7 papulosqumaous disorder

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7 papulosqumaous disorder

  1. 1. Papulosqumaous disorder DR.MIHERETU(MD+DV)
  2. 2. Cont…  Psoriasiform psoriasis seborrheic dermatitis parapsoriasis/mycosis fungiodes  pityrasiform Pityrasis rosea secondary syphilis tinea versicolor
  3. 3. Cont… • LICHENOIDS lichen planus Drug induced lichen planus  ANNULAR Tinea  ERYTHRODERMA
  4. 4. Cont…  Psoriasis is a common, chronic, relapsing, inflammatory and proliferative skin disorder with a strong genetic basis.  The disease is enormously variable in duration ,extent and presentation.  diagnosis is usually made clinically .  Papulosquamous disorder
  5. 5. history  Hippocrates (460–377b.c.) used the terms psora and lepra for conditions that can be recognized as psoriasis.  Later Celsus( 25 b.c.) described a form of impetigo that was interpreted by R. Willian (1757–1812) as being psoriasis.  Willian separated two diseases as psoriasiform entities, a discoid lepra Graecorum and a polycyclic confluent psora leprosa, which later was called psoriasis.  In 1841 Ferdinand von Hebra (1816–1880) unequivocally showed that Willian's lepra Graecorum and psora leprosa were one disease
  6. 6. history  Psoriasis and leprosy had caused much confusion for several centuries  In 1313,Philip de Fair ordered them to be burned  Psoriasis was recognized as a distinct entity from leprosy in the 19th century  Robert Willan (1809) gave an accurate description of psoriasis  In 1841,Hebra definitively separated the clinical features of psoriasis from those of leprosy  1879 Heinrich Koebner described the Koebner’s phenomenon
  7. 7. Epidemiology  is universal in its occurrence  The worldwide incidence varies considerably with race, geography, and environmental factors  prevalence 2% of the population
  8. 8. Cont…  Race:  any race;  a higher prevalence in western European and Scandinavian populations.  1.5-3% of the population is affected  highest documented prevalence is in Arctic Kasach'ye☞12%  Norway→4.8%  2.8% in Faeroe Islands
  9. 9. Cont…  Sex:  Psoriasis affects adult males and females equally.  Among children and adolescents, psoriasis affects females more than males,  Age:  a lifelong threat.  reported to be present at birth; onset at age 108 yrs reported  2 peak age ranges:-  The first peak occurs in persons aged 20-30 years,  the second occurs in persons aged 50-60 years.
  10. 10. Clinical presentation Clinical Classification of Psoriasis Non pustular Pustular  Psoriasis vulgaris, →Pustular psoriasis of von Zumbusch  Psoriatic erythroderma → Pustulosis palmaris et plantaris →Pustular psoriasis, annular type →Acrodermatitis continua → Impetigo herpetiformis
  11. 11. Cont…  SkinSkin  cutaneous lesions are characteristic for the disease and is usu. easy to make the proper diagnosis.  Various morphologic forms .  Lesions show four prominent features:- (1) sharply demarcated (2) silvery scales (3) erythema (4) Auspitz sign
  12. 12. Cont…  Auspitz sign is a specific feature of psoriasis.  It is noted when the scales are removed from the plaque  Within a few seconds small blood droplets appear on the erythematous surface.  it has diagnostic value;  not present in inverse or pustular psoriasis  Koebner's phenomenon can be elicited in~20 percent of patients.  After nonspecific trauma or irritation, psoriatic lesions develop in areas where they were not previously present.
  13. 13. Cont…
  14. 14. Cont…
  15. 15. Cont…
  16. 16. Cont…
  17. 17. Cont…
  18. 18. Cont…
  19. 19. Cont..
  20. 20. Cont…
  21. 21. Cont..
  22. 22. Cont…
  23. 23. Cont…
  24. 24. Palm and sole psoriasis
  25. 25. Cont..
  26. 26. Cont…
  27. 27. Cont..
  28. 28. Natural history  The chief complaints of patients with psoriasis are  the unsightliness of the lesions,  lowered self-esteem,  feelings of being socially outcast,  pruritus,  and pain,  Patients with generalized psoriasis complain more of excessive scale and heat loss.  The increased incidence of arthritis in patients with psoriasis makes arthralgia a frequent complaint
  29. 29. Cont…  Most studies indicate that once psoriasis appears as an early localized disease, it persists throughout life, manifesting itself at unpredictable intervals.  Spontaneous remissions do occur with varying frequencies.  In two separate studies involving about 200 patients per study, remission ranged from 17 to 55 percent.  In another study of 2800 patients, 29 percent reported a remission.  The duration of these remissions ranges from 1 to 54 years.  Data relative to permanent remissions, either spontaneous or induced, appear to be unavailable.
  30. 30. treatment  Largely depends on the exent of skin involvement,clinical variants,age of the patient and previous treatment.  1)chronic plq  2)gutate  3)erytrodermic/pustular
