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. 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 patient, describe and specify why in this particular case is important to know what medications the patient is taking? 5. What others manifestation could present a patient with Psoriasis? C.J. is a 27-year-old male who started to present crusty and yellowish discharged on his eyes 24 hours ago. At the beginning he thought that washing his eyes vigorously the discharge will go away but by the contrary increased producing a blurry vision specially in the morning. Once he clears his eyes of the sticky discharge her visual acuity was normal again. Also, he has been feeling throbbing pain on 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. 1.- Based on the clinical manifestations presented on the case above, which would be your eyes diagnosis for C.J. Please name why you get to this diagnosis and document your rational. 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 and why not. 3.- Based on your answer to the previous question regarding the etiology of the eye affection, which would be the best therapeutic approach to C.J problem.

1. The most common triggers for psoriasis can vary from person to person, but some common triggers include stress, infections, injury to the skin, certain medications, and changes in weather. Psoriasis manifests in different clinical types, including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, erythrodermic psoriasis, and scalp psoriasis. Plaque psoriasis, which K.B. has, is the most common type and is characterized by raised, red patches covered with a silvery-white buildup of dead skin cells. Guttate psoriasis appears as small, red spots on the skin, while inverse psoriasis affects skin folds, such as the armpits and groin. Pustular psoriasis presents as pus-filled blisters, erythrodermic psoriasis affects the entire body, and scalp psoriasis affects the scalp.

2. Treatment options for psoriasis include topical medications, phototherapy, systemic medications, and biologic medications. For K.B.’s relapse episode, the most appropriate approach would depend on the severity and extent of her symptoms. Topical therapies, such as high-potency corticosteroids, can be effective for localized flare-ups. However, since K.B.’s current outbreak is generalized and involves large regions of her body, a combination of therapies may be necessary.

Systemic medications, such as methotrexate or cyclosporine, may be considered for severe cases. These medications work by suppressing the immune system and reducing inflammation. Biologic medications, such as TNF inhibitors or IL-17 inhibitors, may also be an option if other treatments have not been effective.

In addition to pharmacological treatments, non-pharmacological options can also be beneficial. These can include moisturizing the skin regularly, avoiding triggers such as stress and certain foods, and practicing stress-reducing techniques. It may also be helpful for K.B. to receive education and support from a healthcare professional or support group.

3. (Question 3 is missing)

4. Medication review and reconciliation are important in all patients, but particularly so in the case of K.B. with psoriasis. Psoriasis is a chronic condition that requires ongoing management, and medications are a crucial part of treatment. It is important to know what medications K.B. is taking to ensure that there are no interactions between different medications, to assess the potential side effects of any medications being used, and to ensure that K.B. is adhering to the prescribed treatment plan. Additionally, medication review and reconciliation can help identify any medications that may be exacerbating the psoriasis symptoms or contributing to the relapse.

5. Psoriasis can present with several manifestations other than skin lesions. Common manifestations include nail changes, such as pitting, thickening, and discoloration of the nails. Joint pain and swelling can also occur, known as psoriatic arthritis. Psoriasis can also affect the scalp, leading to scalp itchiness, flaking, and redness. In severe cases, psoriasis can lead to emotional and psychological effects, including depression and anxiety. It is important to assess and address these manifestations when managing a patient with psoriasis.