7. What kind of disease that can cause macula eritematosa and skuamosa?

a. Psoriasis is a chronic disorder with polygenic predisposition combined with

triggering environmental factors such as trauma, infection, or medication.
Erythematous scaly papules and plaques; pustular and erythrodermic eruptions occur.
Most common sites of involvement are scalp, elbows, knees, hands, feet, trunk, and
nails. Psoriatic arthritis occurs in 10%25% of patients; pustular and erythrodermic
forms may be associated with fever.Pathology is characterized by uniform elongation
of the rete ridges, with dilated blood vessels, thinning of the suprapapillary plate, and
intermittent parakeratosis. Epidermal and perivascular dermal infiltrates of
lymphocytes, with neutrophils occasionally in aggregates in the epidermis.
b. Parapsoriasis is also known as parapsoriasis en plaques. Parapsoriasis occurs
worldwide and affects mainly adults. Large-plaque parapsoriasis (LPP) and smallplaque parapsoriasis (SPP) are recognized. Large and small plaque lesions actually
present as flat patches rather than infiltrated plaques.Lesions are chronic and favor
non sun exposed skin; LPP may be poikilodermatous.
c. Pitiriasis rosea is common acute papulosquamous eruption normally lasting 410
weeks. Most often begins as a single 2- to 4-cm thin oval plaque with a fine collarette
of scale located inside the periphery of the plaque (herald patch). Similar-appearing,
but smaller, lesions appear several days to weeks later, typically distributed along the
lines of cleavage on the trunk (Christmas tree pattern). Usually asymptomatic,
sometimes pruritic with mild flu-like symptoms. Occurs most commonly in teenagers
and young adults. Probably a viral exanthem associated with reactivation of human
herpes virus (HHV)-7 and sometimes HHV-6. Treatment is usually supportive,
although midpotency topical corticosteroids can reduce pruritus; high-dose acyclovir
for 1 week may hasten recovery.
d. Eritoderma is defined as diffuse erythema and scaling of the skin involving more
than 90% of the total body skin surface area. If the defect of the skin is 50-90% we
call it pre-eritoderma. In this definition, the absolute must appear is erythema while
scalling is not always appear. Diagnostic workup includes a complete history and
physical examination, with careful analysis of pertinent clinical clues and
dermatohistopathology. Other laboratory workup is often required and determined by
clinical clues.
e. Seborreic Dermatitis is both infantile and adult forms exist. It is characterized by
sharply demarcated, yellow to red to brown, greasy or bran-like scaling patches and
plaques. Lesions favor scalp, ears, face, presternal chest, and intertriginous areas.
Flares occur when sebaceous glands are most active (first few months of life, and post
puberty). Generalized and erythrodermic forms rarely occur. The etiology is unclear
but there are associations with Malassezia yeasts, sebum secretion and composition,
and certain drugs. May be a cutaneous marker of HIV and AIDS, especially when
severe, atypical, and therapy-resistant.
Fitzpatricks Dermatology in General Medicine Vol.1 .8th edition. 2012. New York: The
McGraw Hill Companies, Inc. Hal: 197, 285, 259, 266, 458.
Linuwih, Sri. 2016. Ilmu Penyakit Kulit dan Kelamin Ed. 7. Jakarta: Badan Penerbit FKUI.
Hal:228

5. Why can the disease be recurrent even after get the treatment from doctor? (based on
differential diagnose)
a. Psoriasis
Psoriasis is a chronic inflammatory skin disease, with a strong genetic basis,
characterized by complex alterations in epidermal growth and differentiation and
multiple biochemical, immunologic, and vascular abnormalities, and a poorly
understood relationship to nervous system function. Its root cause remains unknown.
From that explanation, we know that the main cause of psoriasis is in genetic factors
and this make the basic principle of psoriasis treatment is to suppress the symptoms
and to recovery the symptom and not to eliminate the main cause. So when there is a
predisposing factors, in this case is stress, psoriasis is possible to relapse/recurrent.
b. Pitiriasis rosea
PR most commonly occurs in teenagers and young adults, and is most likely a viral
exanthem associated with reactivation of human herpes virus 7 (HHV-7) and
sometimes HHV-6,the viruses responsible for rubeola. Recurrences of PR are rare,
which suggests lasting immunity after an initial episode of PR. But rare is not mean
never. In 2% cases of PR, there is recurrences. This can be caused by decrease
function of immunity system.
c. Seborreic Dermatitis
Adults patient of SD tend to have chronic and recurrent disease, and as such, the
patients should be informed that the aim of treatment will be to control rather than
cure the disease. So when there is a predisposing factors, SD is possible to
relapse/recurrent.

Fitzpatricks Dermatology in General Medicine Vol.1 .8th edition. 2012. New York: The
McGraw Hill Companies, Inc. Hal: 197, 259, 458.
Linuwih, Sri. 2016. Ilmu Penyakit Kulit dan Kelamin Ed. 7. Jakarta: Badan Penerbit FKUI.
Hal:226