DERMATOSIS

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

PSORIASIS
PITYRIASIS ROSEA
DERMATITIS SEBORHEIC
ERYTHRODERMIA

PSORIASIS

Clasification :
- Psoriasis Vulgaris :
- Psoriatic Erythroderma
- Pustular Psoriasis

- Acut Guttate
- Chronic Plaque
- Palmo Plantar

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 311h 36 h

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
Munro
DD : Seborheic Dermatitis, Lichen simplex
chronicus, Pityriasis Rosea, T. Corporis

of

DINA

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

lot

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
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 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

Def :very common chronic dermatitis

DEF
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
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
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