DERMATOSIS ERYTHROSQUAMOUSDef: disease are characterized by erythema and scale (squama)

PSORIASISPARAPSORIASISPITYRIASIS ROSEADERMATITIS SEBORHEICERYTHRODERMIALUPUS VULGARIS

Clasification :- Psoriasis Vulgaris :- Acut Guttate - Chronic Plaque - Palmo Plantar - Psoriatic Erythroderma- Pustular Psoriasis

PSORIASIS VULGARISDef : autoimun, chronic, recurring, scaling papules and plaquesEpid : - 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, nailsPSORIASIS

Pathogenesis: abnormality in psoriasis : alteration of the cell kinetic of keratinocytesshortening cell cycle fr 311 h 36 h28x 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, dusky-red 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 malaiseLab : 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 lotOral : cytostatic : Mtx 3x2,5mg/w 3x5mg/w Levodopa 2x250mg-3x500mg/d DDS 2x100mg/d Etretinate 1mg/kgbw/dCyclosporin 6mg/kgbw/d

Def : chronic erythematous papules with scaleEtiol : unknownClasification : - Parapsoriasis Guttata- Parapsoriasis Variegata- Parapsoriasis en PlaquesPARAPSORIASIS

PARAPSORIASIS en PLAQUES2 types : 1. Small-plaque parapsoriasis2. Large-plaque parapsoriasis

Small-plaque parapsoriasis(digitate dermatosis, or chronic superficial dermatitis)- Def : chronic disease characterized by slightly elevated plaques and scalesPhysical exam : round, oval, erythematous, yellowish, slightly elevated plaques,

Large-plaque parapsoriasis*Lessions disappear after sun exposure (in summer), recur (in fall & winter)*Middle agePhysical exam : - barely elevated, erythematous, dusky-red, sometime yellowish plaques with smooth or slightly scalling surface. >10 cm, well defined- predilection : trunk, buttock, breasts & extremitiesDD : early stages of CTCLProg : persist for lifeTx : topical glucocorticoid, PUVA

Def: acute exanthematous with distinctive morphology & often with characteristic self-limited coursefirst: single primary/herald plaque1-2wgeneralized secondary eruption(typical distribution)6wremits spontaneouslyEtiol : ? herpes virus type-7

PITYRIASIS ROSEA

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 patternTypical P Rosea : - only on the face & neck, herald patch may be (-)DD : Drug neruptionSecondary SyphilisGuttate psoriasisErythema MultiformeCourse : spontaneous remission 6-12wTx : symptomatic

DEFSEBORHEIC DERMATITISDef :very common chronic dermatitis characterized by redness & scaling sebaceous gland more active:face, scalp,body fold, presternal areaEpid : - age of onset : infancy (first month) puberty,most 20-50y- sex : M>F- incidence : 2-5% popPredisposing & exacerbating factor :- immunocompetent- emotional stressPahogenesis : ? 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

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

ERYTRODERMA

Physical exam :* Dermatitis & lymfoma/leucemia acute erythema patch12-48 herythroderma(fever, shivers, hot & cold) 2-6 ddequamationwhair loss (scalp & body)onycolysis,thicken nail*History most importantManagement :- Topical : water bath + bath oil bland emollients- Oral : - glucocorticoid remission *Tx syst & topical underlying condition