Details Case study on Psoriasis

1. PRESENTED BY:
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 4td year

2. Psoriasis:
 Psoriasis is a chronic skin condition caused by an
overactive immune system.
 Symptoms include flaking, inflammation, and thick,
white, silvery, or red patches of skin.

3. Patient details- Subjective
o Age- 50 years , Male.
o I.P NO.-3933451
o DOA- 02-12-2018
o DOD –06-12-2018
o WARD- Dermatology

4. Reason for admission- subjective
 Multiple erythematous
 Cover ulcer plaques over his upper and lower limps
and track x 4 month
 Itching and pain in the skin

5. Family and Personal history
Family history – not significant
Personal history –alcoholic,
Previous allergies : not significant
Medication history:-HTN/DM-II/Similar case from 13
yrs

6. On Examination
Pt. calm, conscious and oriented.
R/S – B/L air entry equal. No abnormality detected.
CVS – S1,S2 normal.
P/A – soft , non tender , non distended , no organomegaly.
CNS – intact

7. Vitals signs
Vitals Day 1
(02/12)
Day 2
(03/12)
Day 3
(04/12)
Day 4
(05/12)
Day 5
(06/12)
BP
(mm Hg)
160/100 160/100 140/80 145/80 130/80
PR
(/min)
80 82 80 82 80
RR
(/min)
24 22 24 22 22
Temp.
(˚F)
98.6 98 96 96.2 96

8. Lab Investigations- objective
Constituents Detected values Normal range
AST 74 <30 unit/l
Cholesterol T. 304 180-200mg/dl
VLDL 23.80 2-30 mg/dl
BUN 7.94 2.5 – 7.1 mmol/L
FBS 175 70-99mg/dl
RBS 381 80-130mg/dl
Platelet Count 4.06 150-400 10^9/L
These tests were performed in our hospital laboratory on -02-12-2016.

9. Assessment
Subjective Objective
 DM-II
HTN
 Plaques
Multiple erythematous
FBS & RBS
Cholesterol , VLDL
On the basis of subjective and objective information patient was
diagnosed with Psoriasis , DM-II & HTN

10. TREATMENT PLAN

11. Drug
Dose and
frequency Route
Start
Stop Class
TB. Acitretin 25 mg od oral 02/12 04/12 Retinoid
Tab. Renitidine 300 mg od oral 02/12 -------- H2 R. antagonists
inj. Cefirone
(ceftriaxone)
5 mg OD iv 03/12 06/12 Antibiotic
Inj. Ondensteron 1g od Iv 02/12 06/12 Antiemetic
Tab. Telmisartan 40 mg od oral 02/12 -------- ARB
Tab. Ursodeoxycholic
acid
300 mg od oral 03/12 06/12 Bile acid
Tazarotene gel Topical 02/12 --------- Antipsoriatic
Niosalic oint.
(clobasol)
Topical 02/12 -------- Corticosteroids
Protar oint Topical 02/12 --------- Keratolytics
Remoiz cream Topical 02/12 ------
Inj. Insulin 6 unit Subcuta-
neous
02/12 --------

12. Therapeutic goals
 SHORT TERM GOAL:
 To provide symptomatic relief from Itching and pain in the skin
 To reduce the plaques.
 To reduce the high blood pressure
 maintained the blood glucose level
 LONG TERM GOAL-
 To Preventing recurrent of skin disease
 Maintained B.P & Blood glucose level
 To decrease the mortality.
 To improve quality of life.

13. Monitoring Parameters
Blood pressure
Blood glucose level
Plaques size

14. Discharged summary (06/12/2016)
BP- 130/80 mmHg
PR- 80/min.
RR – 22 /min.
A febrile

15. Discharge medication
 Tab. Renitidine 300 mg od
 Tab. Telmisartan 40 mg od
 Tazarotene gel
 Niosalic oint. (clobasol)
 Protar oint.
 Remoiz cream
 Inj. Insulin 6 unit

16. Patient counselling
 Take daily baths. Bathing daily helps remove scales and calm inflamed skin. Add
Sea salts to the water and soak.
 Avoid hot water and harsh soaps, which can worsen symptoms; use lukewarm water
and mild soaps that have added oils and fats.
 Expose your skin to small amounts of sunlight. A controlled amount of sunlight can
significantly improve lesions.
 Avoid psoriasis triggers, if possible. Find out what triggers, if any, worsen your
psoriasis and take steps to prevent or avoid them. Infections, injuries to your skin,
stress, smoking and intense sun exposure can all worsen psoriasis.
 Avoid drinking alcohol. Alcohol consumption may decrease the effectiveness of
some psoriasis treatments.

17. Patient counselling
Take Niosalic oint. (clobasol) + remoiz cream
at 1:1 ratio and use in morning
Protar oint. + remoiz cream at 1:1 ratio and
use in night
Remoiz cream + coconut oil use
Take insulin just before meal