Clinician Specialty: Dermatologist
Diagnosis:
- Moderate plaque psoriasis, involving elbows, knees, and scalp.
Background:
- Patient referred by GP for management of worsening psoriasis, unresponsive to topical corticosteroids.
- History of intermittent flares over the past 5 years.
Dear colleague,
It was a pleasure to meet with John Smith in clinic today.
History:
- 45-year-old male presenting with a 6-month history of increasingly widespread, itchy, and scaly skin lesions.
- Initial lesions appeared on elbows, gradually spreading to knees and scalp.
- Associated with significant discomfort and occasional bleeding from scratching.
- Previous treatment with betamethasone valerate 0.1% cream provided minimal relief.
Past medical history: Hypertension, controlled with ramipril.
Medication history: Ramipril 5mg daily, betamethasone valerate 0.1% cream (as needed). No known drug allergies.
Family history: Mother has a history of psoriasis.
Social history and impact on life:
Mr. Smith is an accountant, married with two children. He reports that his skin condition is significantly impacting his quality of life, causing embarrassment, difficulty sleeping due to itching, and affecting his concentration at work. He finds social situations challenging due to the visible nature of his lesions.
Examination:
- General appearance: Alert and oriented, no acute distress.
- Skin: Erythematous, well-demarcated plaques with silvery scales observed on bilateral elbows (approx. 5x7 cm), knees (bilateral, approx. 4x6 cm), and scattered patches on the scalp. Nails show mild pitting. No joint swelling or tenderness.
- Vital signs: BP 130/80 mmHg, HR 72 bpm, RR 16 bpm, Temp 36.8°C.
Summary:
Mr. Smith is a 45-year-old male with a 6-month history of worsening plaque psoriasis, primarily affecting his elbows, knees, and scalp. His condition has not responded adequately to topical corticosteroids and is significantly impacting his quality of life. Family history is positive for psoriasis.
Management plan:
- Discussed treatment options, including phototherapy and systemic agents.
- Initiated Dovonex (calcipotriol) ointment twice daily for 4 weeks for localised plaques.
- Prescribed a potent topical corticosteroid, clobetasol propionate 0.05% solution, for scalp involvement, to be used twice daily for 2 weeks.
- Provided patient education on proper application of topical agents and discussed potential side effects.
- Referred for narrowband UVB phototherapy commencing in 2 weeks.
GP action: Continue current ramipril. Please monitor blood pressure and ensure compliance with topical treatments.
Follow up:
Patient to return to dermatology clinic in 6 weeks for review of treatment efficacy and to assess progress with phototherapy.
