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Psoriasis
The assessment tool to be used here to rate the severity of the patient's psoriasis will be the Psoriasis Area and Severity Index (PASI). PASI provides a "measure of fthe average redness, thickness, and scaliness of the lesions (each graded on a 0-4 scale), weighted by the area of involvement" (Feldman, Kreuger, 2005, p. ii65). I am choosing this tool because it is the most traditional and widely used way of rating the severity of psoriasis in spite of its limitations. Nonetheless, the PASI is admittedly the "gold standard for assessment of severe psoriasis (Feldman, Krueger, 2005, p. ii65). The 1-2 glasses of whiskey at night may also be a contributing factor as alcohol is known to affect psoriasis (Orenstein, 2013). He needs to eliminate smoking as much as possible and remove the stress from his life, as much as possible. Stress is not good for the body and by smoking, drinking, and moving into a new location, he is putting his body under undue stress -- which is showing it in the sudden worsening of his psoriasis. This stress is also evident and made more exacerbating by his high cholesterol (Hyperlipidemia) and hypertension. John needs to relax, quit his smoking, cut down on his drinking, get some fresh air and a little sunlight, and begin to re-apply the ointments that have worked best for him in the past. He may also try a new topical cream if one is recommended.
A second assessment tool could be the Physician Global Assessment (PGA), which can be used for extensive break-outs or localized plaques (Feldman, Krueger, 2005). The static form is the most reliable in assessing the severity of psoriasis and has become a standard assessment tool.
A third assessment tool in development is the lattice system of assessment, which gives a global psoriasis rating based on elevation, erythema and scaliness, as well as body surface area -- all of which is used to categorize the psoriasis on a scale. This assessment tool is helpful because it provides a clear and coherent system of analysis and categorization.
Differential diagnosis might include: contact dermatitis, resulting from the application of the Clobetasol Ointment, which may be exacerbating the skin issues from which John is suffering rather than helping them. In this case, the ointment should…
References
Feldman, S., Kreuger, G. (2005). Psoriasis assessment tools in clinical trials. Ann Rheum Dis, 64(Suppl II): ii65-ii68.
Kimball, A. (2005). The Psychosocial Burden of Psoriasis. American Journal of Clinical Dermatology, 6: 383-392.
Orenstein, B. (2013). Alcohol and Psoriasis: Why They Don't Always Mix. Everyday
Health. Retrieved from http://www.everydayhealth.com/psoriasis/alcohol-and-psoriasis-why-they-dont-always-mix.aspx
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