How to Identify Psoriasis and What to Do About it

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). 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.

The primary diagnosis in this case is that John's stress (moving in with daughter and son-in-law) as well as his hefty smoking habit are causing his psoriasis to flare up and become worse. 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. 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 be discontinued and skin therapy begun. Contact dermatitis could also be resulting from an allergic reaction to something in his daughter and son-in-law's house that is irritating John's skin.

Another differential diagnosis could be: eczema or atopic dermatitis, which could be caused by the new surroundings and the body's immune system overreacting to the change. Atopic dermatitis could be adding to the stress of the body. A third differential diagnosis could be: the onset of gout, which affects the joints and can cause severe pain in skin and body due to inflammation. John's drinking may be in excess of what his body can physically handle, which could lead to the gout.

Secondary diagnosis would depend upon further examination and might include secondary leprosy infection (Teixeira et al., 2011). Possible rheumatic disease could also be examined pertaining to new aches in hands and legs. Types of psoriasis would also be examined -- plague, inverse, erythrodermic, pustular, guttate -- and how they overlap to determine the extent of the disease. Secondary syphilis may also be considered along with tenea corporis, nummular eczema and seborrheic dermatitis (Kimball, 2005).

Ten questions to develop the diagnosis would be: 1) Can you describe your biological family history, if anything? 2) Have you had any recent illnesses? 3) What is your social/sexual history? 4) Are you on any other prescription medications? 5) Do you spend any time outdoors in the sunlight? 6) Do you struggle with depression? 7) Has anyone else in the house shown similar symptoms to make you think it is contagious? 8) Do you get any rest in your new dwellings? 9) What is your diet? 10) Do you have a history of drug/alcohol use/abuse? Are you drinking/smoking more now that you live with your daughter's family? These questions should eliminate a.