- The patient presented with erythrodermic psoriasis, a severe form of psoriasis affecting most of the body surface. Symptoms included redness, scaling, and itching all over the body. - A skin biopsy confirmed psoriatic erythroderma. The patient was started on methotrexate and folic acid for immunosuppression along with antibiotics, antihistamines, emollients and corticosteroids to treat symptoms. - The patient was counseled on lifestyle modifications including avoiding smoking and alcohol, taking oatmeal baths, moisturizing skin, and minimizing sun exposure to manage their condition.

1. CASE PRESENTATION ON
Erythrodermic Psoriasis
By
Rumana Hameed
170310820021

2.  Psoriatic erythroderma represents the generalized
form of the disease that affects all body sites
including the face, hands, feet, nails, trunk, and
extremities.
 Although all the symptoms of psoriasis are present,
erythema is the most prominent feature, and scaling
is different compared with chronic stationary
psoriasis.

3.  Instead of thick, adherent, white scale there is superficial
scaling.
 Patients with erythrodermic psoriasis lose excessive heat
because of generalized vasodilatation, and this may cause
hypothermia.
 Patients may shiver in an attempt to raise their body
temperature.
 Psoriatic skin is often hypohidrotic due to occlusion of the
sweat ducts and there is an attendant risk of hyperthermia in
warm climates.
 z

4.  Name:ABC D.O.A:1-05-2015
 Age:6oyrs Reg no:1659/15
 Sex:M Dept: DVL-IV,MSW
 Adrs:HYD Occupation:shopkeeper
SUBJECTIVE

5. Complaints:
 c/o redness,scaling and itching all over the body since 2o
days.
History of present illness:
 Patient was apparently asymptomatic 20 days back then he
developed erythema and scaling over trunk
extremities,face,neck ,scalp and also including palms,soles
and genitelia with itching.
 No H/O joint pains,fever and chills.

6. Past medical history:
 patient is a known hypertensive since 9 months on irregular
medication.
 Known Psoriatic since 10 years.
 No H/O DM,TB,Asthma,Epilepsy.
Family history :
no family history of psoriasis
Personal history:
Appetite :normal
Sleep :disturbed
Diet :normal
CHRONIC ALCOHOLIC AND SMOKER SINCE 20 YEARS

7. OBJECTIVE

8. Vitals DAY 1 DAY 2 DAY 3 DAY 4
BP/mmHg 130/90 120/80 120/80 110/70
Pulse
Rate/min
84 80 84 82
Temp normal normal normal normal
Vitals

9.  RBS:80mg/dl
 Serum urea: 24mg/dl
 Serum creatinine:1.0 mg/dl
 Sodium:133meq
 Potassium:4.0meq
 Serum protiens:6.8
 Serum albumin: 3.6
 T.Bilirubin:0.9 mg/dl
Laboratory Data

10. •B/L symmetrical diffuse
erythma,scaling
associated with itiching
present over
trunk,face,scalp and all
extemities.
•Palms,soles and genetilia
was also involved.
Cutaneous
Examination

11. Cutaneous Examination

12. •Pitting is seen
•Nails have
become brittle.
•Oil drop or
salmon patch is
present.
•Onycholysis is
also seen.
Nails Examination

13.  Hb:14.0 gm/dl
 WBC:8,200 cells/cmm
 Neutrophils:66%
 Lymphocytes:30%
 Esinophils:02%
 Basophils:00%
 Monocytes:02%
 Platelets:Adequate
 ESR:0.5mm
 Few Reactive Lymphocytes:+
Blood picture : NormocyticNormochromic
Complete Blood Picture

14.  Urine: Yellow
 Albumin: +
 Sugar: Nil
 Pus cells:1-2/hpf
 Epithelial cells:2-3/hpf
Urine Examination Report

15.  RESULT:
 Microscopic Examination of the section revealed skin
showing psoriform epidermal hyperplasia
 Confluent parakeratosis layered with neutrophils
 Spongiform pustules
 Hypogranulosis
 Dilated tortuous papillary blood vessels
 IMPRESSION:
 Suggestive of psoriatic eryhtroderma.
Skin Biopsy

