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Psoriasis is a skin disorder caused by an immune-mediated chronic inflammation of the skin cells resulting in a build-up. Genetics play a role in the development of the disease; however, some environmental triggers can induce an exacerbation. Triggers include stress, infections, trauma, systemic drugs, alcohol, gluten, and obesity (Tirant et al., 2020).

Manifestations will be on various parts of the body. The symptoms are categorized into several clinical types: Plaque (chronic), erythrodermic (acute or chronic), guttate, inverse, and pustular. According to Dlugasch & Story (2021), the plaque type is the most common, and it consists of thick, red plaques covered by silver-white scales on the skin that may cause bleeding if lifted. The plaques are found on the scalp, elbow, and knees. The erythrodermic type has intense erythema, itching, and painful scaling within large body areas that are at most risk for infections. Guttate type has small, pink-red papules on the trunk and extremities. The inverse type entails erythema and irritation without scaling on the armpits, groin, and skin folds. The pustular type includes papules and plaque with pus, erythema, malaise, and fever. Other manifestations included with psoriasis are dryness, flaking, pain, and psychological concerns.

           Although there is no cure for psoriasis, there are three main types of treatment strategies to decrease the cell buildup: 1) topical treatments (e.g., corticosteroids, retinoids, salicylic acid, and moisturizers); 2) phototherapy (e.g., sunlight, ultraviolet A&B, and excimer laser); 3) oral or injected systemic medications (e.g., retinoids, methotrexate, hydroxyurea) (Dlugasch & Story, 2021). The patient may take a systemic medication due to the exacerbation in many areas of her body (but only for a limited time because of extreme side effects) and sunlight phototherapy to slow the growth of the cells and decrease inflammation. Non-pharmacological treatment is to avoid triggers, keep hydrated with moisturizers, natural sunlight, and daily baths.

           Certain medications can cause an exacerbation of psoriasis, so it is essential to take a thorough review of current medications. Patient K.B. has been diagnosed with psoriasis for five years with a relapse of three times since diagnosis and remission for the last 18 months. The flare-up caused an increase in body surface area, so the appropriate review would be to ask about current medications. Beta-blockers, lithium, anti-malarial drugs, and interferons strongly affect psoriasis exacerbation (Balak & Hajdarbegovic, 2017).

                                                                                                 Sensory Function Case Study

The patient of this case study presents with crusty yellow discharge on bilateral eyes that developed within twenty-four hours. In addition, his conjunctiva is red, and vision is blurry in the mornings despite washing of the eyes. His visual acuity returns to normal once the discharge is gone. His left ear is painful with a red, bulging, and opaque tympanic membrane upon examination. My diagnosis for the patient would be bacterial conjunctivitis. This type of conjunctivitis produces mucopurulent yellow-green discharge in one or both eyes. It can accompany otitis media, which displays as tympanic membrane inflammation as red and bulging (Dlugasch & Story, 2021).

The symptom manifestations, frequency of occurrence, and level of severity determine the diagnosis. Labs and cultures are not used to confirm conjunctivitis unless suspected of gonococcal infections (Dlugasch & Story, 2021). However, a rapid viral test for adenovirus can differentiate viral and bacterial etiology (Dlugasch & Story, 2021). The best therapeutic approach for the patient is warm compresses and eye drop or topical antibiotics.

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