DERMATOSIS

ERYTHROSQUAMOUS
Def: disease are characterized by erythema
and scale (squama)
1.
2.
3.
4.
5.
6.

PSORIASIS
PARAPSORIASIS
PITYRIASIS ROSEA
DERMATITIS SEBORHEIC
ERYTHRODERMIA
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
Munro
DD : Seborheic Dermatitis, Lichen simplex
chronicus, Pityriasis Rosea, T. Corporis

of

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, dusky- red,
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 self-limited
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