Psoriasis Assessment, Diagnosis, and Treatment Plan
This paper presents a clinical assessment of a patient experiencing a psoriasis flare-up linked to lifestyle and environmental stressors. Using established tools such as the Psoriasis Area and Severity Index (PASI) and the Physician Global Assessment (PGA), the paper evaluates lesion severity and extent. It proposes a primary diagnosis attributing the worsening condition to stress, smoking, and alcohol use, while exploring differential diagnoses including contact dermatitis, atopic dermatitis, and gout. Secondary diagnoses are also considered. The paper concludes with ten targeted diagnostic questions and a treatment plan emphasizing stress reduction, smoking cessation, decreased alcohol consumption, and appropriate topical therapy.
- Assessment Tools for Psoriasis Severity: PASI, PGA, and lattice system explained
- Primary Diagnosis and Contributing Factors: Stress, smoking, alcohol worsen psoriasis flare
- Differential Diagnoses: Contact dermatitis, eczema, and gout considered
- Secondary Diagnoses: Leprosy, rheumatic disease, psoriasis types reviewed
- Diagnostic Interview Questions: Ten questions to narrow the diagnosis
- Treatment Recommendations: Lifestyle changes and topical therapy advised
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What makes this paper effective
- Clearly justifies the selection of each assessment tool, explaining clinical rationale rather than simply naming them.
- Logically connects the patient's lifestyle factors — stress, smoking, and alcohol — to the worsening psoriasis, demonstrating clinical reasoning.
- Presents a well-organized differential diagnosis section that considers multiple alternative conditions systematically.
- The ten diagnostic questions are practical and directly tied to ruling out competing diagnoses, showing applied clinical thinking.
Key academic technique demonstrated
This paper demonstrates clinical case analysis, a core technique in health sciences writing. The author builds from assessment tools to primary diagnosis, then expands outward to differentials and secondary diagnoses before narrowing back to a specific treatment plan — a classic diagnostic reasoning funnel used in medical and nursing education.
Structure breakdown
The paper opens with three assessment tools (PASI, PGA, and the lattice system), moves into primary and differential diagnoses supported by cited evidence, lists targeted patient interview questions, and closes with treatment recommendations. Each section is concise and purpose-driven, making the clinical logic easy to follow across roughly 600 words.
Assessment Tools for Psoriasis Severity
The assessment tool used here to rate the severity of the patient's psoriasis is the Psoriasis Area and Severity Index (PASI). PASI provides a measure of the average redness, thickness, and scaliness of lesions — each graded on a 0–4 scale — weighted by the area of involvement (Feldman & Krueger, 2005, p. ii65). This tool is selected because it is the most traditional and widely used method for rating psoriasis severity, despite its limitations. The PASI is widely acknowledged as the "gold standard for assessment of severe psoriasis" (Feldman & Krueger, 2005, p. ii65).
A second assessment tool is the Physician Global Assessment (PGA), which can be used for both extensive flare-ups and localized plaques (Feldman & Krueger, 2005). The static form is the most reliable for assessing psoriasis severity and has become a standard clinical assessment tool.
A third assessment tool currently in development is the lattice system of assessment, which provides a global psoriasis rating based on elevation, erythema, and scaliness, as well as body surface area. All of these factors are used to categorize the psoriasis on a standardized scale. This tool is useful because it offers a clear and coherent system of analysis and categorization.
Primary Diagnosis and Contributing Factors
The primary diagnosis in this case is that the patient's stress — stemming from a recent move into a daughter and son-in-law's home — along with a significant smoking habit, is causing the psoriasis to flare up and worsen. The consumption of one to two glasses of whiskey each night may also be a contributing factor, as alcohol is known to affect psoriasis (Orenstein, 2013).
The patient needs to reduce smoking as much as possible and minimize stress. Stress is harmful to the body, and the combination of smoking, drinking, and adjusting to a new living situation is placing the body under undue strain — a strain that is manifesting in the sudden worsening of the psoriasis. This stress is further compounded by the patient's high cholesterol (hyperlipidemia) and hypertension.
It is recommended that the patient relax, work toward quitting smoking, reduce alcohol consumption, spend time outdoors in the sun, and resume applying the topical ointments that have previously been effective. A new topical cream may also be considered if one is clinically recommended.
Differential Diagnoses
Differential diagnoses include the following possibilities:
Contact dermatitis — This may be resulting from the application of Clobetasol Ointment, which could be exacerbating the patient's skin condition rather than helping it. In this case, the ointment should be discontinued and alternative skin therapy initiated. Contact dermatitis could also be the result of an allergic reaction to something in the new household that is irritating the patient's skin.
Eczema or atopic dermatitis — This condition could be triggered by the new surroundings and an overreaction of the body's immune system to environmental change. Atopic dermatitis may be adding to the overall physiological stress experienced by the patient.
Gout — The onset of gout, which affects the joints and can cause severe pain and inflammation in the skin and body, is another possibility. If the patient's alcohol intake exceeds what the body can physically process, this could contribute to the development of gout.
References
Feldman, S., & Krueger, G. (2005). Psoriasis assessment tools in clinical trials. Annals of the Rheumatic Diseases, 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
Teixeira, F., et al. (2011). Secondary leprosy infection in a patient with psoriasis during treatment with infliximab. Journal of Clinical Rheumatology, 17(5), 269–271.
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