A CASE OF PSORIASIS.

K. C. YEO, M.B., B.S.

L. S. Male, Chinese aet. 20 years, waiter, was admitted to the University Medical Clinic on the 7th. of June, 1926, for eruption of scalp, trunk, upper and lower limbs of a period of five months.

History of Past Illness:

As a child, patient often had boils on the scalp. Usually every summer he has some sort of skin condition. Last year, he had a crop of boils on the gluteal region, and a bad infection of scabies. He denied having venereal disease.

History of Present Illness:

Five months ago patient noticed a profuse desquamation of the epithelium of his scalp. On asking a friend to examine his head, he was told that he had a large patch, about the size of a dollar, of silvery white scales on the scalp. He cut his hairs short and applied some Chinese ointment but with little improvement. Five weeks later, he noticed that the same type of eruption appeared successively on the extensor surfaces of the upper limbs, lower limbs and the chest and back. The eruption became worse during the last 212 months.

Condition of Admission:

General Condition: Except for his skin condition, patient was otherwise quite healthy. His Wassermann was negative.

The Eruption:

Scalp: The whole scalp was covered by white silvery scales, which, when scratched off, left a bright red shiny film, dotted over with minute red puncta. When the film was scratched through, bleeding from the injured capillaries occurred in the form of punctate haemorrhages. The growth of the hair was not interfered with.

Limbs and Trunk: The eruption here took the form of circular or oval patches with well-defined borders, and covered by fine whitish scales, which if not noticeable

could be made prominent by gently scratching the surfaces, when they assumed a distinctly silvery appearance. Many of the patches extended peripherally and coalesced.

Tongue: The anterior two-thirds of this organ was affected. The eruption consisted of circular patches, which coalesced, giving the appearance of parts of circles joined together. Each patch had a definitely raised periphery which was white and shiny in appearance. The eruption as a whole presented a white shiny appearance. The parts of the tongue not affected especially the edges were red.

Treatment:

Locally-Ungt. Chrysarobin was applied for 3 or 4 days until the patches had an erthematous look. It was then stopped and Ungt. Ac. Salicylici 10% was given for a few days. The course of Chrysarobin followed by Ungt. Ac. Salicylici was repeated on reappearance of the scales. Calamine Cream was sometimes used after the Chrysarobin, especially when there was too much inflammation of the patches.

Internally-Arsenic was prescribed. For the condition of the tongue a mouth wash of Liquor Hydrarg. Perchlor. was used.

Condition of Discharge:

The silvery scales had failed to reappear over the patches which were dwindling in size. The condition of the tongue showed little improvement.

Remarks:

The lesion worthy of note is the tongue. In text-books, the condition is usually described as leucoplakia. The term lingual psoriasis is a fitting name because the patches on the tongue resemble closely those on other parts of the body.

Thanks are due to Professor J. Anderson, physician in charge, for his kind permission to record this case.