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23
Jun

A 58-year-old woman with psoriasis vulgaris recieved full recovery in 6 months

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Case Presentation

case_10_a

A 58-year-old female Singaporean had been well until a year earlier when she developed a scaly red rash over her knees and shins, and then with an identical distribution on both arms. She was clinically diagnosed with plaque psoriasis at the National Skin Centre.

Initially dermasone (Betamethasone) cream—a class of potent (group III) corticosteroid— was administered for temporary relief, but the psoriatic lesions continued spreading to the trunk. Thereafter, in January 2009, she was treated with UVB, 1 minute per session, 2 sessions per week, for a total of 20 sessions for 2 months.

case_10_b

The patient presented at the Tangs Clinical Centre in April 2009 because of persistent flareups of psoriatic papules. On examination, psoriatic papules appeared with a salmon color involving both arms, the lower limbs and the trunk area; and discrete small papules on the arms, knees, shin, back and forehead (Fig.1-A, Fig.2-A). The patient disclosed no familial history of psoriasis. Tangs Psoria capsules were prescribed, at 1440mg three time a day. No immunosuppressant therapy was given to her. The psoriatic lesions flared up in month 1 (Fig.1-B, Fig.2-B) due to dermasone and UVB withdrawal; thereafter, the patient responded very well to TANGS treatment (Fig.1-C,D,E,F, Fig.2-C,D,E,F, Fig.3-C,D,E,F). The patient achieved complete healing at the end of month 6

case_10_c

Discussion

There was marked flare-up on the psoriatic lesion (Fig.1-B, Fig.2-B) 1 month after stopping the topical steroid and UVB, which is called Immunosuppressant Withdraw Effect, flare-up wave occured especially on the skin areas where the corticosteroid cream was frequently applied. The subsidised lesion area on two legs fadeaway liken in greyish color (Fig.2-C,D,E) in months 2,3,4 as patient disclosed dermasone were frequently applied on her two lower limbs, however the subsided lesion area on her arms and back fadeaway liken vitiligo in color (Fig.1-C,D,E, Fig.3-C,D,E), where patient did not apply steroid on her arm and back area, which return on a natural skin tone color (Fig.1-F, Fig.3-F) one month later on. On examination in October, patient's finger/toe nails were fully investigated without any pitting sign found, meanwhile 50 degree water test on patients whole scalp disclosed no pink or reddish color change, hence no further medication is required thereafter.

The above series of photographs shows the psoriasis recovery process confirmed, and disclose two important nuggets of information regarding the TANGS treatment:

1.Time Needed for Recovery:
The frequency and severity of the Wavelike Processess (Fig.1-B, Fig.2-B) and the Full Recovery Period (6 months in this case) will have to depend on the dosage, strength and potency of the immunosuppressants (total corticosteroid cream 100gram and UVB 20 minutes) therapy that the user had formerly received.

2. Prognosis for the Curative Process:
At the juncture, psoriasis sufferers will see their skin lesions all eradicated (Fig.1-C, Fig.2-D, Fig.3-C). Subsequently, when some of the formerly affected skin begins to heals, it will take on a lighter tone (a fadeaway colour like that in vitiligo) compared to surrounding normal skin. (Fig.1-C, Fig.3-C) This signals that complete healing will take another 3 months (the time needed for skin-cell renewal). No further medication is required thereafter. Relapse will be unlikely to take place for the next 30 years.

Follow-up

Subsequent follow-up in March 2010, 5 months after recovery, revealed no relapse or complaints from the above patient.

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