1. Case Presentation
Psoriasis
Dr. K. Peduruarachchi
Department of Cikitsa
Faculty of Indigenous Medicine
Gampaha Wickramarachchi University of Indigenous Medicine
2. Clinical Case Record
• Name: Mr. K. M. Namal Wijethunge
• Age: 27 yrs old
• Address: No.22, Pamburana, Matara
• Marital status: Single
• Occupation: Labour work at RDA
• Religion: Buddhism
3. • Chief Complain- Gradual onset of multiple skin lesions with itchy
slivery scaling over the chest, abdomen, back region also on both
upper limbs and itching over them for 4/12
• History of Present Complain- According to patient, he was well
before 4 months ago, after that he started complaining of small red
blisters like lesions over the abdomen and itching over it, gradually it
increased and spread all over the abdomen, chest, back region and
both upper limbs along with itching slivery scalings. The patient took
allopathic medications for above complaints, but he did not get
satisfactory relief, so he came to Gampaha Wickramarachchi
Ayurveda Hospital for further treatment.
4. Other Complaints- on and off headache, loss of sleeping
Other Illnesses: recurrent history of Tonsillitis, HTN°, CHL°, DM°
Drug History: According to pt he has taken allopathic medications.
PSHx- Not related
Family History: No any family history was presented regarding psoriasis or any
dermatological disorders
• Patient had recurrent history of Tonsillitis. No any family history was present regarding
psoriasis or any dermatological disorders. Disturbed sleep due to the i t c h i n g a n d t h
e r e i s l a c k o f a p p e t i t e . Ashtavidha Pariksha was within normal limit but only
mala was asamyak due to irregular bowel habits, jivha was saam and sparsha was kina
khara sparsha and parusha with ruksha pidika. On Examination, all vitals of the patient
were within normal limit. Pulse rate 80permin regular and vata pittaj, Blood pressure was
130/80mmHg. Respiratory rate was 18 per min, temperature was 98o f.
5. • Social History:
• Lives with grandmother in a urban area now.
• Nature of Work: Hard Working and significant sun exposure while he is
working
• Food Habits: Irregular Diet, Non vegetarian, excessive intake of ushna and
savory foods, junk foods like fried rice kottu, rolls and tomato sauce etc.
Prefer to eat more pineapples.
• Loss of appetite and anorexia+
• Addictions: No alcohol addiction but smoke since 5yrs- 5 cigarettes/day
• Allergies- F+( Balamalu) D° P°
6. • Physical Examination:
General examination
Appearance – depressed looking
Height – 168 cm
Weight- 77kg
Head- No macrocephaly or microcephaly, normal head shape, no surgical
scars, whitish flakes appear
Eyes- Palor+, ptosis°, cyanosis°, nustagmus°, no enlarge pupils
Nose- Turbinate hypertrophy, No septam deviation or nasal polyps
Face- Wrinkles°, no muscle wasting
Ears- several Rain drop like red raised patches with skin covered silvery
scales.
7. Lips- Dry, blackish red discoloration
Mouth- cyanosis°, No leukoplaqia, no noted tooth decay, dental
plaque+
Tongue- white coated, cyanosis°, fissures°, dental marks°
• Neck- No swelling or tracheal deviation,2-3erythematous plaques+
• Breast- erythematous plaques with raised margin
• Chest- erythematous plaques++ and skin covered with slvery scales
8. • Abdomen- slivery scales covered the skin , dark colour dry skin
• Upper Limbs-slivery scales covered the skin , dark colour dry skin, pin
point bleeding+ in the places of scaled
• Lower Limbs-slivery scales covered the skin , dark colour dry skin
• Skin- Dry,
• State of Hydration- poor
• Nutrition- Poor
• Gait- stepping quickly with head bowed
9. • Pulse Rate- 82/min
Rhythm- Irregular
Volume- low
Tension- hard
• Heart Rate- not examined
• Blood Pressure- 140/70mmHg
• Stools- Constipation+++ - once in two days , hard dry stools, dark
brown colour and should strained to pass stool
• Urine- D/N- 6-7/3, dysurination+++, dark yellow colour+
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10. Systemic Examination – Integumentory System
• Examination of Skin
• Inspection-
• Several thick scaly, sharply demarcated red scaly patches of skin with a
silvery sheen on back, elbows and legs and thighs and chest, abdomen
• Plaque coverage is about 75% of the body.
• Palpation- No pitting oedema on abdominal or chest area.
• Rough, peeling off brisky whitish silvery scales on abdomen and both lowerlimbs
anf upper limb.
12. Other systems
• CVS
• Inspection-
• Several thick scaly, sharply demarcated red scaly patches of
skin with a silvery sheen on shest
• No noted JVP, barrel chest0, pigeon chest0, funnel chest0,
• Palpation- No thrills
•Auscultaion- No detected abnormal heart sounds
13. • GIT
• Inspection- Several thick scaly, sharply demarcated red scaly
patches of skin with a silvery sheen
• Umbilicus centered, no superficial veins, striae0 , no visible
peristalsis
• Palpation- soft, non tender, no visceromegaly
• Percussion- noted normal, Shifting dullness and fluid thrill –ve
• Auscultation- bowel sounds audible, no hepatic or renal bruit