  31. 31. Cont..  1) chronic plaque I)Mild,<10% BSA First line Emoillent,topical steriods,and Vit D analogs 2nd line Coal tar,tazarotene and ditranol II) moderate,>10%-- <30% BSA
  32. 32. Cont…  1st line 2nd line NB UVB PUVA BB UVB climatotheraphy III)>30%BSA Systemic 1st line methotrexate,actretin and biological 2nd fumaric acid esters,cyclosporin Goeckerman regimen
  33. 33. Cont..  2) gutate no treatment NB UVB BB UVB topical steriods and Vit D 3)erythrodermic /pustular Actretin,cyclosporin,PUVA,NB UVB,methotrexate and biologicals.
  34. 34. Lichen planus  Idiopathic inflammatory disease of the skin, hair, nails and mucous membranes, seen most commonly in middle-aged adults  Flat-topped violaceous papules and plaques favor the wrists, forearms, genitalia, distal lower extremities and presacral area  Some lichenoid drug eruptions have a photodistribution, while others are clinically and histologically indistinguishable from idiopathic lichen planus  The most commonly incriminated drugs include angiotensin converting enzyme (ACE) inhibitors, thiazide diuretics,antimalarials, quinidine and gold  T-cell-mediated autoimmune disorder, basal keratinocytes express altered self-antigens on their surface
  35. 35. history  Lichen planus: lichen Greek tree moss  planus Latin flat  initially introduced by Erasmus Wilson in 1869 to describe the condition that had been previously named leichen ruber by Hebra I.
  36. 36. Epidemiology  Affect 1% to 2% of population  B=W  2/3 of case occur b/n the age 30-60yrs.  Children and elderly are rarely affected  M=F  Mucosal involvement observed in up to 75% patient with cutaneous lichen planus
  37. 37. Cont…  Clincal presentation : 1)configuration anular and linear 2)morphology atrophic ,hypertrophic, vesiculobollus, erosive and ulcerative, lichen planopilaris and,lichen pigmentosum 3)Anatomic site
  38. 38. Cont…  Six ps : purple/pink Polygonal Pruritic Papule Plaque planar
  39. 39. Cont…  actinic
  40. 40. Cont..
  41. 41. Cont..  Diagnosis histolopatology lichenoid interface dermatitis hypergranulosis pigment inconitnence Colloid bodies Bands of lymphocyte infiltration
  42. 42. DDX Differential diagnosis:  lupus erythematosus (LE), lichen nitidus, lichen striatus, lichen sclerosus,  pityriasis rosea, erythema dyschromicum perstans (ashy dermatosis), psoriasis, annular lichenoid eruption, lichenoid GVHD and secondary syphilis.
  43. 43. Treatment  Topical corticosteroids (2)  Superpotent topiCal corticosteroids (oral LP (1); cutaneous LP (2))  Topical calcineurin inhibitors (e.g. pimecrolimus and tacrolimus in oral LP (1);  tacrolimus in vulvar (2) and other forms (3) of LP)  Intralesional corticosteroids (2)  Intramuscular triamcinolone acetonide [0.5-1 mg/kg/month x 3-6 months] (3)  Narrowband UVB (2)  Oral metronidazole* [500 mg po bid] (2)  Antimalarials* (2)  Systemic retinoids* (1 for etretinate)  Griseofulvin* (2)  PUVA (2)  UVA1 (2)  308-nm excimer laser for oral LP (2)  Systemic corticosteroidst (1)  Low-dose weekly methotrexate (2)  Mycophenolate mofetil (2)  Thalidomide (2)  Cyclosporine (3)  Sulfasalazine* (2)  Extracorporeal photochemotherapy (2)  Basiliximab, alefacept, efalizumab (3)  "Implicated in lichenoid drug eruptions.  t Often a first-line therapy for severe, acute cutaneous LP.
  44. 44. Pityriasis rosea  Defn  Normally lasting 4 to10 weeks.  Most often begin ass a single 2 - to 4-cm  Thin oval laouwe itha fine collaret 0tef  scalleo cateinds idteh ep eripheorfty h e  plaqu(e"h eraplda tchS")i,m ilarappear  ing,b uts malleler,s iontsh ena ppeasre veradl  ayst0 w eeklsa tear nda ret ypically  distributeadlo ngth el ineso fc leavagoen  thetr un(kl na " Christmtraese p" attern),  Usuaallsyy mptombautistc 0, metimes  associatwedit hp rurituasn dm ildfl u-like  symproms,
  45. 45. Pityriasis rosea  Occurms osct ommoninlyt e enagearns d  younagd ults.  Besst cientifeicv idencseu D00rtthse t heoryt  hatp ityriasrioss eare presenat vsi ral  exantheamss 0ciatwedit hr eactivatioofn  humahne rpesv7ir aunsd s ometimes  humahne rpesv6ir,us  Treatmeisnu t suallsyu pportivaelt,h ough  mid-potentocyp icaclo rticosterociadns  beu sefdo ra ssociapterudr ituOsn. e  reposrtu ggesthtsa at dministraotfion  high-dosaec yclovfoirr 1 weekm ayh astenr  ecovefrrovm th ed isease
  46. 46. Pityriasis rosea  Occurms osct ommoninlyt e enagearns d  younagd ults.  Besst cientifeicv idencseu D00rtthse t heoryt  hatp ityriasrioss eare presenat vsi ral  exantheamss 0ciatwedit hr eactivatioofn  humahne rpesv7ir aunsd s ometimes  humahne rpesv6ir,us  Treatmeisnu t suallsyu pportivaelt,h ough  mid-potentocyp icaclo rticosterociadns  beu sefdo ra ssociapterudr ituOsn. e  reposrtu ggesthtsa at dministraotfion  high-dosaec yclovfoirr 1 weekm ayh astenr  ecovefrrovm th ed isease

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