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

PSORIASISPITYRIASIS ROSEADERMATITIS SEBORHEICERYTHRODERMA

Clasification :- Psoriasis Vulgaris :- Acute Guttatae- Chronic Plaque- Palmo Plantar

- Psoriatic Erythroderma

- Pustular Psoriasis

PSORIASIS

PSORIASIS VULGARISDef : 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 keratinocytesshortening cell cycle from 311h 36h28x 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, 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%) - PUVAScalp : 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

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 pattern

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

DEFSEBORHEIC DERMATITIS

Epid : - age of onset : infancy (first month) puberty,most 20-50y - sex : M>F - incidence : 2-5% popPredisposing & exacerbating factor :- immunocompetent- emotional stressPathogenesis : ? 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 ddesquamationweekshair 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