A man with psoriatic lesions in plaques and guttate
Psoriasis is a chronic inflammatory skin disease with a variable range of severity, affecting up to 11.8% of world population, and up to 2.5% in Iran, with impairment in quality of life. Accurate primary care attention allows efficient control of limited disease, which also may have marked psychosocial impact because of the lesions on the genitalia, face, scalp, and nails.
Diagnosis and follow-up of cutaneous psoriasis by primary care professionals.
A 45-year-old man was followed in primary health care attention because of recurrent dermatological changes due to psoriasis. With 15 years of duration, topic treatment was effective. Two weeks before the current episode, he had progressive difficulty to perform daily activities, and social embarrassment related to the aspect of visible lesions. He was a tobacco smoker (30 pack years) and denied use of illegal drugs and alcohol abuse. There was no other significant pathological medical antecedent. Except for the control of recurrent episodes of the cutaneous manifestations, he did not utilize other kind of medicines. He denied personal and family antecedent of atopy, photo- sensibility, as well as arthralgia. Physical examination showed BMI: 22.93 kg/m2 and normal vital signs. Remarkable findings were cutaneous: scaly erythematous lesions on the neck, abdomen, elbows, hands, thighs, knees, legs, and on the trunk. There were dystrophic changes in fingernails, fissures in the extensor surfaces of the hands, elbows and knees; and scaling plaques on the palms and soles. Worthy of note was the lack of lesions in inguinal and flexor areas of the limbs. The results of routine laboratory determinations were normal, including blood counts, glucose, lipid profile, serum proteins, and thyroid, renal, hepatic, and pancreatic functions. The tests for hepatitis B and C, HIV, and other sexually transmitted diseases were negative. He successfully underwent oral immunosuppressive and folic acid schedule, with significant clinical improvement within three weeks of treatment. The patient was further referred to dermatologic and rheumatologic complementary.
He never used methotrexate (MTX), corticoids or antimalarial drugs, or TNF-α inhibitors , and the lesions of the flare-up were controlled by MTX 15 mg weekly and folic acid 5 mg daily .
Considering that time constraints and low knowledge about psoriasis may play a role in primary care attention to this group of patients, case reports can be useful for the primary health workers.
VITORINO MODESTO DOS SANTOS, TEMÍSTOCLES BARBOSA SOUSA NETO, DAVID LIMA PEDROSA, YANNA PONTES PRADO PAULO DE SOUZA