Case Study Analysis – A 24-Year-Old Male with Scalp Dandruff, Nail Pitting, and Joint Pain

Case Study Analysis – A 24-Year-Old Male with Scalp Dandruff, Nail Pitting, and Joint Pain

This case study involves a 24-year-old male presenting with significant scalp dandruff, pitting of fingernails, and morning joint pain. These symptoms suggest an underlying autoimmune or inflammatory condition. This analysis will explore the likely diagnosis, potential genetic factors, and the role of immunosuppression in the disease process.

Explanation of Symptoms

The presence of scalp dandruff, pitting of nails, and joint pain put me under high suspicion for psoriasis with probable psoriatic arthritis. Psoriasis can be defined as an autoimmune disease in which skin cells multiply more rapidly than normal, resulting in a build-up of skin cells, inflammation, and, in some instances, arthritis. Nail pitting is one of the modes of presentation of psoriasis which is said to have a direct link with the intensity of the disease. The morning joint pain of the patient, which worsens at night and eases with exercise, matches the features of psoriatic arthritis, a form of arthritis related to psoriasis that entails joint stiffness and pain that reduces during the day.

The failure of the patient to respond to dandruff shampoos indicates that the dandruff is not a result of a simple superficial fungal infection as in seborrheic dermatitis. Still, it is a part of the inflammatory process of psoriasis. ESR is only slightly above the normal range, which indicates systemic inflammation, but the rheumatoid factor is negative, thus ruling out rheumatoid arthritis – another autoimmune condition that involves joint pain (Tetsuya Akaishi et al., 2020).

Genetic Associations

Psoriasis and Psoriatic arthritis are hereditary, although the exact mode of inheritance is not clear. Psoriasis has been known to be associated with certain specific genes such as HLA-Cw6, IL-12B, and IL23R genes. Among all the antigens linked to psoriasis, HLA-Cw6 is particularly important as it is implicated in the early-onset form of the disease (Angel & Zito, 2019). The sixth chromosome contains another gene relevant to psoriasis: polymorphic locus PSORS1, which affects the immune processes that result in pathology and its defining manifestations. Understanding the genetic make-up helps diagnose the disease and in the case of early and severe manifestations of psoriasis (Patel et al., 2023).

Immunosuppression and its Effects

Psoriasis is characterized by an overactive immune system that mistakenly attacks healthy skin cells, leading to rapid cell turnover, inflammation, and the development of plaques. The immune response in psoriasis is primarily driven by T cells, especially Th1 and Th17 cells, which release pro-inflammatory cytokines such as TNF-α, IL-17, and IL-23. These cytokines promote the inflammation and abnormal keratinocyte proliferation seen in psoriasis. Immunosuppressive therapies are therefore essential in managing psoriasis by targeting these specific immune pathways and reducing the aberrant immune activity (Dhabale & Nagpure, 2022).

Nevertheless, immunosuppressive agents affect not only the recipient’s immunity but the organism as a whole. Although it works to suppress troublesome immune function in diseases such as psoriasis, it will also decrease nonpathological immune response, making the body more vulnerable to infections from pathogens. Also, patients on long-term immunosuppression are at an increased risk of certain types of cancer because the immune system, which normally recognizes and destroys tumor cells, is suppressed. Consequently, the release of immunosuppressive drugs calls for keen checks and proper dosage to overcome the effects of disease while reducing the effects of drugs (Habashy, 2019).

Conclusion

Based on the patient’s symptoms, a diagnosis of psoriasis, possibly with co-present psoriatic arthritis, can be ruled out. These are allied to genes like HLA-Cw6 that have been acclaimed for having a chief causal efficacy in the occurrence of the disease. Suppression of the immune response is an essential part of treating psoriasis due to the boosted immune activity in this skin condition. However, immunosuppression has generalized impacts on the body which need supervision to avoid side impacts such as infection and cancer. The knowledge of genetic and immunological basis facilitates the development of therapy, which helps to enhance the treatment results for patients with psoriasis.

References

Angel, A., & Zito, P. M. (2019). Immediate hypersensitivity reactions. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK513315/

Dhabale, A., & Nagpure, S. (2022). Types of Psoriasis and Their Effects on the Immune System. Cureus, 14(9), e29536. https://doi.org/10.7759/cureus.29536

Habashy, J. (2019, August 2). Psoriasis: Practice Essentials, Background, Pathophysiology. Medscape.com. https://emedicine.medscape.com/article/1943419-overview

Patel, H., Rishab Revankar, Pedroza, S. T., Graham, S. A., & Feldman, S. R. (2023). The Genetic Susceptibility to Psoriasis and the Relationship of Linked Genes to Our Treatment Options. International Journal of Molecular Sciences, 24(15), 12310–12310. https://doi.org/10.3390/ijms241512310

Tetsuya Akaishi, Yamasaki, K., Mori, Y., Takahashi, T., Takuya Izumiyama, H. Terui, Abe, M., Takayama, S., Setsuya Aiba, & Ishii, T. (2020). Psoriatic arthritis with skin lesions localized to the scalp: A case report. Journal of General and Family Medicine, 21(6), 264–267. https://doi.org/10.1002/jgf2.358           

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Case study: A 24-year-old male presents to the clinic with a chief complaint of developing large areas of dandruff to his scalp and pitting of his fingernails. He also started noticing that he is having morning joint pain that partially relieves after he gets ready for work. He has used multiple types of dandruff shampoo without relief of symptoms. He is unable to remember any significant family history concerns. Labs include a rheumatoid factor which was negative. His ESR was mildly elevated.

A 24-Year-Old Male with Scalp Dandruff, Nail Pitting, and Joint Pain

LEARNING OBJECTIVES

Students will:

-Evaluate cellular processes and alterations within cellular processes
-Analyze alterations in the immune system that result in disease processes
-Identify racial/ethnic variables that may impact physiological functioning
-Evaluate the impact of patient characteristics on disorders and altered physiology
The Assignment

– Develop a 1- to 2-page case study analysis in which you:

-Explain why you think the patient presented the symptoms described.
-Identify the genes that may be associated with the development of the disease.
-Explain the process of immunosuppression and the effect it has on body systems.

Things to remember:
APA format is required for all assignments (title page, introduction, Summary, reference)

One of the three references
– Justiz-Vaillant, A. A., & Zito, P. M. (2019). Immediate hypersensitivity reactions Download Immediate hypersensitivity reactions. In StatPearls. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK513315/