Date:
Patient:
Reason for Visit:
Follow-up for psoriasis
Evaluation of disease activity and response to treatment
New symptom evaluation (e.g., joint pain, nail changes)
History:
Present Illness:
Onset, duration, and course of psoriasis
Location and severity of plaques (e.g., scalp, elbows, knees, body) – use tools like Psoriasis Area and Severity Index (PASI) if applicable
Impact on daily activities and quality of life
Past Medical History (PMH):
Psoriatic arthritis (inflammatory joint disease associated with psoriasis)
Other relevant medical conditions (obesity, hypertension, diabetes)
Family History: Family members with psoriasis
Social History:
Smoking and alcohol use (can worsen psoriasis)
Stressful life events (may trigger flares)
Medications:
Current medications for psoriasis (topical steroids, immunosuppressants, biologics)
Over-the-counter medications used for itching or pain
Physical Exam:
Skin:
Inspect for psoriatic plaques:
Red, raised, scaly patches with well-defined borders
Silver-white scale on the surface
Evaluate for nail involvement (pitting, discoloration)
Assess for signs of secondary skin infections (bacterial or fungal)
Joints:
Look for swelling, tenderness, redness, or limitation of movement (suggestive of psoriatic arthritis)
Diagnostic Tests (may be ordered depending on clinical presentation):
Complete Blood Count (CBC) – to rule out infection or inflammatory processes
Streptococcal test (throat swab) – if guttate psoriasis is suspected (sudden onset of small, red papules)
X-rays or imaging studies (for psoriatic arthritis evaluation)
Assessment:
Psoriasis type (e.g., plaque psoriasis, guttate psoriasis, pustular psoriasis): Based on clinical presentation
Disease severity: Consider plaque location, body surface area involved, and impact on quality of life (e.g., PASI score)
Psoriatic arthritis: Presence or suspicion based on joint exam and imaging (if done)
Treatment response: Evaluate effectiveness of current medications and identify any side effects.
Plan:
Treatment plan based on disease severity, type, and patient factors:
Topical corticosteroids (first-line treatment for mild to moderate psoriasis)
Vitamin D analogues (to improve skin barrier function and reduce inflammation)
Calcineurin inhibitors (tacrolimus, pimecrolimus) – for mild to moderate psoriasis, particularly on sensitive areas like the face
Coal tar preparations (may be messy but effective for scalp psoriasis)
Light therapy (phototherapy) – effective for widespread psoriasis
Methotrexate, cyclosporine, or other systemic medications (for moderate to severe psoriasis or psoriatic arthritis)
Biologic therapies (tumor necrosis factor-alpha inhibitors or interleukin-17 inhibitors) – for severe psoriasis or psoriatic arthritis unresponsive to other treatments
Lifestyle modifications:
Maintain a healthy weight
Smoking cessation
Stress management techniques
Moisturize skin regularly
Referral to a dermatologist: For complex cases, diagnosis uncertainties, or consideration of biologic therapy.
Patient education: Provide information about psoriasis, triggers, treatment options, potential side effects, and the importance of self-care and medication adherence.
Follow-up:
Schedule for follow-up appointments to monitor disease activity, adjust treatment plan as needed, and address any new concerns.
Discuss the importance of long-term management for psoriasis, as it is a chronic condition.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of psoriasis