CHAPTER 11: Pityriasis Rosea, Pityriasis Rubra Pilaris, and Other Papulosquamous and Hyperkeratosis Flashcards
hanging curtain sign or xmas tree sign
PITYRIASIS ROSEA
is a mild inflammatory exanthem character- ized by salmon-colored papular and macular lesions that are at first discrete but may become confluent
Pityriasis rosea
Hyperpigmented or yellowish red scaling patches with sharply defined regular borders
Trunk, 1-5cm, mildly itchy or asymptomatic
Male preponderance
No induration
Small plaque parapsoriasis (SPP
Treatment for small plaque parapsoriasis
Refractory to steroids alone
Phototherapy +/- topical steroids
1 week after the herald patch in Pityriasis rosea, new lesions appear and spread rapidly.
They usually disappear spontaneously after how much time?
After 3-8 weeks
Pityriasis rosea is a viral exanthem that represents reactivation of which virus?
HHV 6
HHV 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
Pityriasis rubra pilaris
Types of Pityriasis rubra pilaris that have a good prognosis
Type I -classic adult (clears within 3 years)
Type III- juvenile (clears in 1 year)
Management of pityriasis rubra pilaris
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
Excessive formation of keratin on the palms and soles
palmoplantar keratoderma
Superficial exfoliative dermatosis of palms and soles
Lesions rupture- produce annular adherent collarette
Px have atopic background
Generally asymptomatic
Keratolysis exfoliativa
Keratolysis exfoliativa treatment
Spontaneous involution in a few weeks
Most occur in black patients
1-5mm depression filled with a comedo-like keratinous plug
Localized to creases of palms or fingers
Keratosis punctata
Pruritic papules, spiny keratoderma that occurs in the palms and soles
Treated with mechanical debridement and excision
Punctate keratoderma
Pruritic papules, spiny keratoderma that occurs in the palms and soles
Treated with mechanical debridement and excision
Punctate keratoderma
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
Porokeratosis plantaris discreta
Hyperkeratosis of the palms and soles (usually heels) at the time of menopause
Keratoderma climactericum
Dominantly inherited marked congenital thickening of the epidermal horny layer of the palms and soles that occur symmetrically and all parts equally
Hyperhidrosis
Hereditary palmoplantar keratoderma (Unna-Thost)
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
Mutilating keratoderma of Vohwinkel
Congenital sharply marginated palmoplantar keratoderma and periorificial keratotic plaques
Constriction of digits
Linear keratotic streaks on flexural aspect of wrists
Olmsted syndrome
Autosomal recessive
Palmoplantar keratoderma and destructive periodontitis
Severe gingival inflammation with alveolar bone loss
Papillon-Lefèvre syndrome
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.
Richner-Hanhart syndrome (tyrosinemia type 2)
Generalized exfoliative dermatitis
Intense pruritus
Leonine facies
Alopecia
Palmoplantar hyperkeratosis
Onychodystrophy
Sézary syndrome
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.
EXFOLIATIVE DERMATITIS (ERYTHRODERMA)
