DERMATOSIS ERYTHROSQUAMOUS

Def: disease are characterized by erythema and scale (squama)

1. 2. 3. 4.

PSORIASIS PITYRIASIS ROSEA DERMATITIS SEBORHEIC ERYTHRODERMA

PSORIASIS

Clasification : - Psoriasis Vulgaris : - Acute Guttatae - Chronic Plaque - Palmo Plantar - Psoriatic Erythroderma - Pustular Psoriasis

PSORIASIS VULGARIS

Def : autoimun, chronic, recurring, scaling papules and plaques

Epid : - incidence : US : 3-5 million western : 1,5-2% - sex : m=f

- trigger factor : - physical trauma - infection - stress - drugs : syst. Glucocorticoid, oral lithium, antimalaria, interferon - predilection : scalp, knees, elbows, anogenital, nails

Pathogenesis:

abnormality in psoriasis : alteration of the cell kinetic of keratinocytes shortening cell cycle from 311h 36h 28x normal epidermal cell prod

Clinical features :

- sharply marginated erythematous papules-plaques with transparent silvery-white scales. Scale are lameller, loose scratching easy remove minute blood droplets (Auspitz sign) acute guttatae type : - salmon-pink papules (gutta, drop) with transparent scale - trunk - resolve spontaneously few weeks recurrent chronic stable type : sharply marginated, dullred plaques, lamellar silvery-white scales palms and soles : massive silvery-white / yellowish hyperkeratosis & scalling, is not easily remove painful fissures

 scalp : plaques, sharply marginated thick adherent scale nail : pitting, subungual hyperkeratosis, onycholysis, yellowish-brown spots under nail plate (oil spot) pathognomonis Lab: - serology : antistreptolysin titer uric acid gouty arthritis - histopatho : acanthosis, mitosis keratinocytes, parakeratotic hyperkeratosis, microabscesses of Munro DD : Seborheic Dermatitis, Lichen simplex chronicus, Pityriasis Rosea, T. Corporis

DINA

Management : - Treat the trigger factor - Topical Steroid high potency oint - Occlusive dressing - Vit D analogues - Topical Anthralin - Tar/ketokonazol shampoo-steroid lot scalp

PUSTULAR PSORIASIS Def :characterized by pustules arising on normal/inflamed, erythematous skin. 2 types : generilized & palmo-plantar Palmo-plantar : Def : - chronic, relapsing eruption limited to the palms &soles. - steril, yelow, deep-seated pustules dusky-red crusts -Symp :tingling, burning iching - Skin lessions : pustules 2-5 mm, deep-seated, duskyred macules crusts in erythema, scaling or normal skin - DD : T Manus, Dyshidrotic eczematous Dermatitis, HSV Inf

GENERALIZED ACUTE PUSTULAR PSORIASIS (VON ZUMBUSCH)

- Def : psorisis with characterized by fiery-red erythema that spread in hours with pin point pustules appearing in clusters. - Symp : fever, generalized weakness, severe malaise - Lab : leucocytosis

PSORIATIC ERYTHRODERMA - Def : condition in which psoriasis involve practically the entire skin and leads to constitutional symptoms

Management : Topical : - steroid agent in oint base - hydrocolloid dressing - anthralin - analog vit D (calciprotriene 0,05%)cream - Tacrolimus 0,1% - Tazarotene (retinoid 0,050,1%) - PUVA Scalp : tar/ketokonazol shampoo betametason valerat lot

Oral : cytostatic : Mtx 3x2,5mg/w 3x5mg/w Levodopa 2x250mg-3x500mg/d DDS 2x100mg/d Etretinate 1mg/kgbw/d Cyclosporin 6mg/kgbw/d

PITYRIASIS ROSEA Def: acute exanthematous with distinctive morphology & often with characteristic selflimited course first: single primary/herald plaque 1-2w generalized secondary eruption (typical distribution) 6w remits spontaneously Etiol : ? herpes virus type-7

Pysical exam :

- Herald patch : oval, slightly raised plaque 2-5cm, salmon-red, fine colarette scale at periphery - Exanthem : fine scaling papules & plaques with marginal collarette.

Characteristic dist: long axes of the oval lesion following the lines of cleavage in a christmas tree pattern

Typical P Rosea : - only on the face & neck, herald patch may be (-) DD : Drug neruption Secondary Syphilis Guttate psoriasis Erythema Multiforme Course : spontaneous remission 6-12w Tx : symptomatic

SEBORHEIC DERMATITIS

Epid : - age of onset : infancy (first month) puberty,most 20-50y DEF - sex : M>F - incidence : 2-5% pop Predisposing & exacerbating factor : - immunocompetent - emotional stress Pathogenesis : ? Malassezia furfur play a role

Physical exam : orange-red or gray-white skin often with greasy or white dry scaling macules & papules (5-20mm) sticky crusts & fissures (fold behind the external ear), scalp marked scaling (dandruff) Tx : topical :glucocorticoid, ketokonazol 2%, tar, tacrolimus UV radiation
syst : 13-cis retinoic acid 1mg/kgbw

ERYTRODERMA

Def : the term for all clinical feature that characterized by generalized and uniform redness and scaling involving practically the entire skin. Pathogenesis : The most freq : - dermatitis - psoriasis - lymfoma & leucemia - adverse cutaneous drug eruption

Physical exam : * Dermatitis & lymfoma/leucemia acute erythema patch 12-48 h erythroderma (fever, shivers, hot & cold) 2-6 d desquamation weeks hair loss (scalp & body) onycolysis, thicken nail *History most important

Management : - Topical : water bath + bath oil bland emollients - Oral : - glucocorticoid remission

*Tx syst & topical underlying condition