REASON
CHIEF COMPLAINT: This is a followup of psoriasis and probable steroid-induced acne on the face.
HISTORY
The patient has a long history of psoriasis and has been treated with methotrexate in the past. See Dr. Stewart's note from 04/21/2016. Because of the lengthy time of his methotrexate usage which was approximately eight years, methotrexate was stopped by Dr. Stewart in April and the patient has been using just topical care only. He did discontinue his triamcinolone cream on his face and his steroid induced acne is much improved since discontinuing same. Currently, he is using triamcinolone 0.1% cream about once a day to twice a day chiefly to the skin folds in the groin, in gluteal cleft and perianal area included and then …show more content…
There is no significant residual active acne present. He has mild to moderate psoriasis in the nasolabial folds, in the ears, in the postauricular folds and moderate inverse psoriasis in the gluteal cleft and perianal area in the groin. There are few scattered plaques over his legs and elbows.
IMPRESSION
Psoriasis flaring mildly with a prominent component of facial and inverse psoriasis.
PLAN
1. I feel like this patient needs to start using Protopic ointment 0.1% b.i.d. to the areas prone to the psoriasis over his face, ears, inguinal folds, gluteal cleft and perianal area. This would relieve him of the chance of the risk of developing side effects of chronic steroid use in those areas. He was advised to stop his triamcinolone 0.1% in these areas when the Protopic 0.1% became available.
2. Discontinue clobetasol and start augmented betamethasone dipropionate ointment b.i.d. to the plaques over his scalp, over his trunk and arms and avoid use on the face and skin folds.
3. Start calcipotriene ointment (Dovonex ointment) b.i.d. to his elbows knees and legs in the areas prone to psoriasis. Avoid use of Dovonex ointment on the face. Please return to the dermatology clinic in three
CHIEF COMPLAINT: This is a followup of psoriasis and probable steroid-induced acne on the face.
HISTORY
The patient has a long history of psoriasis and has been treated with methotrexate in the past. See Dr. Stewart's note from 04/21/2016. Because of the lengthy time of his methotrexate usage which was approximately eight years, methotrexate was stopped by Dr. Stewart in April and the patient has been using just topical care only. He did discontinue his triamcinolone cream on his face and his steroid induced acne is much improved since discontinuing same. Currently, he is using triamcinolone 0.1% cream about once a day to twice a day chiefly to the skin folds in the groin, in gluteal cleft and perianal area included and then …show more content…
There is no significant residual active acne present. He has mild to moderate psoriasis in the nasolabial folds, in the ears, in the postauricular folds and moderate inverse psoriasis in the gluteal cleft and perianal area in the groin. There are few scattered plaques over his legs and elbows.
IMPRESSION
Psoriasis flaring mildly with a prominent component of facial and inverse psoriasis.
PLAN
1. I feel like this patient needs to start using Protopic ointment 0.1% b.i.d. to the areas prone to the psoriasis over his face, ears, inguinal folds, gluteal cleft and perianal area. This would relieve him of the chance of the risk of developing side effects of chronic steroid use in those areas. He was advised to stop his triamcinolone 0.1% in these areas when the Protopic 0.1% became available.
2. Discontinue clobetasol and start augmented betamethasone dipropionate ointment b.i.d. to the plaques over his scalp, over his trunk and arms and avoid use on the face and skin folds.
3. Start calcipotriene ointment (Dovonex ointment) b.i.d. to his elbows knees and legs in the areas prone to psoriasis. Avoid use of Dovonex ointment on the face. Please return to the dermatology clinic in three