Mr. N.C.S, Patient Identification Number: 13205, visited the clinic on 18 January 2010 with the complaints of Psoriasis.

Mr. N.C.S presented with reddish itchy patches on the legs since last 15 years, the skin patches were very itchy and there was oozing and bleeding from the patches. The inflammatory process had become very active in last 2 years. His itching was more during the evening hours, it would increase after taking oily and spicy food. He was a vegetarian and he had craving for spicy and sour food. He had a dislike for salty food. His sweating was excess and all over. He could not tolerate hot weather and thermally was a hot patient. His bowel and urine habits were normal.

He mentioned having some disturbances in his sleep pattern. His sleep would be disturbed during the early morning hours.

Mr. N.C.S was working in a vodaphone as a sales head, his wife was a home maker, he had a daughter who was studying in 2nd standard. He was staying with his parents in a joint family.

His case was taken in details.

He was short tempered and would get angry on small matters, since he was working in a sales sector so the work pressure was high and there were many targets deadlines which had to be met. The deadlines always caused pressure on him and he be under pressure most of the time.

He was a family oriented person and he was very attached to his family members. He was a emotional person at home but at work place was very strict and disciplined. There were differences between his wife and his mother and he would try to make things smooth between the two of them.

At 2 months follow up on 19 March 2010, Mr. N.C.S reported not much change in his psoriasis. He was explained about the nature of psoriasis and the need to keep more patience in order to see more positive changes in his skin condition.

At 6 months follow up on 9 July 2010, Mr. N.C.S reported no change in his skin. The inflammatory process was still active and the itching, redness was still the same. He also mentioned his sleep disturbance being the same.

His case was re-evaluated, he opened up and mentioned about the stresses that he was undergoing in more details.

There were personal stresses as the difference between his mother and wife had escalated to such an extent that they were planning to separate out. Although he was not very comfortable with this decision but he could not find out any other solution to this problem. At the same time, work pressures were very high. He could not keep a smooth balance between his personal responsibility and professional demands. This had made him very short tempered and he would get angry on silly issues.

He was counseled about keeping a calm mind and to find a solution by discussing the problem with everyone openly rather then taking hasty decision.

The medicines were altered and prescribed by Dr. Shah.

At 10 months follow up on 12 November 2010, Mr. N.C.S reported slight improvement, he said in last 15 years this is the first time he has seen improvement in his condition. His skin redness and itching was lesser in intensity, he felt that his irritability is also less now.

At 15 months follow up on 1 March 2011, Mr. N.C.S reported a increase in his skin patches again, there was change in the weather, the excess of heat had an effect on his skin. The skin patches were very red and itchy again. He was advised to keep the skin moist by using a good moisturizer more often and the medicines were altered.

At 18 months follow up on 20 June 2011, Mr. N.C.S reported 60 % improvement in his psoriasis, the itching was less and the skin had started clearing up, the hyperpigmentation had started reducing. This was a significant positive response and he stated that in last 15 years this was the first time where he had experienced such a good response. With the skin responding so well, he also felt mentally relaxed and was now in a position to resolve his personal stresses.

At 20 months follow up on 25 August 2011, Mr. N.C.S reported improvement in his condition. The skin patches had cleared up and they were showed appearance of the normal color skin coming. There was no itching, no redness. There were no new patches.

Since he has been responding well to the treatment, he has been giving follow up every 6 months where in he has reported very good improvement in his skin condition. He is managing the work pressure well and his personal problems were also settled.

Uploaded by Dr. Z.A on 29 September 2012.