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, 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 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 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 characterized by redness

& scaling sebaceous gland more active:face, scalp,body
DEF 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

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