WEL COME TO

Organized by:Organized by: Dept. of Dermatology.Dept. of Dermatology.Presented by :Presented by : Dr. Md. Nazrul Islam,Dr. Md. Nazrul Islam,

Medical OfficerMedical OfficerDept. of Dermatology.Dept. of Dermatology.

Chairperson :Chairperson : Dr. Shahab Uddin AhmedDr. Shahab Uddin Ahmed Chowdhury.Chowdhury. Associate Prof. & Head of Associate Prof. & Head of the Dept. of Dermatology the Dept. of Dermatology

Mymensingh Medical Mymensingh Medical College Hospital. College Hospital.

PARTICULARS OF THE PATIENT:PARTICULARS OF THE PATIENT:

Name :Name : Md. Kala Mia.Md. Kala Mia. AgeAge :: 44 Years.44 Years. S/OS/O :: Panju Mia.Panju Mia. VillVill :: Sony pala.Sony pala. Upazilla:Upazilla: Ishargonj.Ishargonj. Dist Dist :: Mymensingh.Mymensingh. Date of Examination : 22-04-06.Date of Examination : 22-04-06. Date of Admission : 22-04-06.Date of Admission : 22-04-06.

CHIEF COMPLAINTS:CHIEF COMPLAINTS:

Appearance of numerous reddishAppearance of numerous reddish

skin lesions covered with scales forskin lesions covered with scales for

1½ Years. 1½ Years.

Itching and discomfort on theItching and discomfort on the

lesions for 1½ years.lesions for 1½ years.

HISTORYHISTORY OF PRESENT ILLNESS: OF PRESENT ILLNESS:

The patient states that he was quite well 1The patient states that he was quite well 1½½

Years back. Years back.

Since then he developed multiple number of Since then he developed multiple number of

small reddish skin lesions covered with scales small reddish skin lesions covered with scales

on front and back of trunk, on arms and on front and back of trunk, on arms and

forearms and legs & thighs of both sides. The forearms and legs & thighs of both sides. The

lesions gradually increased in number and lesions gradually increased in number and

size.size.

And for the last 1 year the lesions involved And for the last 1 year the lesions involved

almost all body surface. The patient also almost all body surface. The patient also

developed itching on the lesions for the same developed itching on the lesions for the same

duration which is continuous in nature and duration which is continuous in nature and

moderate in severity. With the above moderate in severity. With the above

complaints, the patient attended skin O.P.D. complaints, the patient attended skin O.P.D.

and was admitted into the Hospital. and was admitted into the Hospital.

HISTORY OF PAST ILLNESSHISTORY OF PAST ILLNESS

H/O Jaundice 5 years back.H/O Jaundice 5 years back.

H/O Pain in both knee joints 3½ H/O Pain in both knee joints 3½

yearsyears

back. back.

TREATMENT HISTORY:

The patient was treated with different

ointments, shampoo and tablets for skin lesions.

But he could not mention the names.

PERSONAL HISTORY:

Occupation – Cultivation as day labour.

Non smoker. Betel nut chewer.

Non alcoholic. H/O Exposure is denied.

SOCIO ECONOMIC CONDITION : Poor.

FAMILY HISTORY:

Married.

No. of Offspring's – 03.

Age of last child - 4½ Years.

History of nothing Contributory to the

disease.

GENERAL EXAMINATION:

Appearance : Ill looking. Build : Normal. Anaemia : (+). Cyanosis Jaundice Oedema dehydration : Absent. Clubbing Koilonychia

GENERAL EXAMINATIONGENERAL EXAMINATION (Contd.)(Contd.)

PulsePulse :: 82/ Min.82/ Min.

B.P.B.P. :: 115/75mmHg.115/75mmHg.

Temp.Temp. :: 98.898.800F.F.

Resp.Resp. :: 18/Min. 18/Min.

Lymph nodes Lymph nodes : : Not enlarged.Not enlarged.

Neck veinNeck vein : : Not engorged.Not engorged.

Thyroid glandThyroid gland : : Not enlarged. Not enlarged.

EXAMINATION OF INTEGUMENTEXAMINATION OF INTEGUMENT

InspectionInspection : Numerous well demarcated, : Numerous well demarcated,

erythematous papules, Patches and plaques erythematous papules, Patches and plaques

of variable size and shape covered with dry, of variable size and shape covered with dry,

grayish and silvery white scales bilaterally grayish and silvery white scales bilaterally

symmetrical in distribution on almost all body symmetrical in distribution on almost all body

surface with sparing of palms and soles and surface with sparing of palms and soles and

relative sparing of face, axillae, relative sparing of face, axillae,

EXAMINATION OF INTEGUMENT EXAMINATION OF INTEGUMENT (Contd.)(Contd.)

elbow flexors and dorsum of fingers and toes.elbow flexors and dorsum of fingers and toes.

Some of the lesions became confluent Some of the lesions became confluent

together to form large patch and plaque; and together to form large patch and plaque; and

some are discrete . On the scalp- the lesions some are discrete . On the scalp- the lesions

are less demarcated and hair loss presentare less demarcated and hair loss present. .

EXAMINATION OF INTEGUMENT EXAMINATION OF INTEGUMENT (Contd.)(Contd.)

