Plaque psoriasis lesions are symmetrically distributed and rarely occur on one side. In the process of treatment, the skin lesions on the trunk subside quickly, while the skin lesions on the limbs, especially the lower legs, subside slowly, because of the resistance to treatment [1]. A case of unilateral localized plaque psoriasis was treated in our department. The report is as follows.
A 73-year-old female was admitted to the Department of Acupuncture and Moxibustion of our hospital on January 4, 2022, due to repeated erythema, scale, and itching of the right leg for 20 years. Two decades ago, the patient developed a rash on the extended side of her right leg without any obvious inducement. It started as the size of soybeans, and then gradually expanded to the knee and instep, accompanied by scale and pruritus. She was once diagnosed with "psoriasis" in the dermatological hospital, while no obvious relief was found after medication (the specific medication is unknown). In the past 20 years, she visited the outpatient department numerous times, and the above symptoms still recurred after improvement. No patients with similar diseases in the family underwent cholecystectomy before.
Physical examination: Generally speaking, no obvious abnormality was found in all system examinations. Dermatological examination showed dark red spots and papules on the extended side of the right leg, covered with a thick layer of white scales, and the skin lesion extended to the knee and 1/3 of the lower leg. Drip-like bleeding was displayed through the gentle scraping of the scale (Fig. 1A).
Laboratory and auxiliary examinations: Routine blood, urine and feces, coagulation function, blood biochemistry, and serum protein electrophoresis showed no obvious abnormalities. Chest CT plain scan considered bronchiectasis of both lungs, and the combined infection was better than the previous absorption. Histopathological examination of skin lesions revealed incomplete keratinization of the epidermis, neutrophil infiltration in local areas, thinning of the granular layer, elongation of epithelial foot like a pestle, and a large number of chronic inflammatory cells in the superficial dermis (Fig. 2).
Diagnosis: psoriasis of the right lower leg
Treatment: Zhuang medicine thread moxibustion combined with blood pricking therapy, once a day, five times a week (qw1-qw5), for 2 weeks. After treatment, the skin lesions in the affected area were significantly improved, the scales basically fell off, and the normal skin was exposed at the rash site, leaving only pigmentation and white spots (Fig. 1B). After 2 months of follow-up, there was no recurrence, and the skin pigmentation gradually subsided after 1 month of continuous intermittent treatment (1-2 times a week). This patient is still in follow-up.