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Case Studies

Assessing the full impact of psoriasis, including invisible effects, on a patient’s professional, personal, and family life.

Explore the full experience of patients with psoriasis.

JIM’S VISIBLE PSORIASIS AND COMORBIDITIES

Profile*

Name: Jim
Age: 42
Sex: Male
Occupation: Plumber

Clinical Assessments

PASI

8.4

BSA

9%

ITCH VAS

71mm

DLQI

12

BLOOD PRESSURE

141/95mm Hg

FASTING
GLUCOSE

6.1mmoI/L

TRIGLYCERIDES

8.2mmoI/L

BMI

27kg/m2

*Hypothetical patient profile based on a dermatologist’s experience.

BMI, body mass index; BSA, body surface area; DLQI, dermatology life quality index; PASI, psoriasis area and severity index; VAS, visual analogue scale.

Presentation

Chronic plaque psoriasis
Disease Duration: 35 years

Presents with thick, flaky scalp psoriasis, some milder patches on the trunk and elbows; joint involvement on right index finger.

Notes

  • Suffered from psoriasis since age 7

  • Treatment: topical therapy

  • Stopped attending dermatology clinic at age 18 after leaving his parents’ home

  • Resumed psoriasis therapy at age 24 (PASI 9.7, BSA 12%, DLQI 5); continued topical therapies with variable adherence

  • Some success with PUVA therapy

  • Fearful of methotrexate despite explanation of dosing (as his sister received it as chemotherapy)

  • Gained some weight over past 2 years, despite trying to keep active

  • Developed hypertension (treatment: candesartan 8 mg/day) and some insulin resistance; swollen joint in right index finger makes it difficult to continue work as a plumber

PUVA, psoralen and ultraviolet A.

The Invisible Impact

I’ve had psoriasis since I was a kid. I used to put up with it because it didn’t affect my life too much—just had patches on my elbows and chest—it would flare every so often, which I mostly covered up with a t-shirt.

But recently my scalp has become so itchy and flaky. I can’t wear dark tops anymore because the flakes on my shoulders become even more obvious. It’s so embarrassing.

My finger has swollen up, too. I feel like I’m in constant pain. Obviously, as a plumber I use my hands all day, and I can’t slow down—competition for work is tough; just one bad review and you’re out of work!

I’ve started to worry about my weight, as well. My flaky scalp means I order dinner in a lot, and I know that type of food’s not the healthiest—it’s just I’d rather avoid the supermarket. I can’t remember the last time I went to a restaurant! My friends ask me why I never see them anymore, but I don’t feel like going out.

What would be your approach to Jim’s healthcare?

ELEANOR’S VISIBLE PSORIASIS AND COMORBIDITIES

Profile*

Name: Eleanor
Age: 37
Sex: Female
Occupation: Recruitment Consultant

Clinical Assessments

PASI

9.6

BSA

6%

ITCH VAS

21mm

DLQI

14

BMI

29.2kg/m2

*Hypothetical patient profile based on a dermatologist’s experience.

Presentation

Inverse and plaque psoriasis
Disease Duration: 19 years

Presents with smooth, non-scaly erythematous areas on approximately 30% of genitals and surrounding groin area, with tightness and some splitting of skin and some involvement of the anal area. Some small plaques on vulva and pubis, with raised plaques on upper thighs and lower torso.

Notes

  • Well-demarcated, erythematous plaques with non-extensive scaling and some pinpoint bleeding

  • Vulva psoriasis presenting as symmetrical glossy red plaques with some minor fissures causing a great deal of pain and embarassment

  • Experienced secondary infections at initial development of genital psoriasis (treated with trimovate)

  • Prescribed topical steroids on genital area when symptoms flare up; conscious not to overuse

  • Uses emollient-based soaps and tacrolimus; experiences a burning sensation when first applied and therefore discontinued use

  • Being treated for ulcerative colitis with mesalazine; may be a cause for concern

The Invisible Impact

When I first noticed I had symptoms of psoriasis at 18 years old, it was mainly on my upper thighs and hips. In the last 9 months or so, since I’ve been trying to go to the gym more, I’ve started to develop tight, red patches in places I didn’t think I would ever get psoriasis.

I’m trying to lose some weight and get more fit by going to the gym, but the psoriasis down there is making it painful and uncomfortable from the itch.

Sex was painful, and when I did have it, my skin would be even more dry afterwards and I would have more flare ups. I had just started a new relationship, but I ended it when I developed the patches because I felt so self-conscious and I didn’t want my new partner to see me or touch me.

I also had to stop my self-care down there as I found shaving or waxing further irritated my skin. I’ve been using steroid creams and emollient-based soaps to clean myself, which provide some temporary improvement, but I want something that helps me more long term.

I had grown to accept that I had psoriasis on my body, and I was able to manage and cope with that. But now it’s on my genitals—I am so unhappy. Some days, it’s even affecting the way I walk! Do I just need to accept this, that having a relationship isn’t going to be straightforward anymore, and that I’m going to be uncomfortable in such an intimate area forever?

What would be your approach to Eleanor’s healthcare?

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PSORIASIS IMPACTS MATTER