Papulosquamous Disorders Flashcards
Leisons of psoriasis, lichen plants & pityrasis rosea
Raised, erythematous, scaly, well defined leisons
Ieison of psoriasis
Well defined erythematous papules and plaques covered by silvery laminated scales
Due to increase in epidermal cell proliferation up to 20 folds and vascular proliferation
Precipitating factors of psoriasis
- Trauma (Koebner phenomenon)
- Infection : streptococcal sore throat precipitate Guttate psoriasis
- Endocrine factors : Pregnancy improve psoriasis, occasionally
provokes generalized pustular psoriasis - Climate: High temperature, humidity and sunlight are generally
beneficial - Metabolic : Hypocalcaemia Cansing erythrodermic psoriasis
- Drugs: Antimalarials, beta-blockers and lithium exacerbate psoriasis
Systemic steroids predispose for erythrodermic or pustular psoriasis. - Psychogenic factors : Emotional stress
Primary lesion of psoriasis
Erythematous papule covered with laminated
silvery scales, which coalesce to form sharply defined plaques
Shapes of Chronic plaque Psoriasis
Psoriasis vulgaris is bilateral and symmetrical
1. Discoid or nummular psoriasis
2. Annular psoriasis: produced by peripheral extension oflesion with central involution
3. Linear psoriasis: presentation of koebner phenomenon
4. Geographic psoriasis: curved patterns on back & tongue
Leison of Guttate psoriasis
Mainly on trunk , rounded small leisons (drop like)
Preceded by acute Streptococcal infection
Describe psoriasis of nails
Nail pitting, transverse striations, subungual Hyperkeratosis or oncholysis
Characteristics of Flexural Psoriasis
Absent or decreased scales due to moisture and continuous friction
Leison in Napkin psoriasis
As a presentation of koebner phenomenon
Leison of erythrodermic psoriasis
Involving all the body with generalized erythema & scaliness
Precipitated by infection, hypovpcalcimia & drugs
The most sever form of psoriasis is
Pustular Psoriasis
DD of psoriasis
Plaque psoriasis «_space;hyperkeratotic lichen planus
Guttate psoriasis «_space;pityriasis rosea
Flexural psoriasis «_space;flexural candidasis
Scalp psoriasis «_space;seborrheic dermatitis
Onchomycosis «_space;fungal infection of nails
TTT of Psoriasis
- Topical therapy :
1. Topical steroids avoided on face, flexures and in young patients
Intralesional steroids in resistant nail leisons
2. Vit D3 analogues as calcipotriol
Inhibit cell proliferation, stimulate keratinocyte differentiation
S.E irritation & hypercalcimia
C.I in pregnancy, lactation & renal insufficiency
3. Emollients as petrolatum
4. Keratolytics as salicylic acid
5. Tar preparation as crude coal ( antiproliferative )
S.E unpleasant odour and staining of cloths
combined with UVB as Goekerman technique
6. Topical retinoids as Tazarotene gel
7. Anthralin [Dithranol]: antimitotic, highly effective but irritant and stains skin. - Phototherapy : Narrow band UVB (NB-UVB) is the mainstay d
treatment for moderate to severe psoriasis - Photochemotherapy: PUVA (psoralen + UVA)
- Systemic therapy :
1. Methotrexate
Folic acid antagonist
Indicated in erythrodermic, generalized pustular, arthropathic & sever psoriasis
2. Acitretin
derivative of vitamin A
Indicated in generalized pustular and erythrodermic psoriasis
3. Cyclosporin
Selective immunosuppressive
Indicated in severe psoriasis
4. Combination : Re-PUVA [Acitretin and PUVA]
Side effects of Methotrexate
S.E hepatotoxicity and bone marrow suppression
C.I in pregnancy and liver disease
Side effects of Acitretin
Main side effects are teratogenicity & increase serum cholesterol
CI in children and pregnancy
Side effects of Cyclosporin
Main side effects are hypertension and nephrotoxicity
Etiology of pityriasis rosea
Viral especially HHV 6,7 ( mainly 7)
Leison of pityriasis rosea
First : Herald patch
Solitary papule enlarges to an oval or annular patch with a fine collarette of scales , center is clear & light brown
Then after 1-2 weeks
Generalized, symmetrical macules or maculopapules erythematous with fine scales (collarette of scales) , resembles a Christmas tree in back
Herald patch not followed by 2ry rash
Abortive type of pityriasis rosea
An inverted type of psoriasis………
Face and limbs affected sparing trunk
DD of pityriasis rosea
Tinea circinata ( Herald patch )
Guttate psoriasis ( 2ry rash )
2ry syphalitic rash
Pityriasiform drug eruption
TTT of P. Rosea
Reassurance
Avoid irritants
Calamine lotion
Moderate potent topical steroids ( relieve pruritus)
Lichen planus is associated with……..
HCV , autoimmune diseases
L. Planus preceded by trauma or sun exposure……..
Koebner phenomenon
A marked symptom of L. Planus…….
Itching
1ry leison of L. Planus
4P : pruritic, polygonal, purple, papules
Itchy flat topped polygonal papules showing whitish striations ( Wickham’s Striae )
Healing of Lichen planus leaving ……..
Residual hyperpigmentation
Lichen planopilaris affect ……
Hair follicles Causing Cicatricial alopecia
Graham Little Syndrome a triad of……
- Multifocal scalp cicatricial alpociea
- Non scarring alopecia of axilla & groin
- Keratotic lichenoid follicular papules
Hypertrophic L.planus affect …….
Shin of the tibia
Leison of Lichen planus Actincus
Non itchy red brown annular macules on face
As a koebner phenomenon to sun
White lines, streaks or patches may occur with ……..
Lichen planus of mucous membranes
May turn to squamous cell carcinoma
Longitudinal ridging, pitting or Complete shedding of nails caused by…….
Lichen planus of nails
Variants of lichen planus
Acute ( eruptive )
Atrophic
Annular
Linear
Bullous
DD of Generalized lichen planus
Lichenoid drug eruption
Guttate psoriasis
Pityriasis rosea
DD of Genital lichen planus
Psoriasis
Scabies
TTT of Lichen planus
- Local :
Topical steroids, Intralesional steroids ( hypertrophic ), sun screens ( Actinic) - Systemic : for extensive involvement, lcerative m.m, scarring nail dystrophy
Antihistamines, Systemic steroids, antimalarials ( Actinic )
