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CASE PRESENTATION ON
Erythrodermic Psoriasis
By
Rumana Hameed
170310820021
 Psoriatic erythroderma represents the generalized
form of the disease that affects all body sites
including the face, ha...
 Instead of thick, adherent, white scale there is superficial
scaling.
 Patients with erythrodermic psoriasis lose exces...
 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
Complaints:
 c/o redness,scaling and itching all over the body since 2o
days.
History of present illness:
 Patient was a...
Past medical history:
 patient is a known hypertensive since 9 months on irregular
medication.
 Known Psoriatic since 10...
OBJECTIVE
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 no...
 RBS:80mg/dl
 Serum urea: 24mg/dl
 Serum creatinine:1.0 mg/dl
 Sodium:133meq
 Potassium:4.0meq
 Serum protiens:6.8
...
•B/L symmetrical diffuse
erythma,scaling
associated with itiching
present over
trunk,face,scalp and all
extemities.
•Palms...
Cutaneous Examination
•Pitting is seen
•Nails have
become brittle.
•Oil drop or
salmon patch is
present.
•Onycholysis is
also seen.
Nails Examin...
 Hb:14.0 gm/dl
 WBC:8,200 cells/cmm
 Neutrophils:66%
 Lymphocytes:30%
 Esinophils:02%
 Basophils:00%
 Monocytes:02%...
 Urine: Yellow
 Albumin: +
 Sugar: Nil
 Pus cells:1-2/hpf
 Epithelial cells:2-3/hpf
Urine Examination Report
 RESULT:
 Microscopic Examination of the section revealed skin
showing psoriform epidermal hyperplasia
 Confluent parak...
 Based upon the cutaneous examination and skin
biopsy report the disease was diagnosed as psoriatic
erythroderma.
ASSESSM...
 Goal:
Restore and maintain body fluids and
temperature, followed by antibiotics as prophylactic
to infections and sympto...
MEDICATION DOSE ROUTE FREQ Generic Name INDICATION
IVF IV
INJj.Monocef 1gm IV BD ceftraixone Antibiotic
INJ.Rantac 2cc IV ...
PATIENT COUNCELLING
NON - PHARMACOLOGICAL
TREATMENT
 Psoriatic erythroderma represents the generalized
form of the disease that affects all body sites,including
the face, ha...
 Methotrexate: Immunosuppresant
 Folic acid: folate supplement
 Monocef: antibiotic as prophylaxis
 Avil: Anti histami...
 SMOKING:
 Smoking (more than 20 cigarettes daily)has also been associated
with more than a twofold increased risk of se...
 Dry skin is more susceptible to outbreaks of psoriasis, so
keep your skin well lubricated. After bathing or showering,
s...
No serious drug interactions were found in the plan.
Methotrexate-Enalapril:
 Methotrexate may cause liver problems, and ...
What Causes Psoriasis?
 Psoriasis is a skin disorder driven by the immune system,
especially involving a type of white bl...
At the time of initiation of
treatment Present picture
All pictures are taken with the
permission of patient.
At the time of initiating the
treatment Present picture
THANK YOU
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Erythrodermic psoriasis case presentation

this is the case of patient presented with psoriatic erythroderma

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Erythrodermic psoriasis case presentation

  1. 1. CASE PRESENTATION ON Erythrodermic Psoriasis By Rumana Hameed 170310820021
  2. 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. 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. 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. 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. 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. 7. OBJECTIVE
  8. 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. 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. 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. 11. Cutaneous Examination
  12. 12. •Pitting is seen •Nails have become brittle. •Oil drop or salmon patch is present. •Onycholysis is also seen. Nails Examination
  13. 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. 14.  Urine: Yellow  Albumin: +  Sugar: Nil  Pus cells:1-2/hpf  Epithelial cells:2-3/hpf Urine Examination Report
  15. 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. 16.  Based upon the cutaneous examination and skin biopsy report the disease was diagnosed as psoriatic erythroderma. ASSESSMENT
  17. 17.  Goal: Restore and maintain body fluids and temperature, followed by antibiotics as prophylactic to infections and symptomatic treatment. Plan
  18. 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. 19. PATIENT COUNCELLING NON - PHARMACOLOGICAL TREATMENT
  20. 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. 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. 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. 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. 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. 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. 26. At the time of initiation of treatment Present picture
  27. 27. All pictures are taken with the permission of patient. At the time of initiating the treatment Present picture
  28. 28. THANK YOU

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