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Abstract: A 35-year-old male presented with large erythematous scaly changes on the skin surface, accompanied by intense pruritus, which worsened for 2 months. Punctate bleeding after scratching seriously affected the quality of life and had an impact on the patient’s physical and mental health. It turns out that this is a large area of skin lesions caused by plaque psoriasis, which is itself an atopic inflammatory infection, and the skin damage gradually subsides after active selection of treatment with targeted oral agents and topical medications.
Basic information】Male, 35 years old
Disease Type】Plaque psoriasis
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Pathological examination + medication (oral Aviatrol capsules + topical carbotriol ointment)
Treatment period】30 days of home treatment, review after 30 days
Effectiveness】Erythematous scaling changes gradually decreased, and itching gradually relieved
I. Initial consultation
A male in his 30s walked into the clinic, and some white flakes could be seen with the naked eye in other areas not covered by his mask, especially in the hairline area. The patient described himself as having psoriasis for many years, and in the last 2 months, there was a significant increase in the skin surface, accompanied by intense itching. On examination, the patient was seen to have erythematous, scaly plaques of varying sizes on the trunk area, with the skin surface of the back and both lower extremities being the most common. Large red patches covered with white flakes were seen on the back, with a mild tendency of fusion at the edges, and the scales were mica-like and could be peeled off layer by layer, with loose surrounding and adhesion in the middle. Large lesions with a diameter of more than 20 cm were seen on both lower extremities, and punctate bleeding could be seen after scraping through a blunt knife. The patient’s clinical symptoms were consistent with the clinical manifestations of psoriasis, and after communication with the patient, the patient agreed to undergo a dermatopathological examination in order to clarify the diagnosis. The results of the dermatopathological examination showed focal hyperkeratosis within the stratum corneum, with neutrophils visible above the hyperkeratosis. Neutrophilic microabscesses were located at multiple levels within the stratum corneum, and the granular layer was focally absent. The epidermal muscular layer is thickened, the epidermal protrusions grow in a globular pattern, the apical dermal papillae are thinned, and the blood vessels within the dermal papillary layer are dilated. It is consistent with the skin diagnosis of plaque psoriasis.
II. Treatment history
The patient had been suffering from psoriasis for many years, and this time her condition had significantly worsened. We communicated with the patient about the occurrence and development of the disease and formulated a treatment plan. When doing dermatopathology, the selected sampling site was the edge of a large lesion on the leg. After disinfection with iodophor disinfectant, lidocaine hydrochloride injection was spread on local infiltration anesthesia, and then a 0.3×0.5 cm skin specimen was taken with a sharp knife. Local pressure was applied to stop bleeding, and 2 stitches of silk suture No. 4 were taken and then disinfected with iodophor disinfectant and aseptically bandaged. Oral Avi A capsules and topical carbotriol ointment were chosen for treatment. Avi A capsule itself belongs to the vitamin A acid class of drugs, after intake into the body can regulate the keratin, the formation of cell proliferation and differentiation to reduce erythema infiltration and desquamation. The carbotriol itself is a vitamin D3 derivative, which can improve skin damage. After the patient took the medication and communicated with the patient about the method of administration, the patient nodded that he understood and went home for home treatment. The patient was instructed to review and remove the stitches after 7 days.
III. Treatment effect
The patient was re-examined in the outpatient clinic after 7 days of medication. After the dressing gauze was removed, the local wound healed well and no redness or swelling was seen at the wound site. The color of the large red patches on the skin surface had gradually darkened, and there was a significant reduction in the surface flakes and a mild reduction in the lesion area. The large area of skin damage on the legs has improved to some extent and the number of surface flakes has decreased. The patient indicated that after 3 days of medication, the medication began to have a significant effect, and by 7 days of application there was significant relief of itchiness. The patient was instructed to go home and continue applying the medication with the original treatment regimen intact. A review was conducted after 30 days of medication.
IV. Precautions
We are glad that the patient’s discomfort was reduced and her condition improved after treatment with the medication. Psoriasis can cause intense itching, and bleeding changes will appear if the local area is scratched frequently. Patients are advised to minimize scratching to prevent isomorphic reactions, which can trigger the expansion of the lesion area. Before the disease is completely cured, patients need to avoid eating spicy and stimulating foods, seafood and fishy hair to prevent skin damage from expanding and affecting the treatment effect of the disease. Pay attention to the cleanliness of the wound area to prevent the growth of bacteria, which can lead to wound infection. If redness and swelling have appeared, consider the possibility of combined bacterial infection, and seek timely medical treatment with appropriate medication.
V. Personal insight
Psoriasis is a chronic recurrent inflammatory skin disease with erythematous scaly patches on the skin surface, which affects the appearance. Progressive psoriasis will appear isomorphic reaction, such as stimulated by trauma, new psoriasis lesions can appear at the injured site. The treatment of this disease is a long-term process, and patients are advised to use the full course of treatment and the full amount of medication. If the medication is stopped too early or the amount of medication is insufficient, it may lead to recurrent attacks. Do not abuse alcohol after the skin damage has subsided to prevent recurring psoriasis attacks after the physique has deteriorated, which is detrimental to health.