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 include stress, infections, injury to the skin, certain medications (such as beta-blockers), and changes in weather or climate. Psoriasis is a chronic inflammatory skin disorder characterized by the development of thick, red, scaly plaques on the skin. There are several different clinical types of psoriasis, including plaque psoriasis, guttate psoriasis, inverse psoriasis, pustular psoriasis, and erythrodermic psoriasis. Plaque psoriasis is the most common type and is characterized by raised, red patches of skin covered with silvery-white scales. Guttate psoriasis appears as small, red, drop-like lesions on the skin, usually after a streptococcal infection. Inverse psoriasis affects the skin in the folds of the body, such as the armpits, groin, and under the breasts, and appears as smooth, red, inflamed patches. Pustular psoriasis is characterized by the presence of pus-filled blisters on the skin, and erythrodermic psoriasis involves widespread redness and shedding of the skin.

2. There are several types of treatments for psoriasis, including topical medications, phototherapy, systemic medications, and biologic therapies. Topical treatments are commonly used for mild to moderate psoriasis and include corticosteroids, vitamin D analogues, retinoids, and salicylic acid. In the case of K.B.’s relapse episode, considering the generalized nature of her outbreak, a combination of topical corticosteroids and vitamin D analogues would be appropriate. These medications can help reduce inflammation, itching, and scaling of the skin. In addition to pharmacological options, non-pharmacological approaches can also be beneficial for managing psoriasis. These may include moisturizing the skin, avoiding triggers, managing stress, and incorporating a healthy diet and lifestyle.

3. (Question 2 was repeated)

4. Medication review and reconciliation are important in all patients, but particularly in the case of individuals with psoriasis. Psoriasis is a chronic inflammatory condition that may require long-term management and treatment with multiple medications. It is essential to know what medications the patient is taking in order to assess potential drug interactions, side effects, and contraindications. Additionally, some medications used to treat other conditions may exacerbate or trigger psoriasis flare-ups. Therefore, understanding the patient’s medication profile is crucial for optimizing treatment outcomes and minimizing any potential adverse effects.

5. Psoriasis can manifest in various ways beyond the classic skin symptoms. These may include nail psoriasis, which can cause pitting, discoloration, and ridges on the nails; psoriatic arthritis, which can cause joint pain, stiffness, and swelling; and psoriasis of the scalp, which can result in flaking, itching, and redness on the scalp. Eyes can also be affected in some cases, leading to dryness, redness, and irritation of the eyes.

1. Based on the clinical manifestations presented in the case of C.J., the diagnosis for his eyes would likely be conjunctivitis, specifically bacterial conjunctivitis. The presence of crusty and yellowish discharge, along with bilateral conjunctival erythema, is indicative of an infection in the eyes. The throbbing pain in his left ear may suggest the spread of the infection from the eyes to the ear, known as ophthalmic zoster oticus.

2. Without further information, it is difficult to determine the precise etiology of the eye infection. However, given the symptoms described, bacterial conjunctivitis is a probable etiology. This is because bacterial conjunctivitis commonly presents with yellowish discharge, redness, and irritation of the eyes. Viral conjunctivitis may also be a possibility, but it typically presents with watery discharge rather than a thick, crusty discharge. Allergic conjunctivitis is another potential etiology, but it is less likely in this case as there is no mention of itching or an allergic reaction. Gonococcal conjunctivitis and trachoma are less common causes of conjunctivitis and would require additional information and testing for a definitive diagnosis.

3. The best therapeutic approach for C.J.’s eye problem would depend on the confirmed etiology of the infection. If bacterial conjunctivitis is confirmed, treatment with topical antibiotics, such as erythromycin or polymyxin B-trimethoprim, would be appropriate. This can help eliminate the bacterial infection and alleviate the symptoms. If viral conjunctivitis is confirmed, management is generally focused on supportive care, such as using lubricating eye drops and practicing good hygiene to prevent the spread of the virus.