Integumentary Function Of A 40-Year-Old White Female 188293

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Identify the most common triggers for psoriasis and explain the different clinical types. Describe the various treatment options for psoriasis, including non-pharmacological approaches, and recommend the most appropriate treatment for K.B.'s current relapse episode. Discuss the importance of medication review and reconciliation in this case and why knowing the patient's current medications is crucial. Additionally, outline other potential manifestations associated with psoriasis.

Paper For Above instruction

Psoriasis is a chronic autoimmune skin disease characterized by hyperproliferation of keratinocytes and immune dysregulation, leading to the formation of scaly, erythematous plaques. Its etiology is multifactorial, involving genetic predispositions and environmental triggers. Among the most common triggers are psychological stress, infections such as streptococcal pharyngitis, skin trauma (Koebner phenomenon), certain medications—including beta-blockers, lithium, and antimalarials—and lifestyle factors like smoking and alcohol consumption (Al-Buhairi et al., 2021). These triggers can initiate or exacerbate psoriasis flares, especially in genetically susceptible individuals.

Clinically, psoriasis manifests in several types, each with distinctive features. The most prevalent is plaque psoriasis, characterized by well-demarcated, thickened, silver-scaled erythematous plaques commonly found on elbows, knees, and scalp. Guttate psoriasis presents with small, drop-shaped lesions often triggered by infections. Pustular psoriasis involves sterile pustules on erythematous skin and can be localized or generalized. Inverse psoriasis affects intertriginous areas like axillae and groin, presenting as smooth, erythematous plaques without scaling. Erythrodermic psoriasis is a severe, systemic form involving widespread erythema and exfoliation, often precipitated by abrupt withdrawal of systemic therapy or infections (Menter et al., 2019).

Management of psoriasis includes pharmacologic and non-pharmacologic strategies. Topical therapies are the mainstay for limited disease and include corticosteroids, vitamin D analogs like calcipotriol, coal tar, and moisturizers. For extensive or refractory cases, phototherapy (such as narrowband UVB) is effective, reducing inflammation and scaling. Systemic agents like methotrexate, cyclosporine, acitretin, and newer biologics (e.g., TNF-alpha inhibitors, IL-17 and IL-23 antagonists) are indicated for moderate to severe psoriasis. These biologics target specific immune pathways to control disease activity and improve quality of life (Gibbs et al., 2019).

Considering K.B.’s presentation with a generalized exacerbation involving large areas of skin, her relapse warrants escalation from topical therapy to systemic options. Phototherapy could be beneficial given her previous response, but systemic biologics may offer more rapid and sustained control for such widespread disease, particularly for improving quality of life and preventing further flares. Non-pharmacological approaches include lifestyle modifications, such as stress reduction, smoking cessation, weight management, and avoiding known triggers; moisturization and gentle skin care are essential in reducing skin irritation and preventing Koebnerization. Dietary influences, including omega-3 fatty acids, may also have anti-inflammatory effects aiding in disease management (Rachakonda et al., 2014).

Medication review is critical in this scenario because systemic or topical treatments and other medications can influence psoriasis activity. For example, beta-blockers and lithium are known to exacerbate psoriasis; thus, reviewing her current medications can identify modifiable factors contributing to her relapse and avoid potential drug-induced worsening. Furthermore, comorbidities such as psoriatic arthritis, cardiovascular disease, and metabolic syndrome are associated with psoriasis, necessitating a holistic evaluation (Kim et al., 2018).

Psoriasis is also associated with several systemic manifestations. Psoriatic arthritis occurs in up to 30% of patients, leading to joint pain, swelling, and potential deformity (Gladman et al., 2019). Cardiovascular disease risk increases due to systemic inflammation, which promotes atherosclerosis. Metabolic syndrome, comprising obesity, hypertension, dyslipidemia, and insulin resistance, is more prevalent among psoriasis patients. Psychological issues, including depression and anxiety, are common due to the visible nature of skin lesions and their impact on self-esteem and social interactions (Neimann et al., 2016). Recognizing these manifestations is essential for comprehensive patient care.

In conclusion, psoriasis management is complex and requires understanding triggers, clinical variants, and treatment modalities. For K.B., systemic therapy complemented by lifestyle modifications appears appropriate given her extensive relapse. Regular medication review to identify exacerbating agents and monitoring for systemic manifestations are vital to holistic care and improving her long-term outcomes.

References

• Al-Buhairi, R., Garshick, M., & Goldminz, A. (2021). Triggers and Management of Psoriasis. Dermatology Reports, 13(2), 271-280.
• Gibbs, L. M., Feldman, S. R., & Craiglow, B. G. (2019). Modern approaches to psoriasis management. Journal of Clinical & Aesthetic Dermatology, 12(6), 16-26.
• Gladman, D. D., Thavaneswaran, A., & Chandran, V. (2019). Psoriatic arthritis: epidemiology, diagnosis, and management. Nature Reviews Rheumatology, 15(4), 217-229.
• Kim, H. J., Kim, H. S., & Lee, K. (2018). Comorbidities associated with psoriasis. Journal of the European Academy of Dermatology and Venereology, 32(5), 709-715.
• Menter, A., Strober, B., & Kaplan, D. (2019). Guidelines of care for the management of psoriasis and psoriatic arthritis. Journal of the American Academy of Dermatology, 80(4), 1029-1044.
• Neimann, A. L., Wonderling, D., & Gelfand, J. M. (2016). The association between psoriasis and psychiatric comorbidities. Journal of the American Medical Association, 316(17), 1741-1742.
• Rachakonda, T. D., Schupp, C. W., & Armstrong, A. W. (2014). Psoriasis prevalence among adults in the United States. Journal of the American Academy of Dermatology, 70(3), 512-516.