case report

PSORIASIS VULGARIS
Arinda Calvine Santoso / 0907101010038
Dede Yusuf Fahma Razi / 0907101010013
Supervisor :
Mimi Maulida
INTRODUCTION
Psoriasis is a chronic inflammatory condition of the
skin and another organ with well characterized
pathology occurring in the skin and often the joint


EPIDIMIOLOGY & INSIDENCE
0
1
2
3
4
5
6
AmericaEurope Asia
5,7
0,4
Men
50%
Women
50%

0%

0%
2
%
Psoriasis
Vulgaris
seborrhoic like psoriasis
inverse psoriasis
napkin psoriasis
psoriasis arthritic
generalized pustular psoriasis (von
zombusch)
guttate psoriasis
acrodermatitis continua of hallopeau
impetigo herpetiformis
keratoderma bleennorrhagica,
and erythrodema psoriasis


PREDILECTION SITE OF THE BODY



CASE REPORT
IDENTITY OF PATIENT

Name : Mrs. K
Sex : Female
Registration number : 0-87-14-52
Age : 60 years old
Address : Desa Gani, Ingin Jaya,
Aceh Besar
Examination Date : March 4
th
2014

ANAMNESE
Red patches on the lower
hand since 2 months ago.
Chief
Complaint
Patient came to the hospital with complaints of
appearing red patches on her arms.This
condition has been occured since two months
ago and became worse time over time. At the
first time, patches appeared only on the back of
ears and spread to the body. Those condition
happened since 18 years ago. Patient also feels
a litle bit itchy and it became more intents if the
patient is sweaty. If the patient scratched these
patches, that would make another lession at the
scratched mark. At the beginning, red patches is
thin and become thick then white greyish
History of
Present
Illness
ANAMNESE (cont..)
Patient ever got the same disease 18
years ago and it was healed for 5 years.
At the same time, patient also had
gastritis
History of
Previous
Illness
The patient is a house keeping
History of
Social
Economy
None of her family had ever got the
same complaints as she felt
History of
Family
Diseas
ANAMNESE (cont..)

Patient ever came to the dermatologist
and she got oral and topical medicine.
She ate oral medicines 4 tablets a day,
but she didnt remember the name of
medicine. It was 18 years ago. After 5
years, the medicines was stopped, she
said that the doctor didnt give her
anymore
History of
Treatment
The patient has financial problem
Over sweating
The is no caries in her tooth
History of
Social
Habits:
PHYSICAL EXAMINATION
Vital Sign : Not checked
Dermatological status :
At regios trunkus anterior and posterior, extremity
superior and inferior and head. Red patcthes with thick
grayish white squama above, multiples, the distribution is
generalisata.

TEST
CLINICAL TEST
Kaarsvlek Phenomen : positif, there are scrathes wax
Auspitz sign : positif, there are reddish spot

ADDITIONAL TEST
KOH test : There is no hyfa founded

DIFFERENTIAL DIAGNOSE
Psoriasis vulgaris
Tinea corporis
Seborrheic dermatitis
Dermatitis Contact Allergy
Fixed Drug Eruption

TREATMENT
Systemic Medication:
Ceterizine 10 mg 1 x 1

Topical Medication:
Salisic Acid 3% + LCD 5% + Inerson 0,25%
Salisic Acid 3% + LCD 5% + Nerilon 0,1 %

EDUCATION
Do not scratch the macules
Consume the medicated medicines according the doctor
guideline
Keep the body dry

PROGNOSIS
Quo ad Vitam :Dubia ad bonam
Quo Ad Functionam :Dubia ad bonam
Quo ad Sanactionam :Dubia ad bonam

FOLLOW UP
( March 12
th
, 2014)
PROBLEMS
Lessions become dry

ASSESSMENT
Psoriasis Vulgaris

TREATMENT
Systemic Medication
Ceterizine 10 mg 1 x 1

Topical Medication
Salisic Acid 3% + LCD 5% + Vaselin Album 50 gr

DISCUSSION
Patient Literature
In this case, patient is female and the age for the first
she got the disease is 42 years. There is no other family
has this disease.





