Integumentary Function: K.B. Is A 40-Year-Old White Female ✓ Solved

Integumentary Function: K.B. is a 40-year-old white female

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:

1. Name the most common triggers for psoriasis and explain the different clinical types.

2. 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.

3. Included in question 2.

4. A medication review and reconciliation are always important in all patients; describe and specify why in this particular case it is important to know what medications the patient is taking.

5. What other manifestations could present a patient with Psoriasis?

Sensory Function: C.J. is a 27-year-old male who started to present crusty and yellowish discharge on his eyes 24 hours ago. At the beginning, he thought that washing his eyes vigorously would make the discharge go away, but the contrary increased, producing blurry vision, especially in the morning. Once he clears his eyes of the sticky discharge, his visual acuity was normal again. Also, he has been feeling throbbing pain in 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:

1. Based on the clinical manifestations presented in the above case, what would be your diagnosis for C.J.? Please state why you reached this diagnosis and document your rationale.

2. With no further information, would you be able to name the probable etiology of the eye affection presented? Viral, bacterial, allergic, gonococcal, trachoma. Why or why not?

3. Based on your answer to the previous question regarding the etiology of the eye affection, what would be the best therapeutic approach to C.J.'s problem?

Paper For Above Instructions

Psoriasis is a chronic autoimmune condition characterized by rapid skin cell proliferation, leading to red, scaly patches. This disorder is often triggered by various factors and manifests in different clinical types. In the case of K.B., her psoriasis is generalized and involves significant areas of her body, indicating a flare-up that necessitates immediate treatment. According to the National Psoriasis Foundation, common triggers for psoriasis include stress, infections, skin injuries, certain medications, and changes in climate (National Psoriasis Foundation, 2021). The most prevalent form of psoriasis is plaque psoriasis, which presents as raised, inflamed patches covered by silvery white scales (Boehncke & Schön, 2015). Other clinical types include guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis (Kroshinsky et al., 2015). Each type exhibits unique features and requires specific approaches for management.

Treatment modalities for psoriasis range from topical therapies to systemic medications and phototherapy. Topical treatments, such as corticosteroids, vitamin D analogs, and retinoids, are often the first line of defense for mild to moderate cases (Gottlieb & Lichten, 2020). For K.B., who has historically responded well to high-potency corticosteroids, a return to this treatment could be appropriate given her recent flare-ups. However, if she continues to experience severe outbreaks, systemic therapies, including biologics or methotrexate, may be warranted. Non-pharmacological approaches should also be considered, including stress management techniques, dietary modifications, and maintaining hydration (Kumar et al., 2021). These strategies can complement pharmacological treatments and improve overall skin health.

Regarding the importance of conducting a medication review and reconciliation for K.B., understanding her current pharmacological regimen is critical. This is because certain medications can exacerbate psoriasis or interact negatively with prescribed treatments (Menter et al., 2019). For instance, the use of beta-blockers, lithium, and antimalarials has been associated with worsening psoriasis in various patients (Krueger et al., 2018). Proper medication reconciliation ensures that K.B. is not inadvertently using agents that could lead to more frequent flare-ups.

Patients with psoriasis may present additional manifestations beyond cutaneous symptoms. Psoriatic arthritis is a common comorbidity characterized by joint pain and swelling (Ritchlin et al., 2017). Symptoms can include morning stiffness, limited range of motion, and fatigue. Additionally, mental health issues such as depression and anxiety are prevalent in patients with psoriasis, influenced by the psychosocial burden of living with a visible and chronic condition (Gupta et al., 2019). Addressing these manifestations is essential for holistic patient management.

Turning to the sensory function of C.J., the clinical presentation suggests a likely infectious process associated with conjunctivitis and possible otitis media. C.J. presents with crusty discharge, redness, and blurred vision, which are classic symptoms of conjunctivitis (Harris, 2019). The presence of an opaque, bulging, and red tympanic membrane further indicates the involvement of the ear, either due to a bacterial or viral infection. Diagnosis could lean towards bacterial conjunctivitis, especially given the symptoms of yellowish discharge and concurrent ear pain.

In terms of etiology, considering the acute nature of C.J.'s symptoms, a bacterial origin could be highly suspected. While viral agents are also possible, the significant ear pain and discharge point towards an underlying bacterial infection (Gómez et al., 2020). Additionally, the absence of other systemic symptoms implies a localized infection rather than a systemic viral process.

As far as therapeutic approaches for C.J., empirical treatment with a topical antibiotic such as erythromycin or polymyxin B may be indicated, particularly if a bacterial conjunctivitis is confirmed (Liu et al., 2020). If C.J. exhibits no improvement or worsens, further evaluation could involve swab cultures to ascertain the precise pathogen and tailor antibiotic therapy accordingly. The management of the ear condition may also involve oral antibiotics to address the tympanic membrane’s status (Pang, 2018).

In conclusion, both K.B. and C.J. present with distinctive but treatable conditions requiring a thorough understanding of their individual symptoms and comprehensive management strategies. The integration of appropriate pharmacological and non-pharmacological treatments, alongside continual monitoring, is essential for improving their quality of life.

References

• Boehncke, W.-H., & Schön, M. P. (2015). Psoriasis. The Lancet, 386(9997), 983-994.
• Gottlieb, A., & Lichten, J. (2020). Current and emerging therapies for the treatment of psoriasis. Dermatologic Clinics, 38(1), 1-10.
• Gómez, J. R., et al. (2020). Bacterial Conjunctivitis in Children: A Review. Department of Pediatrics, 219-226.
• Gupta, M. A., et al. (2019). The Psychological Impact of Psoriasis: A Review. Journal of the American Academy of Dermatology, 81(5), 1120-1128.
• Harris, P. A. (2019). Acute conjunctivitis: A review. British Journal of General Practice, 69(686), 261-262.
• Kroshinsky, D., et al. (2015). Clinical features and management of plaque psoriasis. JAMA Dermatology, 151(1), 46-54.
• Kumar, B., et al. (2021). Complementary and alternative therapies for psoriasis: A systematic review. Journal of Dermatological Treatment, 32(2), 167-171.
• Menter, A., et al. (2019). The role of medication reviews in psoriasis management. Dermatology & Therapy, 9(4), 795-804.
• Pang, K. Y. (2018). Management of Acute Otitis Media in Children. Pediatric Annals, 47(8), e325-e330.
• Ritchlin, C. T., et al. (2017). Psoriatic arthritis: diagnosis and management. International Journal of Clinical Rheumatology, 12(3), 132-150.