16.  Based upon the cutaneous examination and skin
biopsy report the disease was diagnosed as psoriatic
erythroderma.
ASSESSMENT

17.  Goal:
Restore and maintain body fluids and
temperature, followed by antibiotics as prophylactic
to infections and symptomatic treatment.
Plan

18. MEDICATION DOSE ROUTE FREQ Generic Name INDICATION
IVF IV
INJj.Monocef 1gm IV BD ceftraixone Antibiotic
INJ.Rantac 2cc IV BD ranitidine H2RB
INJ .Avil 2cc IV BD Pheneramine
malate
Anti histamine
Tab.Mext-F 2.5mg oral Once
weekly
methotrexate Immunosupres
sant
Tab.Folic acid oral On rest
of days
Folic acid supplement
Tab. MVT 1 Tab oral OD Multi vitamin Vitamins
Tab.BC 1Tab oral OD B complex Vitamin
Tab.Enam 5mg oral OD Enalapril Anti HTN
Tab.calcium 1Tab oral OD Calcium Supplement
Liquid Paraffin E/A mrng Liquid paraffin Emollient
Betamethasone cream E/A night Betamethasone Anti
inflammatory
Pharmacological TREATMENT

19. PATIENT COUNCELLING
NON - PHARMACOLOGICAL
TREATMENT

20.  Psoriatic erythroderma represents the generalized
form of the disease that affects all body sites,including
the face, hands, feet, nails, trunk, and extremities.
 A particularly inflammatory form of psoriasis that often
affects most of the body making skin look burned.
Regarding diseased state

21.  Methotrexate: Immunosuppresant
 Folic acid: folate supplement
 Monocef: antibiotic as prophylaxis
 Avil: Anti histamine
 Rantac:Antacid
 Liquid paraffin :Emollient
 Betamethasone cream:anti inflammatory
 Enam :anti hypertensive
Regarding medication

22.  SMOKING:
 Smoking (more than 20 cigarettes daily)has also been associated
with more than a twofold increased risk of severe
psoriasis.smoking appears to have a role in the onset of psoriasis
.Recently, a gene–environment interaction has been identified
between low activity of the cytochrome P450 gene CYP1A1 and
smoking in psoriasis.
 Avoid alcohol and smoking as it may trigger the psoriasis.
 Take oatmeal baths they can help loosen the scaling and reduces
itching.
 Bathing in very hot water or using abrasive cleaners can also make
your psoriasis flare up.
 Avoid stressful situations when you can, and take extra steps to
take care of yourself such as eating well, exercising, and getting
enough sleep.
Regarding lifestyle modification

23.  Dry skin is more susceptible to outbreaks of psoriasis, so
keep your skin well lubricated. After bathing or showering,
seal in moisture by applying a generous amount of
moisturizing cream or oil to your skin.
 Use talcum powder to prevent oozing skin from sticking.
 Minimize sun exposure.

24. No serious drug interactions were found in the plan.
Methotrexate-Enalapril:
 Methotrexate may cause liver problems, and using it
with other medications that can also affect the liver
such as enalapril may increase that risk.
 Avoid or limit the use of alcohol while being treated
with these medications.
Drug-Drug Interaction

25. What Causes Psoriasis?
 Psoriasis is a skin disorder driven by the immune system,
especially involving a type of white blood cell called a T
cell. Normally, T cells help protect the body against
infection and disease. In the case of psoriasis, T cells are
put into action by mistake and become so active that
they trigger other immune responses, which lead to
inflammation and to rapid turnover of skin cells.
Drug Information Query

26. At the time of initiation of
treatment Present picture

27. All pictures are taken with the
permission of patient.
At the time of initiating the
treatment Present picture

28. THANK YOU