Nails Nails :: Mild pitting. Mild pitting.

Few transverse Few transverse grooving ingrooving in

finger nails.finger nails.

Lip and oral mucosa: Lip and oral mucosa: Normal.Normal.

HairHair : : Some hair loss onSome hair loss on

scalp and on otherscalp and on other

affected areas.affected areas.

EXAMINATION OF INTEGUMENT EXAMINATION OF INTEGUMENT (Contd.)(Contd.)

Palpation:

Skin temp. : Raised on lesions. Scales : Loosely adherent

micaceous. Auspitz sign : Positive. Sensation : Intact.

Nerve Enlargement: Absent.

EXAMINATION OF CARDIOVASCULAR SYSTEMEXAMINATION OF CARDIOVASCULAR SYSTEM: : NADNAD..

EXAMINATION OF RESPIRATORY SYSTEMEXAMINATION OF RESPIRATORY SYSTEM : : NAD.NAD.

EXAMINATION OF LOCOMOTOR SYSTEMEXAMINATION OF LOCOMOTOR SYSTEM :: NAD NAD..

SALIENT FEATURE:SALIENT FEATURE:

Md. Kala Mia of 44 years complaints of Md. Kala Mia of 44 years complaints of

appearance of numerous reddish itchy skin appearance of numerous reddish itchy skin

lesions covered with scales distributed on lesions covered with scales distributed on

almost all body surface for 1½ years. almost all body surface for 1½ years.

Examination shows Numerous well Examination shows Numerous well

demarcated, erythamatous papules, patches demarcated, erythamatous papules, patches

and plaques covered with dry, grayish toand plaques covered with dry, grayish to

SALIENT FEATURES (Contd.)SALIENT FEATURES (Contd.)

silvery whitesilvery white micaceous scalesmicaceous scales bilaterally bilaterally

symmetrical in distribution on almost all symmetrical in distribution on almost all

body surface with sparing of palms and body surface with sparing of palms and

soles. soles. Auspitz’s sign is Positive.Auspitz’s sign is Positive.

PROVISIONAL DIAGNOSIS : PSORISISPROVISIONAL DIAGNOSIS : PSORISIS

D/DD/D Mycoses fungoides.Mycoses fungoides. Pityriasis rubra pilaris (PRP).Pityriasis rubra pilaris (PRP). Sebhoric dermatitis.Sebhoric dermatitis. Atopic dermatitis.Atopic dermatitis. Dermatophytosis.Dermatophytosis. Psoriasiform syphilid.Psoriasiform syphilid. Lepromatous Leprosy.Lepromatous Leprosy.

INVESTIGATION:

SKIN BIOPSY FOR HISTOPATHOLOGY:

The epidermis reveal hyperkeratosis, acanthosis with regular elongation of rete ridges, diminished granular layer, thinning of suprapapillary epidermis. The upper dermis show oedema with mononuclear cell infiltration.

Diagnosis : Psoriasis.

INVESTIGATION (Contd,):

Skin scraping for Fungus : No fungalelement found.

Slit skin smear for AFB : AFB not found.Blood For Hb% : 60% TC of WBC : 10,000/cumm of blood. Neutrophil : 65%

Lymphocyte : 29%Monocyte : 03%Eosinophil : 03%Basophil : 00%

ESR : 50mm in 1st hr.

INVESTIGATION (Contd,):INVESTIGATION (Contd,): Platelet count:2,50,000/cumm of

blood.

PBF. : RBC - mild dimorphic

WBC - Mature

Platelete – Normal morphology

Sezary Cells : suggestive.

BT : 3 min 10 sec.

CT : 4 min. 50 sec.

INVESTIGATION (Contd.)

RBS : 81 mg/dl. ASO titre. : 200 iu/ml.

VDRL. : Non reactive.

HbsAg. : Negative.

Serology for Hepatitis C Virus: Not done.

S. Bilirubin.: 0.4 mg/dl.

SGPT. : 74 unit/l.

INVESTIGATION (Contd.)INVESTIGATION (Contd.)

S. CreatitinineS. Creatitinine :: 0.7mg/dl.0.7mg/dl.

S. Urea.S. Urea. :: 36mg/dl.36mg/dl.

Serum total protein: 8.1 gm/dl.Serum total protein: 8.1 gm/dl.

A/G ratioA/G ratio :: 1.8 : 11.8 : 1

Urine for R/E.Urine for R/E. :: NAD.NAD.

X-ray – Chest P/A view.:X-ray – Chest P/A view.: Normal finding.Normal finding.

Hands B/VHands B/V : Normal finding. : Normal finding.

ECGECG : Normal finding. : Normal finding.

USG of W/A.USG of W/A. : No definitive : No definitive abnormality.abnormality.

DIAGNOSISDIAGNOSIS

PSORIASIS VULGARIS.

TREATMENT : TREATMENT :

Care for Maintainance of temp. Care for Maintainance of temp.

Nutritious diet.Nutritious diet.

Application of white Vaseline. Application of white Vaseline.

Application of Tar preparations.Application of Tar preparations.

Applicatin of Steroid.Applicatin of Steroid.

Systemic use of : Methotrexate Systemic use of : Methotrexate

Folic acid.Folic acid.