new cases of psoriasis admitted to the Massachusetts General Hospital per year per total hospital admissions. The prevalence of the disease would be expected to be much higher than the incidence, since once it appears it rarely goes away and it does not decrease the life expectancy of the... 

A study found that diclofenac 100 mg daily did not affect the pharmacokinetics of methotrexate however, 5 patients taking low-dose methotrexate 7.5 to 12.5 mg weekly for psoriasis or rheumatoid arthritis developed serious/fatal neutropenias. These cases probably involved other drug interactions, but diclofenac may have been an additional factor in two of them. Other cases involving diclofenac are mentioned in the sections on indometacin (k) and ketoprofen (1). 

A study in patients with rheumatoid arthritis found that the clearance of oral methotrexate 7.5 to 15 mg was unaffected by the concurrent use of paracetamol. In a study of patients with psoriasis taking methotrexate in doses up to 25 mg weekly, no cases of toxicity occurred in 4 patients also taking paracetamol or indometacin. In one study, methotrexate clearance was reduced by NSAIDs but not by paracetamol, which was included in the study as a control. ... 

While no toxic effects were observed, only 2 patients experienced slight improvement. Two patients in this group had psoriasis but these patients received no benefit from Cu therapy. It was recognized that greater beneficial effects might have been expected in a clinical trial where cases of short duration were not excluded from the group of patients studied. 

Skin Psoriasis Determination of the relative risk of psoriasis as a function of psychotropic medication has been studied in the UK General Practice Research Database [54 ], in which 36 702 cases of psoriasis were identified and the same number of matched controls. Use of psychotropic drugs was determined by current and four previous prescriptions. Long-term lithium... 

Chronic hyperkeratotic dermatitis is chiefly encountered in middle-aged or elderly men. It may be a manifestation of psoriasis (Menne and Bachman 1979). However, a 10-year review of 32 cases by Hersle and Mobacken (1982) did not support this view. Thirteen of their patients had been engaged in hard manual work. They proposed a clinically real entity of hyperkeratotic hand eczema. Wilkinson (1985) suggested that friction and pressure play a determining role in this condition. The condition is severe and accounted for 2.5% of all applications for permanent disability determined in a Danish study (Menne and Bachman 1979). Hyperkeratotic dermatitis of the palms was reviewed recently by Menne (1994), and he accepted this disease as an own entity, independent of psoriasis and of mechanical irritation. 

---