Mr P.S, 12517 visited the clinic on 12 August 2009 for his complaints of psoriasis since last 2-3 months.

The patches were on the elbows, around the neck area, and mainly on the palms and soles. Although his palmo-plantar psoriasis was of recent origin but his cracks were very severe and were effecting his routine work.

There were excessive cracks followed with bleeding which was very painful, specially on palms and soles.

He was also an hypertensive and was on Anti hypertensives for it.

He was very friendly as a person but having suffered from psoriasis since last 2-3 months had made him very irritable. His case was taken in details on the day of the visit.

He was a vegetarian and his appetite was good. He had liking for sweets and salty food. He would have alcohol in moderate quantity but his intake was daily, he was also cautioned about the effect of alcohol on psoriasis and was asked to reduce the intake.

His thirst for water was average. He had excess sweating all over the body. His urine and bowel habits were normal. Thermally he was a hot patient. His sleep was disturbed due to some personal stresses.

He was working as a director in a insurance firm. His wife was working in India life insurance. He had a daughter who was into marketing.

He was doing well in his career but off lately the personal stresses were taking a a toll on his health. His daughter was undergoing a divorce so he was worried about her life and future.

He said that he jad done well in life and career and had no regrests, howver he couldn't see his daughter suffering so much. He couldn't do much about it but would just blame himself for this situation. He voice broke when he spoke about his daughter's condition. He felt helpless. He couldn't concentrate on his work and had become very short tempered which was not going very well with his co-workers. It seemed that he was losing control of life.

At 2 months follow up (14 October 2009), Mr P.S reported mild improvement in the palms, the itching as less. However the soles specially the cracks were very severe.

At 5 months follow up(28 January 2010), Mr P.S reported 70 % improvement in his condition. The itching and scaling was less and the cracks had reduced.

At 9 months follow up(1 June 2010), Mr P.S reported much good improvement and the skinwas clearing up. There were no cracks, no bleeding and the normal skin was appearing on palms and soles.

He was not regular to follow up in between but gave us a telephonic feedback about the doing well.

At 1.8 years months follow up(4 May 2011), Mr P.S visited the clinic and reported increase in the psoriatic patches on palms and soles. He was explained about psoriasis being a recurring condition and was explained to keep patience. Infact he could identify the psoriasis increasing when ever he was mentally stressed. He was counselled about keeping a calm mind. Based on the feedback the medicines were altered.

At 2.2 years follow up(14 September 2011), Mr P.S reported good improvement in his condition. His skin was clearing up again. The itching and the scaling had reduced and the bleeding was also less.

At 2.5 years follow up(15 December 2011), Mr P.S reported much better in his skin. The palms and soles were much better and the neck area was also showing significant improvement.

At 3 years follow up(3 May 2012), Mr P.S reported with complete clearance of palms and soles and he also specially thanked Dr. Shah for the the timely counselling done which helped him in facing all the diffculties with a calm mind and more patience. He was asked to stop the treatment as he was much better and appeared mentally very calm.

Uploaded by Dr. Z.A.