11- Pityriasis Rosea, PRP, Hyperkeratotic

Question 1

Hyperpigmented or yellowish red scaling patches with sharply defined regular borders

Trunk, 1-5cm, mildly itchy or asymptomatic
Male preponderance
No induration

Answer 1

Small plaque parapsoriasis

Question 2

Treatment for small plaque parapsoriasis

Answer 2

Refractory to steroids alone

Phototherapy +/- topical steroids

Question 3

salmon colored papular and macular lesions that can be confluent, usually on the trunk

Covered with finely crinkled, dry epidermis that often desquamates (collarette scaling)

Begins with a single herald/mother patch, parallel lines of cleavage, spares sun exposed surfaces

Answer 3

Pityriasis rosea

Question 4

1 week after the herald patch in Pityriasis rosea, new lesions appear and spread rapidly.

They usually disappear spontaneously after how much time?

Answer 4

After 3-8 weeks

Question 5

Pityriasis rosea is a viral exanthem that represents reactivation of which virus?

Answer 5

HHV 6

HHV 7

Question 6

Chronic skin disease characterized by small follicular papules, disseminated yellowish pink scaling patches and palmoplantar hyperkeratosis

Papules reddish brown, topped by a central horny plug

Small islands of normal skin within affected areas

Answer 6

Pityriasis rubra pilaris

Question 7

Types of Pityriasis rubra pilaris that have a good prognosis

Answer 7

Type I -classic adult (clears within 3 years)

Type III- juvenile (clears in 1 year)

Question 8

Management of pityriasis rubra pilaris

Answer 8

Systemic retinoids

Isotretinoin 0.5-1mg/kg/day
6-9 months for full involution to occur

Acitretin, methotrexate
Phototherapy
Topical calcineurin inhibitors, lactic acid, urea preparations

Question 9

Excessive formation of keratin on the palms and soles

Answer 9

Palmoplantar keratoderma

Question 10

Superficial exfoliative dermatosis of palms and soles

Lesions rupture- produce annular adherent collarette
Px have atopic background
Generally asymptomatic

Answer 10

Keratolysis exfoliativa

Question 11

Keratolysis exfoliativa treatment

Answer 11

Spontaneous involution in a few weeks

Question 12

Most occur in black patients
1-5mm depression filled with a comedo-like keratinous plug

Localized to creases of palms or fingers

Answer 12

Keratosis punctata

Question 13

Pruritic papules, spiny keratoderma that occurs in the palms and soles

Treated with mechanicsl debridement and excision

Answer 13

Pinctate keratoderma

Question 14

Sharply marginated rubbery wide based papule that reveals an opaque plug on blunt dissection without bleeding on removal

Multiple, painful and found on weight bearing area of the sole

Answer 14

Porokeratosis plantaris discreta

Question 15

Hyperkeratosis of the palms and soles (usually heels) at the time of menopause

Answer 15

Keratoderma climactericum

Question 16

Dominantly inherited marked congenital thickening of the epidermal horny layer of the palms and soles that occur symmetrically and all parts equally

Hyperhidrosis

Answer 16

Hereditary palmoplantar keratoderma (Unna-Thost)

Question 17

Honeycomb palmoplantar hyperkeratosis

• starfish like keratosis on backs of hands and feet
• linear keratosis of elbows and knees
• annular constriction (pseudo-ainhum) of digits that may lead to auto amputation

Autosomal dominant

Answer 17

Vohwinkel keratoderma

Question 18

Congenital sharply marginated palmoplantar keratoderma and periorificial keratotic plaques

Constriction of digits
Linear keratotic streaks on flexural aspect of wrists

Answer 18

Olmsted syndrome

Question 19

Autosomal recessive
Palmoplantar keratoderma and destructive periodontitis

Severe gingival inflammation with alveolar bone loss

Answer 19

Papillon-Lefèvre syndrome

Question 20

Extensive erythema and scaling
Dull scarlet body surface covered by small laminated scales that exfoliate profusely

Telogen effluvium noted, Itching may be severe and accompanied by fever and chills

Due to generalization of preexisting dermatosis

Answer 20

Exfoliative dermatitis (Erythroderma)

Question 21

Generalized exfoliative dermatitis
Intense pruritus 
Leonine facies
Alopecia
Palmoplantar hyperkeratosis
Onychodystrophy

Answer 21

Sézary syndrome