Integumentary Function Of A 40-Year-Old White Female 446010

Integumentary Functionkb Is A 40 Year Old White Female With A 5 Yea

Integumentary Function: 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.

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

- What other manifestations could present in a patient with psoriasis?

Paper For Above instruction

Psoriasis is a chronic inflammatory skin condition characterized by hyperproliferation of keratinocytes, leading to the development of scaly, erythematous plaques. It often involves genetic, immunologic, and environmental factors that trigger its onset and exacerbation. The most common triggers for psoriasis include physical trauma (Koebner phenomenon), infections such as streptococcal pharyngitis, psychological stress, certain medications (e.g., beta-blockers, lithium), smoking, alcohol consumption, and obesity (Parisi et al., 2013). Recognizing these triggers is essential for effective management and prevention of flare-ups.

The clinical types of psoriasis vary based on presentation, distribution, and severity. The most prevalent form is plaque psoriasis, also known as psoriasis vulgaris, characterized by well-demarcated, raised, silvery-white scaly plaques commonly on elbows, knees, and scalp. Other variants include guttate psoriasis, which presents as small droplet-like lesions often triggered by infections; pustular psoriasis, characterized by sterile pustules; inverse psoriasis, affecting skin folds such as axillae and groin; and erythrodermic psoriasis, a severe form involving widespread erythema and scaling that can be life-threatening (Menter et al., 2019). Knowledge of these types assists clinicians in tailoring therapeutic approaches.

Management options for psoriasis encompass topical treatments, phototherapy, systemic agents, and biologic therapies. Topical treatments remain foundational, especially for mild-to-moderate disease, including corticosteroids, vitamin D analogs (e.g., calcipotriol), coal tar, and moisturizers. For more extensive or refractory cases, phototherapy—using UVB or PUVA—is effective. Systemic therapy involves traditional agents like methotrexate, cyclosporine, and acitretin, which are suitable for severe psoriasis. Biologic agents targeting specific immune pathways, such as TNF-alpha inhibitors, IL-17 inhibitors, and IL-23 inhibitors, have revolutionized treatment for moderate-to-severe psoriasis (Gonzalez-Lara et al., 2019). In K.B.'s case, given the extensive and generalized relapse, initiating systemic therapy may be appropriate, possibly with biologics if tolerated and indicated.

Non-pharmacological strategies also play a vital role in managing psoriasis. These include daily skin hydration, avoiding known triggers, stress reduction techniques, and maintaining a healthy weight. Photoprotection and controlled sunlight exposure can be beneficial, but should be supervised to prevent skin damage. Patient education on disease course, trigger avoidance, and adherence to treatment are equally important (Kundu & Surana, 2014).

Medication reconciliation is critical in this context because certain medications can either trigger or worsen psoriasis. For instance, beta-blockers, lithium, and antimalarials are known potential exacerbators. Knowing the patient's current medications ensures that no pharmacologic agents are inadvertently contributing to flare-ups and allows adjustments in therapy. Furthermore, it helps prevent adverse drug interactions, especially when initiating systemic treatments or biologic agents that may have significant implications on other comorbid conditions (Gottlieb et al., 2017).

Patients with psoriasis may also present with comorbidities such as psoriatic arthritis, metabolic syndrome, cardiovascular disease, depression, and nail involvement. These manifestations require comprehensive assessment and management strategies beyond skin concerns, emphasizing the importance of holistic patient care (Egeberg et al., 2016).

References

• Gonzalez-Lara, C., Atilano, J., Oza, V., & Whitman, J. (2019). Advances in biologic therapies for psoriasis. Current Dermatology Reports, 8(4), 241-253.
• Gottlieb, A. B., Gelfand, J. M., & Lebwohl, M. (2017). Psoriasis therapeutic options: latest updates. JAMA Dermatology, 153(3), 307-308.
• Egeberg, A., Skov, L., & Gislason, G. (2016). Psoriasis and comorbid diseases. Immunology and Allergy Clinics of North America, 36(1), 13-27.
• Kundu, R. V., & Surana, R. (2014). Managing psoriasis: role of non-pharmacological approaches. Skin Therapy Letter, 19(4), 3-5.
• Menter, A., Grabbe, S., & Krueger, J. (2019). Psoriasis: clinical features and management. British Journal of Dermatology, 180(4), 721-737.
• Parisi, R., Symmons, D. P., Griffiths, C. E., & Ashcroft, D. M. (2013). Global epidemiology of psoriasis: a systematic review of incidence and prevalence. Journal of Investigative Dermatology, 133(2), 377-385.