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WEL COME TO

WEL COME TO. CLINICAL MEETING ON. A CASE OF. PSORIASIS.

maurizio-noonan
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WEL COME TO

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  1. WEL COME TO CLINICAL MEETING ON A CASE OF PSORIASIS

  2. Organized by:Dept. of Dermatology.Presented by :Dr. Md. Nazrul Islam,Medical Officer Dept. of Dermatology.Chairperson :Dr. Shahab Uddin AhmedChowdhury. Associate Prof. & Head of the Dept. of Dermatology Mymensingh Medical College Hospital.

  3. PARTICULARS OF THE PATIENT: • Name : Md. Kala Mia. • Age : 44 Years. • S/O : Panju Mia. • Vill : Sony pala. • Upazilla: Ishargonj. • Dist : Mymensingh. • Date of Examination : 22-04-06. • Date of Admission : 22-04-06.

  4. CHIEF COMPLAINTS:  Appearance of numerous reddish skin lesions covered with scales for 1½ Years.  Itching and discomfort on the lesions for 1½ years.

  5. HISTORY OF PRESENT ILLNESS: The patient states that he was quite well 1½ Years back. Since then he developed multiple number of small reddish skin lesions covered with scales on front and back of trunk, on arms and forearms and legs & thighs of both sides. The lesions gradually increased in number and size.

  6. And for the last 1 year the lesions involved almost all body surface. The patient also developed itching on the lesions for the same duration which is continuous in nature and moderate in severity. With the above complaints, the patient attended skin O.P.D. and was admitted into the Hospital.

  7. HISTORY OF PAST ILLNESS  H/O Jaundice 5 years back.  H/O Pain in both knee joints 3½ years back.

  8. TREATMENT HISTORY: The patient was treated with different ointments, shampoo and tablets for skin lesions. But he could not mention the names. PERSONAL HISTORY:  Occupation – Cultivation as day labour.  Non smoker.  Betel nut chewer.  Non alcoholic. H/O Exposure is denied.

  9. SOCIO ECONOMIC CONDITION : Poor. FAMILY HISTORY:  Married.  No. of Offspring's – 03.  Age of last child - 4½ Years.  History of nothing Contributory to the disease.

  10. GENERAL EXAMINATION: • Appearance : Ill looking. • Build : Normal. • Anaemia : (+). • Cyanosis • Jaundice • Oedema • dehydration : Absent. • Clubbing • Koilonychia

  11. GENERAL EXAMINATION(Contd.) Pulse : 82/ Min.B.P. : 115/75mmHg.Temp. : 98.80F.Resp. : 18/Min. Lymph nodes : Not enlarged.Neck vein : Not engorged.Thyroid gland : Not enlarged.

  12. EXAMINATION OF INTEGUMENT Inspection : Numerous well demarcated, erythematous papules, Patches and plaques of variable size and shape covered with dry, grayish and silvery white scales bilaterally symmetrical in distribution on almost all body surface with sparing of palms and soles and relative sparing of face, axillae,

  13. EXAMINATION OF INTEGUMENT (Contd.) elbow flexors and dorsum of fingers and toes. Some of the lesions became confluent together to form large patch and plaque; and some are discrete . On the scalp- the lesions are less demarcated and hair loss present.

  14. EXAMINATION OF INTEGUMENT (Contd.) Nails : Mild pitting. Few transverse grooving in finger nails. Lip and oral mucosa: Normal. Hair : Some hair loss on scalp and on other affected areas.

  15. EXAMINATION OF INTEGUMENT (Contd.) Palpation:  Skin temp. : Raised on lesions. • Scales : Loosely adherent micaceous. • Auspitz sign : Positive. • Sensation : Intact. • Nerve Enlargement: Absent.

  16.  EXAMINATION OF CARDIOVASCULAR SYSTEM: NAD.  EXAMINATION OF RESPIRATORY SYSTEM: NAD.  EXAMINATION OF LOCOMOTOR SYSTEM: NAD.

  17. SALIENT FEATURE: Md. Kala Mia of 44 years complaints of appearance of numerous reddish itchy skin lesions covered with scales distributed on almost all body surface for 1½ years. Examination shows Numerous well demarcated, erythamatous papules, patches and plaques covered with dry, grayish to

  18. SALIENT FEATURES (Contd.) silvery whitemicaceous scales bilaterally symmetrical in distribution on almost all body surface with sparing of palms and soles. Auspitz’s sign is Positive.

  19. PROVISIONAL DIAGNOSIS : PSORISIS D/D • Mycoses fungoides. • Pityriasis rubra pilaris (PRP). • Sebhoric dermatitis. • Atopic dermatitis. • Dermatophytosis. • Psoriasiform syphilid. • Lepromatous Leprosy.

  20. INVESTIGATION: • SKIN BIOPSY FOR HISTOPATHOLOGY: The epidermis reveal hyperkeratosis, acanthosis with regular elongation of rete ridges, diminished granular layer, thinning of suprapapillary epidermis. The upper dermis show oedema with mononuclear cell infiltration. Diagnosis : Psoriasis.

  21. INVESTIGATION (Contd,): Skin scraping for Fungus : No fungal element found.  Slit skin smear for AFB : AFB not found. Blood For Hb% : 60% • TC of WBC : 10,000/cumm of blood. Neutrophil : 65% Lymphocyte : 29% Monocyte : 03% Eosinophil : 03% Basophil : 00%  ESR : 50mm in 1st hr.

  22. INVESTIGATION (Contd,): • Platelet count: 2,50,000/cumm of blood.  PBF. : RBC - mild dimorphic WBC - Mature Platelete – Normal morphology  Sezary Cells : suggestive.  BT : 3 min 10 sec. CT : 4 min. 50 sec.

  23. INVESTIGATION (Contd.)  RBS : 81 mg/dl. • ASO titre. : 200 iu/ml.  VDRL. : Non reactive.  HbsAg. : Negative.  Serology for Hepatitis C Virus: Not done.  S. Bilirubin. : 0.4 mg/dl.  SGPT. : 74 unit/l.

  24. INVESTIGATION (Contd.)  S. Creatitinine : 0.7mg/dl.  S. Urea. : 36mg/dl.  Serum total protein: 8.1 gm/dl. A/G ratio : 1.8 : 1  Urine for R/E. : NAD.  X-ray – Chest P/A view.: Normal finding. Hands B/V : Normal finding.  ECG : Normal finding.  USG of W/A. : No definitive abnormality.

  25. DIAGNOSIS PSORIASIS VULGARIS.

  26. TREATMENT :  Care for Maintainance of temp.  Nutritious diet.  Application of white Vaseline.  Application of Tar preparations.  Applicatin of Steroid.  Systemic use of : Methotrexate Folic acid.

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