A 35-year-old male Indian Singaporean had been well until approximately 7 years earlier, when papules developed first on his right forearm, and then in an identical distribution on the left arm. He was clinically diagnosed with plaque psoriasis. Initially, calcipotriol (Davonex) cream was administered and offered temporary relief. Later on, corticosteroid (betamethasone dipropionate) and calcipotriol (Davonex) cream was prescribed, but the psoriatic lesions continued spreading to his trunk; he was treated with UVB for 1.5 months, resulting in a remission of the symptoms. But approximately 3 months later, psoriatic thick lesions flared up and spread on even more skin area than before.
Two-and-a-half years before presentation, the patient had seen a private skin specialist and was treated with chemotherapy MTX methotrexate with 15mg/week-12.5mg/week-10mg/week-7.5mg/week-5mg-mg/week-2.5mg/week for two years. Multiple large scaling thick plaques developed on his trunk, arm and abdomen after MTX was discontinued. Fortunately, the patient’s laboratory liver function tests were in the normal range.
On examination of the skin, there was massive silvery white hyperkeratosis and scaling on the forearms, palms, and soles, sharply marginated with thick adherent scales involved with both forearms (Fig.1-A). Some single round thick lesions with diameters of 3cm-5cm were disseminated on his abdomen, back, trunk, legs, face, knees, palms. Serum laboratory investigations revealed no abnormal findings. The patient was administered Tangs Psoria capsules 1440mg three times daily. He responded very well (Fig.1-B,C,D), and with five months of Tangs Psoria monotherapy, there was a marked improvement. There were no adverse events raised by the patient during the Tangs Psoria monotherapy.