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DERMATOSIS ERYTHROSQUAMOUS

Def: disease are characterized by erythema and scale (squama) 1. PSORIASIS 2. PARAPSORIASIS 3. PITYRIASIS ROSEA 4. DERMATITIS SEBORHEIC 5. ERYTHRODERMIA 6. LUPUS VULGARIS

PSORIASIS
Clasification : - Psoriasis Vulgaris :- Acut Guttate - 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 fr 311 h 36 h 28x normal epidermal cell prod

Physic exam :

- shaply 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 scid gouty arthritis - histopatho : acanthosis, mitosis keratinocytes, parakeratotic hyperkeratosis, microabscesses of Munro DD : Seborheic Dermatitis, Lichen simplex chronicus, Pityriasis Rosea, T. Corporis

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 fieryred 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 0,05-0,1%) - 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

PARAPSORIASIS
Def : chronic erythematous papules with scale Etiol : unknown Clasification : - Parapsoriasis Guttata - Parapsoriasis Variegata - Parapsoriasis en Plaques

PARAPSORIASIS en PLAQUES
2 types : 1. Small-plaque parapsoriasis 2. Large-plaque parapsoriasis

Small-plaque parapsoriasis (digitate dermatosis, or chronic superficial dermatitis) - Def : chronic disease characterized by slightly elevated plaques and scales - Physical exam : round, oval, erythematous, yellowish, slightly elevated plaques, <5 cm with slight scale and wrinkled surface with cigarette-paper appearance. - DD : Pityriasis Rosea, Large-plaque parapsoriasis - TX: Lubricant/ topical steroid PUVA

Large-plaque parapsoriasis *Lessions disappear after sun exposure (in summer), recur (in fall & winter) *Middle age - Physical exam : - barely elevated, erythematous, duskyred, sometime yellowish plaques with smooth or slightly scalling surface. >10 cm, well defined - predilection : trunk, buttock, breasts & extremities - DD : early stages of CTCL - Prog : persist for life - Tx : topical glucocorticoid, PUVA

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 25cm, 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
Def :very common chronic dermatitis characterized by redness & scaling sebaceous gland more active:face, scalp,body fold, presternal area Epid : - age of onset : infancy (first month) puberty,most 20-50y - sex : M>F - incidence : 2-5% pop Predisposing & exacerbating factor : - immunocompetent - emotional stress Pahogenesis : ? Malassezia furfur play a role

DEF

Physical exam : orange-red or gray-white skin often with greasy or white dry scaling macules & papules (5-20mm) sticky c rusts & 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 dequamation w 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