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Papulosquamous diseases
구진인설질환
Department of Dermatology
Seoul National University College of Medicine
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Papulosquamous diseases
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What is papulosquamous
disease?
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이렇게 생긴걸 전부 papillosquamous Ds.라고 부른다.
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What is the difference from the other
erythematous skin lesions?
5
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Psoriasis
(건선)
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Epidemiology
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mode of inheritance
• multifactorial inheritance
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Pathogenesis
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Genetic factors
• PSORS1 gene
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genetic background가 있다.
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Immunopathogenesis
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immunopathogenesis of psoriasis
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Clinical types of psoriasis
• Koebner(isomorphic) phenomenon
• Auspitz sign
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early psoriasis
; typical scaly papule
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chronic plaque type psoriasis
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Guttate psoriasis
• acute psoriasis
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guttate psoriasis
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Pustular psoriasis (1)
• sterile pustules
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localized pustular psoriasis
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Pustular psoriasis (2)
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generalized pustular psoriasis
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Erythrodermic psoriasis
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erythrodermic psoriasis
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Psoriasis of specific areas
• scalp
• face
• nails
• genitalia
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scalp psoriasis
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facial psoriasis
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nail psoriasis (nail pitting)
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nail psoriasis (subungual hyperkeratosis)
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genital psoriasis
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Disease modifying factors
• Obesity: severe psoriasis
• Infection
• HIV
• Drugs
• Cardiovascular diseases
• Fatty liver
• Psoriatic arthritis
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organs or diseases caused by IMIDs
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Diagnosis
• clinical findings
• skin biopsy
• differential diagnosis
• nummular eczema
• mycosis fungoides
• superficial fungal infection
• other papulosquamous diseases
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histopathology of
psoriasis
Munro microabscess
spongiform pustule of Kogoj
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Treatment
• principles of psoriasis treatment
• maximum effectiveness
• rotational therapy
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Topical agents
• retinoid: tazarotene
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Phototherapy
• UVB phototherapy
• UVA phototherapy
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Systemic medications
• Retinoids: acitretin, etretinate
• Cyclosporine A
• Methotrexate (MTX)
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Biologics
• T cell blocker
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Pityriasis rosea
(장미색 비강진)
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Epidemiology
• age group: 15 ~ 40
• no racial difference
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Etiology
• not clear
• prodromal symptoms
• clustering of disease
• spontaneous remission
• no recurrence
• insect bite, autoimmune disorder, drug rash
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Clinical manifestations
• prodromal symptoms: 5%
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herald patch (원발반)
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Christmas tree pattern rash
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Diagnosis
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Treatment
• conservative treatment
• antihistamines
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Pityriasis rubra pilaris
(모공홍색비강진)
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Epidemiology
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Etiology
• poorly understood
• vitamin A deficiency
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Clinical manifestation
• scaling erythroderma
• follicular hyperkeratosis
• palmoplantar keratoderma
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childhood PRP
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follicular papules in PRP
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nappes claires: clear island like normal skin in erythroderma
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orange-yellow tint sandal-like keratoderma
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Diagnosis
• clinical findings
• keratoderma
• biopsy
• differential diagnosis
• psoriasis, ichthyosis
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Treatment
• methotrexate
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Lichen planus
(편평태선)
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Clinical manifestations
• Wickham striae
• itching: severe
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Clinical types of lichen planus
• acute widespread
• chronic localized
• hypertrophic
• atrophic
• vesiculo-bullous
• follicular (lichen planopilaris)
• annular
• actinic
• hepatitis-associated
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Wickham striae
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oral lichen planus - lace like pattern
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Etiology
• idiopathic
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Diagnosis
• clinical findings
• biopsy
• differential diagnosis
• psoriasis
• syphilid
• lichenoid drug eruption
• oral lesion: leukoplakia, candidiasis
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Treatment
• no specific treatment
• topical steroids
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Pityriasis alba
(백색잔비늘증, 백색비강진)
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• common benign condition of preadolescent
children
• no subjective symptoms
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Pityriasis alba
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Thank you for your attentions.
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