Patient came to the hospital with complaints of
appearing red patches on her arms. This condition has
been occured since two months ago and became worse
time over time. At the first time, patches appeared
only on the back of ears and spread to the body. Those
condition happened since 18 years ago. Patient also
feels a litle bit itchy and it became more intents if the
patient is sweaty.If the patient scratched these
patches, that would make another lession at the
scratched mark.At the beginning, red patches is thin
and become thick then white greyish

The incidence in Asia is low approximately 0,4%.
Psoriasis may begin at any age, but it is uncommon
under the age 10 years. It is most likely to appear
between the age 15 until 30 years. Equal incidence in
males and females.


Psoriasis is a chronic inflammatory condition of the skin
and another organ with well characterized pathology
occurring in the skin and often the joint.
1,2,3,5
Pruritus is
reasonably common symptom, especially in scalp and
anogenital psoriasis. Another symptom are burn, sting,
and bleed easily in affected areas.
10
Clinical
presentation varies among individuals, from those with
only a few localized plaques to those with generalized
skin involvement. Several clinical expressions. The
classic lesions of psoriasis is a well-demarcated, raised,
red plaque, with a white scaly surface.
5
Pustular
eruptions and erythroderma occur.
6



Patient Literature
In this case lessions at regios trunkus anterior and posterior,
extremity superior and inferior and head, red patches lessions
with thick silver white scale above, multiples, the distribution is
generalisata. Kaarsvlek phenomenon and autzpit sign positif









In this case lessions at regios trunkus anterior and posterior,
extremity superior and inferior and head, macules
erythematous lessions with thick grayish white squama above,
multiples, the distribution is generalisata. We know that the
lesion is psoriatic lesion the result from autoreactive immune
response.
Psoriasis vulgaris is the most common form of psoriasis, seen in
approximately 90% of patients. Red, scaly, symmetrically
distributed plaques are characteristically localized to the
extensor aspects of the extremities, particularly the elbows and
knees, along with scalp, lower lumbosacral, buttocks, and
genital involvement. Other sites of predilection include the
umbilicus and intergluteal cleft. Scales are lamellar, loose, and
easily removed by scratching. Removal of scale results in the
appearance of minute blood droplets (Auspitz sign). Papules
grow to sharply marginated plaques with lamellar scaling that
coalesce to form polycyclic or serpiginous patterns


The most obvious abnormalities in psoriasis are (1) an
alteration of the cell kinetics of keratinocytes with a shortening
of the cell cycle from 31 to 36 h, resulting in 28 times the
normal production of epidermal cells, and (2) CD8+ T cells,
which are the overwhelming T cell population in lesions. The
epidermis and dermis react as an integrated system: the
described changes in the germinative layer of the epidermis
and inflammatory changes in the dermis, which trigger the
epidermal changes. Psoriasis is a T celldriven disease. There
are many CD8+ T cells present in psoriatic lesions surrounding
the upper dermal blood vessels, and the cytokine spectrum is
that of a TH1 response. Maintenance of psoriatic lesions is
considered an ongoing autoreactive immune response.
5,6,12


Patient Literature
Patient got Ceterizine 10 mg 1x1 a
day. For the topical Salisyl Acid 3% +
LCD 5% + Desoximetason 0,25% and
Salisyl Acid 3% + LCD 5% +
Difluocortolone 0,1 %.

Topical treatment for psoriasis such as
topical steroid, vitamin D analogues,
tazarotene, and calcineurin inhibitors.
Systemic treatment for psoriasis, such
as cyclosporine A 2,5 mg/kg daily,
increased every 2-4 weeks up to 5
mg/kg daily, methotrexate 2,5 mg,
increased dose until therapeutic level
is achieved 10-15 weekly, acitretin 25-
50 mg daily, fumaric acid esters 1,2 g/
day, hydroxyurea 5 mg daily, 6-
thioguanne 80 mg twice weekly,
mycophenolate mofetil 500-750 mg,
sulfasalazine 500 mg





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