47 years male papulosqamous lesions on both legs and front and back of the body since 13 years. Itching occasionally. Burning also with occasionally. Worker in finance . Type of psoriasis? How to manage it?

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Chronic plaque psoriasis. Investigations CBC, LFT, KFT, BLOOD SUGAR , X RAY CHEST Treatment -- subject to normal CBC, X RAY, LFT. ( Adjust dose as per KFT) Test dose of 2.5 mg methotrexate oral once .Repeat CBC after a week, if no fall in counts give methotrexate 15 mg weekly in 5% dextrose I/V . Monitor LFT and CBC initially weekly then monthly . TOPICAL - Chlobetasone propionate + salisylic acid. Hydroxyzine Hydrochloride 25 mg TID oral .

Any biologic use ?
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The color of some of the lesions especially which show arciform and sigmoidal cofiguration with violacious colour and scanty scaling. Biiopsy them to r/o the pissibilty of CTCL, as the duration of psoriasiform lesion is 13yrs which may musquerade ss psoriasis or chr eczema. If it is ruled out u know what is best for the pt.

Thank you Doctors, Widespread bizarre lesions with evolution in one side and resolution in other side more favour to GYRATE TYPE PF PSORIASIS. Monitoring the case is very important by doing all investigations before going treatment. TREATMENT: 1) 12% Salicylic acid cream morning. Calcipotriol in night time. 2) Tab Mext 7.5 pack contains 30 tabs folic acid daily and Methotrexate 2.5 mg weekly once for 6 to 8 packs good remission. But monitoring of patient of CBP and LFT are important. 3) Tab Hydroxyzine 25 mg daily morning and night. 4) good nutrition , good habits and good rest with tensionless life will improve the condition

Chronic Plaque Psoriasis 1.Topically. .High potent steroid cream +salicylic acid. 2.Vitamin D analogues 3.PUVA treatment 4.Topical retinoids 5.Topical immunosuppressant..Tacrolimus  6.Anthralin ,coal tar preparation 7.PUVA therapy 8.Systemic therapy for psoriasis includes methotrexate; cyclosporine.Methotrexate, cyclosporine, and oral retinoids all have serious side effects including myelosuppression, hepatotoxicity, renal impairment, and teratogenicity.Monitoring of LFT,KFT,CBC,Bl.sugar is VERY IMPORTANT during systemic medication.

Good afternoon sir Erythematous and scaly Psoriasis vulgaris Discoid lesions become confluent to give rise to gyrate and polycyclic lesions Sir tt is Topical steroids , coal tar, dithranol , calcipotriol Oral methotrexate, cyclosporine@Dr. P.kishore Kumar

Chronic Plaque Psoraisis. Agree with Dr Gurcharan Singh. But long standing plaques do need a biopsy to rule out large plaque Parapsoriasis leading to Mycosis Fungoides.

But the case is posted as a case of psoriasis. so it is assumed a case of confirmed psoriasis of which type and management demanded as the subject for discussion. Yes I agree MF should be ruled out .
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Psoriasis vulgaris

psoriatic dermatitis

Chronic plaque psoriasis R/o PS arthritis and metabolic syndrome Ix Hb and platelets RFT LFT Rx CsA @ 3mg per kg Monitor closely adv Add MTX and Substitute. NBUVB can be added. Emolient topically will help.

? PSORIASIS

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