CHARACTERIZED BY ERYTHEMA,

PLAQUES AND SCALING

A. TRUE EPS
1. PSORIASIS
2. P. ROSEA
3. SEBORRHEIC DERMATITIS
4. ERYTHRODERMA
5. PARAPSORIASIS
6. PITYRIASIS RUBRA PILARIS
7. LICHEN PLANUS
8. LICHEN STRIATUS
9. LICHEN NITIDUS

PAPULES

OR

B. EPS - LIKE
1. DERMATOFITOSIS
2. T. VERSIKOLOR
3. DRUG ERUPTION
4. SYPHILIS II
5. LUPUS ERYTHEMATOSUS
6. MORBUS HANSEN
7. MYCOSIS FUNGOIDES

PSORIASIS
* IS A COMMON PAPULO SQUAMOUS DISEASE
* E/ ?
* SHOWING WIDE VARIATION IN SEVERITY & IN
DISTRIBUTION
* CHRONIC

EPIDEMIOLOGY :
- PSORIASIS IS FOUND ALL OVER THE WORLD
- MALES FEMALES
- THE ONSET OF THE DISEASE IS LESS COMMON
IN THE VERY YOUNG & THE ELDERY

ETIOLOGY & PATHOGENESIS

AT THE CELLULAR LEVEL IT IS ACCEPTED
THAT PSORIATIC KERATINOCYTE DIFFERS
FROM

THE

GENETICALLY

NORMAL
IN

ITS

KERATINOCYTE
RESPONSE

VARIOUS STIMULI
ENDOGENOUS & EXTERNAL STIMULI

TO

CLINICAL MANIFESTATIONS
- A SHARPLY DEFINED BORDER, A BRIGHT RED
COLOR & A SILVERY - WHITE SCALE DELINEATE
THE LESION OF PSORIASIS
- SITE OF PREDILECTION

THE ELBOWS &

KNEES, THE
SCALP & LUMBO
SACRAL SKIN

- SUBTLE DISTORTIONS OF NAILS, MUCOSAL

CHANGES, ISOMORPHIC PHENOMENON

CLINICAL FORMS OF PSORIASIS

- COMMON PLAQUE OR NUMULAR PSORIASIS
- INVERSE OR FLEXURAL PSORIASIS
- GUTTATE PSORIASIS
- FOLLICULAR PSORIASIS
- PALMAR PSORIASIS
- PUSTULAR PSORIASIS
- EXFOLIATIVE PSORIASIS
- PSORIATIC ARTHRITIS

HISTOPATHOLOGY
- ACANTHOSIS WITH ELONGATION OF THE RETE RIDGES
- ELONGATION OF THE DERMAL PAPILLAE
- PARAKERATOSIS
- MUNROS MICROABSCESSES

TREATMENT
- TOPICAL : * SALICYLIC ACID
* TARS
* CORTICOSTEROIDS
* SUN - UV LIGHT THERAPHY
ANTHRALIN GOECKERMAN TECHNIQUE
AND THE INGRAM TECHNIQUE
* PUVA

- SYSTEMIC : * CORTICOSTEROIDS
* ANTIMITOTIC AGENTS
* ETRETINATE
* AROXMATIC RETINOIDS
- DIALYSIS

PROGNOSIS

QUO AD VITAM

TYPE OF PSORIASIS

QUO AD FUNCTIONAM AD BONAM

QUO AD SANATIONAM DUBIA AD
BONAM

SEBORRHEIC DERMATITIS
CHRONIC DERMATOSIS CHARACTERIZED BY
REDNESS & SCALING
ITS OCCURS IN THE AREAS OF THE SKIN IN WHICH
THE SEBACEOUS GLANDS ARE MOST ACTIVE
FACE, SCALP, IN THE BODY FOLDS, PRESTERNAL
REGION

ETIOLOGY

MANY HYPOTHESES HAVE BEEN MADE

AS TO ITS CAUSE

- SEBORRHEA
- PITYROSPORUM OVALE INFECTION
- INFECTION BY CANDIDA OR STAPHYLOCOCCI
- EMOTIONAL RESPONSES TO STRESS OR FATIQUE
- ABNORMAL DIET

