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.
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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.