Dermatology case discussion: Enduring psoriasis on a 14-year-old girl

In this week's general dermatology case discussion, presented by Dr Dianne King, we look at a 14-year-old girl who presents with psoriasis that has not responded to intermittent topical steroid treatment over the past year. Her mother also has psoriasis.

Examination

Examination reveals widespread psoriatic plaques involving the trunk, limbs and scalp. No nail changes are present, and the palms and soles are unaffected. There are no symptoms suggestive of psoriatic arthritis.

Given the extent of disease, a referral to dermatology is initiated.

What would you do next?

What management plan would you recommend for this patient? Consider both treatment of the current flare and longer-term skin barrier care.

Management plan

Here is Dr Dianne King's management plan:

• Calcipotriol/betamethasone foam prescribed once daily to body plaques.
• A ceramide-containing emollient prescribed twice daily with specific written instructions.
• Clobetasol shampoo prescribed for scalp involvement.

Outcome

At four weeks, there is modest improvement. At eight weeks (see photos below), clearance is dramatic.

On questioning, it emerges she stopped vaping between the four- and eight-week visits, encouraged by her mother. The dermatology referral is deferred following marked improvement.

Clinical takeaway

Always ask about vaping, not just smoking. Nicotine from any source is a significant trigger, and cessation can produce clinical improvement that outpaces any topical treatment.

Interested to learn more?

This general dermatology case is presented by Dr Dianne King and featured in A Practical Guide to Common Skin Conditions in Primary Care, developed by HealthCert Education in partnership with CeraVe.

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