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7 papulosqumaous disorder

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  • 1. Papulosqumaous disorder DR.MIHERETU(MD+DV)
  • 2. Cont…  Psoriasiform psoriasis seborrheic dermatitis parapsoriasis/mycosis fungiodes  pityrasiform Pityrasis rosea secondary syphilis tinea versicolor
  • 3. Cont… • LICHENOIDS lichen planus Drug induced lichen planus  ANNULAR Tinea  ERYTHRODERMA
  • 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. 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. 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. Epidemiology  is universal in its occurrence  The worldwide incidence varies considerably with race, geography, and environmental factors  prevalence 2% of the population
  • 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. 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. 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. 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. 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. Cont…
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  • 19. Cont..
  • 20. Cont…
  • 21. Cont..
  • 22. Cont…
  • 23. Cont…
  • 24. Palm and sole psoriasis
  • 25. Cont..
  • 26. Cont…
  • 27. Cont..
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Cont…  Six ps : purple/pink Polygonal Pruritic Papule Plaque planar
  • 39. Cont…  actinic
  • 40. Cont..
  • 41. Cont..  Diagnosis histolopatology lichenoid interface dermatitis hypergranulosis pigment inconitnence Colloid bodies Bands of lymphocyte infiltration
  • 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. 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. 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. 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. 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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