This patient is most likely to have plaque psoriasis, the most common form of psoriasis in young adults, with the average age of onset in the early twenties (Dunphy, Winland-Brown, Porter, & Thomas, 2015).)
The risk factors for the development of psoriasis are family history. One-third of all patients with psoriasis have a relative with the disease, as in the case study above. When a parent is affected the children have a tendency for an early onset of the condition. Not only that but when both parents are affected the chance increases to forty-one percent of the children having the condition. This patient had an upper respiratory infection prior to the outbreak of the rash; this predisposes her for an outbreak of psoriasis. Even though there is a genetic disposition of the offspring of the parents having the disease, the exact genetic cause is unknown. Research is ongoing regarding the genetic and environmental influences on the cellular effects of the disease (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
The diagnostic tests to order for this patient are a CBC with differential and serum chemistry profile, serum uric acid level, antinuclear antibody titer, and rheumatoid factor. The serum uric acid level may be elevated. Diagnostic procedures are the Psoriasis Area and Severity Index, which evaluates overall severity and BSA involvement, and the Dermatology Life Quality Index. The top three differentials are seborrheic dermatitis, nummular eczema, and atopic dermatitis (Dominic, Bolder, & Golding, 2019)
The goal of treatment for the condition of Psoriasis is to identify and avoid triggers. If the condition is mild to moderate keeping the skin hydrated with petrolatum ointments is helpful. Topical corticosteroids are also helpful initially in treating the disease and preventing skin atrophy. In the adult, initial therapy should be corticosteroids with varying potencies. These treatments should not be used longer than 4 weeks (Hendriks… et al, 2013).
Follow-ups should be done to measure the body surface area involvement and to see if the therapy is working. If the therapy is not working alternative treatments should be prescribed or the addition of another agent to treat the condition should be done. If the psoriasis is greater than twenty percent of the body surface area, or severe extremity involvement especially of the hands and feet develops, a referral is needed (Menter, Gottlieb, Feldman, Van Voorhees, Leonardi, Gordon, et al…2008).
References
Domino, F., Baldor, R. A., & Golding, J. (2019). The 5-minute clinical consult. (27th
Ed.). [Mobile application software.] Retrieved from http://itunes.apple.com
Dunphy, L.M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2015). Primary
care: the art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.
Hendriks, A. G., Keijsers, R. R., de Jong, e. M., Seyger, M. M., van de Kerkof, P. C.
(2013). Efficacy and safety of combinations of first-line topical treatments in chronic plaque psoriasis: a systematic literature review. J Eur Acad Dermatol Venereol. 27(8) 931-951. doi:10.1111/jdv.12058
Menter A, Gottlieb A, Feldman SR, Van Voorhees AS, Leonardi CL, Gordon KB,et al.
(2008). Guidelines of care for the management of psoriasis and psoriatic arthritis: Section 1. Overview of psoriasis and guidelines of care for the treatment of psoriasis with biologics. J Am Acad Dermatol. 58(5):826-50.
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