EPIDEMIOLOGY
- AGE : * INFANCY
* PUBERTY
* > 50 YEARS
- SEX : MALES
- INCIDENCE : VERY COMMON
- PREDISPOSING FACTOR : OFTEN A GENETIC DIATHESIS

CLINICAL MANIFESTATIONS
INFANCY
* CRADLE CAP
* GLABROUS : FLEXURAL, DIAPER AREA &
TRUNK
* GENERALIZED : LEINERS DISEASE
ADULTS
* SCALP

PITYRIASIS SICCA

* FACIAL, FLEXURAL & TRUNCAL

* GENERALIZED

ERYTHRODERMA

LABORATORY FINDINGS
HISTOPATHOLOGY
DIFFERENTIAL DIAGNOSIS
- ATOPIC DERMATITIS
- ALLERGIC AND IRRITANT CONTACT
DERMATITIS
- PITYRIASIS ROSEA
- DERMATOPHYTE INFECTION
- CANDIDIASIS

TREATMENT :
* CONSERVATIVE
- SHAMPOO
- EMOLLIENTS & CREAMS
* INTENSIVE
- KETOCONAZOLE CREAM
- TOPICAL STEROIDS
- TAR PREPARATIONS
PROGNOSIS :

QUO AD VITAM AD BONAM

QUO AD FUNCTIONAM AD BONAM
QUO AD SANATIONAM DUBIA AD BONAM

PITYRIASIS ROSEA
PROBABLY CAUSED BY AN INFECTIOUS AGENT
AGE : 10 - 35 YEARS
DURATION OF LESIONS :
- A HERALD PATCH PRECEDES THE
EXANTHEMATOUS PHASE
- THE EXANTHEMATOUS PHASE DEVELOPS OVER A
PERIOD OF 1 TO 2 WEEKS

PHYSICAL EXAMINATION :
- SKIN SYMPTOMS : PRURITUS

ABSENT, MILD OR
SEVERE

- SKIN LESIONS
* HERALD PATCH

2 - 5 CM, BRIGHT RED, SCALE

* FINE SCALING MACULES AND PAPULES WITH

MARGINAL COLLARETTE
CHARACTERISTIC PATTERN OF THE LESIONS
THE LONG AXES OF THE LESIONS FOLLOW
THE LINES OF CLEAVAGE IN A
CHRISTMAS TREE DISTRIBUTION
TRUNK & PROXIMAL OF THE ARMS & LEGS

DIFFERENTIAL DIAGNOSIS
- DRUG ERUPTIONS
- T. CORPORIS
- SECONDARY SYPHILIS
- T. VERSICOLOR

TREATMENT
- TOPICAL : * POWDER
* CREAM ( CORTICO STEROID )
- SYSTEMIK : ANTIHISTAMINES

PROGNOSIS :
QUO AD VITAM AD BONAM
QUO AD FUNCTIONAM AD BONAM
QUO AD SANATIONAM AD BONAM

SPONTANEOUS REMISSION IN 6 - 12 WEEKS

ERYTHRODERMA
REACTION PATTERN OF THE SKIN CHARACTERIZED BY
GENERALIZED, CONFLUENT REDNESS, SCALING
ASSOCIATED WITH SYSTEMIC SYMPTOMS
AGE ~ ETIOLOGY
ETIOLOGY
- EXTENSION OF PREEXISTING DERMATOLOGIC
DISEASE
PSORIASIS, ATOPIC DERMATITIS, SEBORRHEIC
DERMATITIS

&

- DRUGS REACTIONS
- SEZARY SYNDROME
- EXTENSION OF SYSTEMIC DISEASE
LUPUS ERYTHEMATOSUS

SKIN LESION :
SKIN IS RED, THICKENED & SCALY

UNIVERSALIS

LABORATORY & HISTOPATHOLOGY ~ ETIOLOGY

TREATMENT ~ ETIOLOGY
- THE PATIENT SHOULD BE HOSPITALIZED
- TOPICAL : EMOLLIENTS
- SYSTEMIC : CORTICOSTEROID

PROGNOSIS ~ ETIOLOGY