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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the signs and symptoms of moderate-to-severe psoriasis

  • Describe the comorbidities and risks in patients with psoriasis

  • Recommend an appropriate treatment plan for a patient with psoriasis

  • Recommend appropriate monitoring parameters for a patient with psoriasis

  • Provide appropriate counseling information to a patient with psoriasis

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PATIENT PRESENTATION

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Chief Complaint

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"I'm so itchy! This stuff just keeps on spreading! I don't know what to do!"

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History of Present Illness

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Kathryn Leahy is a 32-year-old female who presents to her primary care provider complaining of severe itching, redness, and a psoriatic flare-up. She was diagnosed with psoriasis 4 years ago, and has experienced sporadic flare-ups during this time, the most recent being 4 months ago. She has been able to control her flare-ups over the years with a variety of creams and lotions. Most recently, she has been using betamethasone 1% cream and calcipotriol 50 mcg/g cream. Although this combination has worked well for her in the past, she is concerned that she is not seeing improvement in her current condition as rapidly as she had previously. The patient is also complaining of being both physically and emotionally drained, and having difficulties sleeping.

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Past Medical History

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Psoriasis diagnosed 4 years ago

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Melanoma diagnosed 2 years ago

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Depression × 2 years

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Anxiety × 6 weeks

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Prediabetes × 6 months

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Family History

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Mother is alive at the age of 62 with type 1 DM, had a psoriatic episode in her late forties but has since been in remission. Father is alive at age 63. He has had two melanoma removed over the past 15 years. She has 1 brother and 1 sister, both of whom are healthy.

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Social History

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The patient is a lawyer at a prominent and established law firm, working to make partner in the next eighteen months. She is recently married, and is planning to stop her birth control in the coming months to start a family.

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Tobacco/Alcohol/Substance Use

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Social drinker; (−) tobacco or illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Sulfa antibiotics (rash as child)

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Codeine (rash postop melanoma)

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Medications (Current)

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Alprazolam 1 mg PO PRN anxiety

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Betamethasone valerate 1% cream daily PRN treatment of psoriatic plaques

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Calcipotriol 50 mcg/g cream daily PRN treatment of psoriatic plaques

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Ibuprofen 200 mg and diphenhydramine citrate 38 mg PO PRN sleep

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NuvaRing insert vaginally for 3 weeks and remove for 1 week

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Sertraline 50 mg PO once daily

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Review of ...

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