Clinical cases

Psoriasis is an inflammatory, polygenic, immunemediated
disorder that presents cutaneous and systemic
manifestations. Multiple exogenous or endogenous factors
can act as triggers for the disease, such as physical or
chemical trauma, emotional stress, systemic infections, or
some medications, such as beta-blockers.
There are different clinical forms of psoriasis, psoriasis
vulgaris is the most commonly form, characterized by the
appearance of erythematous plaques, well delimited,
covered by coarse scales. Other clinical variants are guttate
psoriasis, erythrodermic psoriasis, pustular psoriasis,
palmoplantar, inverse psoriasis and nail psoriasis.
The therapeutic management must follow both the
psychological stress of the patient, by improving the quality
of the patient’s life and the part of the physical,
multisystemic impairment, so it is desired to obtain a
therapeutic conduct adapted and individualized to each
We present the case of a 46-year-old male patient,
known with high blood pressure and type II diabetes, who
presents in the clinic for an erythematous-squamous rash,
spread on the scalp, torso and limbs, evolving for about 5
years, the disease presenting a burst in the last months. The
patient underwent homeopathic treatment, but without
clinical improvement. The suspicion of disseminated
psoriasis vulgaris was raised and a skin biopsy was
performed with histopathological examination, where
suggestive elements for the diagnosis of psoriasis vulgaris
were detected.
We initiated systemic immunosuppressive therapy
with subcutaneous Methotrexate 15 mg, in combination
with topical therapy and phototherapy, with desired
The severe cases management of psoriasis can
sometimes be a challenge for the clinician. Aggravated
forms that associate with different comorbidities and
require systemic therapy or even the combination of several
topical and systemic therapies.
The current guidelines for the treatment of psoriasis
vulgaris can offer us many therapeutic alternatives, so the
purpose of the treatment is primarily to improve the quality
of the patient life and to improve the symptoms.