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18
Jun

A 44-year-old man with chronic plaque psoriasis located at both lower extremities - successful first-line therapy by Tangs psoria

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Case Presentation

Case_7A 44-year-old male presented with large confluent reddish plaques on the legs (Fig.1-A). He had been diagnosed with psoriasis 8 years earlier. On examination, well-demarcated erythematous plaques arising on the lower legs (Fig.1-A) could be seen. No hair loss and no diarrheal, with no other diseases reported by the patient. Laboratory serum investigation revealed no abnormal findings, temperature was 37.1°C. The patient reported no oral medication use during the past 8 years, but was unable to recall the names and types of creams applied previously.

Topical or systemic corticosteroids may have few side effects with normal use, but can become impractical for those with diseases covering more than 10 percent of their bodies. Frequently such treatments become ineffective with continued use—thus the herbal drug Tangs Psoria Capsule was given as the first-line therapy in place of steroids and calcipotriene, which are the common agents used among dermatologists. During the TANGS treatment, no other conventional medication was used. After 5 months of treatment, the psoriasis cleared to a near-complete extent(Fig.1-D).

GENERAL CONSIDERATION

When choosing a treatment regimen, it is important to reconcile the extent and the measurable severity of the disease with the patient's own perception of his or her disease. In this context, it is notable that a recent study found that 40 percent of patients felt frustrated with the ineffectiveness of their current therapies.1 As psoriasis is a chronic condition, it is important to know the safety of a treatment during long-term use. In most treatments, the duration of a treatment is restricted because of the cumulative toxicity potential of an individual treatment, and, in some instances, treatment efficacy may diminish with time (tachyphylaxis). Some treatments, such as topical corticosteroids, dithranol, tar, photo(chemo)therapy, and cyclosporin are not indicated for continuous chronic use.2 Tachyphylaxis to treatment with topical corticosteroids is a well-established phenomenon in psoriasis. Long-term topical corticosteroids may cause striae (Fig. 2) and adrenal suppression. In cases of itchy/pruritic psoriasis, treatments with an irritative potential, such as dithranol, vitamin D3 analogues, and photo(chemo)therapy, should be used cautiously. Patients with chronic plaque psoriasis who respond well to the treatment may not require a change of treatment.

 

 

 

case_7_fig

Fig.2 illustrates severe atrophy with striae distensae after several years of treatment with potent topical steroid creams.

REFERENCE

1. Krueger G et al: The impact of psoriasis on quality of life: Results of a 1998 National Psoriasis Foundation patientmembership survey. Arch Dermatol 137:280, 2001 2.
2. van de Kerkhof PC: Therapeutic strategies: Rotational therapy and combinations. Clin Exp Dermatol 26:356, 2001
3. Wolff, Klaus; Goldsmith, Lowell A.; Katz, Stephen I.; Gilchrest, Barbara A.; Paller, Amy S.; Leffell, David J. Edit, Fitzpatrick's Dermatology in General Medicine, 7th Edition, 2008 McGraw-Hill

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