Skill Checkup: A 32-Year-Old Man With an Acute Flare of Psoriasis

David T. Robles, MD, PhD, FAAD


May 11, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 32-year-old man presents with an acute flare of psoriasis. He was first diagnosed 6 years ago. His psoriasis is severe, covering 15% of his body surface area (BSA) and involving the trunk, scalp, extremities, and penis. He does not have psoriatic arthritis. He did not respond to topical therapies, which he tried for 6 months and cannot fit phototherapy into his busy work schedule. He tried apremilast for 2 months, but it caused nausea and diarrhea. He was switched to adalimumab and etanercept and currently is taking infliximab, all of which were initially successful but then failed. He reports being depressed and has started to drink one to two martinis almost every night. The patient has type 2 diabetes. His body mass index (BMI) is 26.2.


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