CHAPTER 11: Pityriasis Rosea, Pityriasis Rubra Pilaris, and Other Papulosquamous and Hyperkeratosis

Question 1

hanging curtain sign or xmas tree sign

Answer 1

PITYRIASIS ROSEA

Question 2

is a mild inflammatory exanthem character- ized by salmon-colored papular and macular lesions that are at first discrete but may become confluent

Answer 2

Pityriasis rosea

Question 3

Hyperpigmented or yellowish red scaling patches with sharply defined regular borders

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

Answer 3

Small plaque parapsoriasis (SPP

Question 4

Treatment for small plaque parapsoriasis

Answer 4

Refractory to steroids alone

Phototherapy +/- topical steroids

Question 5

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

They usually disappear spontaneously after how much time?

Answer 5

After 3-8 weeks

Question 6

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

Answer 6

HHV 6

HHV 7

Question 7

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 7

Pityriasis rubra pilaris

Question 8

Types of Pityriasis rubra pilaris that have a good prognosis

Answer 8

Type I -classic adult (clears within 3 years)

Type III- juvenile (clears in 1 year)

Question 9

Management of pityriasis rubra pilaris

Answer 9

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 10

Excessive formation of keratin on the palms and soles

Answer 10

palmoplantar keratoderma

Question 11

Superficial exfoliative dermatosis of palms and soles

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

Answer 11

Keratolysis exfoliativa

Question 12

Keratolysis exfoliativa treatment

Answer 12

Spontaneous involution in a few weeks

Question 13

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

Localized to creases of palms or fingers

Answer 13

Keratosis punctata

Question 14

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

Treated with mechanical debridement and excision

Answer 14

Punctate keratoderma

Question 15

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

Treated with mechanical debridement and excision

Answer 15

Punctate keratoderma

Question 16

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 16

Porokeratosis plantaris discreta

Question 17

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

Answer 17

Keratoderma climactericum

Question 18

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

Hyperhidrosis

Answer 18

Hereditary palmoplantar keratoderma (Unna-Thost)

Question 19

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 19

Mutilating keratoderma of Vohwinkel

Question 20

Congenital sharply marginated palmoplantar keratoderma and periorificial keratotic plaques

Constriction of digits
Linear keratotic streaks on flexural aspect of wrists

Answer 20

Olmsted syndrome

Question 21

Autosomal recessive
Palmoplantar keratoderma and destructive periodontitis

Severe gingival inflammation with alveolar bone loss

Answer 21

Papillon-Lefèvre syndrome

Question 22

character- ized by corneal opacities and keratosis palmoplantaris. The skin manifestations usually develop after the first year of life and relate to defects in tyrosine aminotransferase. Newborn screen- ing can allow early intervention with dietary restriction.

Answer 22

Richner-Hanhart syndrome (tyrosinemia type 2)

Question 23

Generalized exfoliative dermatitis
Intense pruritus
Leonine facies
Alopecia
Palmoplantar hyperkeratosis
Onychodystrophy

Answer 23

Sézary syndrome

Question 24

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

Erythroderma is frequently the result of generalization of a preexisting chronic dermatosis such as psoriasis or atopic dermatitis.

Answer 24

EXFOLIATIVE DERMATITIS (ERYTHRODERMA)