Pityriasis rosea,lichenoides

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Pityriasis rosea,lichenoides

  1. 1. PITYRIASIS ROSEA PITYRIASIS LICHENOIDES BY AJAI SASI MALABAR MEDICAL COLLEGE
  2. 2. PITYRIASIS • Any of several skin diseases marked by the formation and desquamation of fine scales
  3. 3. PITYRIASIS ROSEA • Self limited dermatitis lasting from 4-7 weeks • Predominantly occur in adolscents and young adults • May be asymptomatic or pruritic • Etiology unknown,viral origin has been suggested
  4. 4. • Characterized by development of self limiting eruption • Eruption preceded with large scaly annular plaque known as Herald patch or mother patch • It is a raised Plaque • Within a week after heralad patch formation • Numerous oval shaped uniform papules and macules with peripheral collateral scales appear abruptly(1-2cm of size)
  5. 5. • Distributed bilaterally symmetrically on • 1.Trunk • 2.Proximal portions of limbs
  6. 6. • On the back of trunk ,lesion show a fur tree or christmas tree like pattern
  7. 7. • Hanging curtain sign positive • When individual lesion is stretched along the long axis ,the scales tend to fold across the lines of stretch • Histological features • Focal parakeratosis • Mild acanthosis • Spongiosis • Exocytosis • Perivascular dermal infilitration with lymphocytes
  8. 8. DIAGNOSIS • Usually easily diagnosed by its morphology and distribution • Can also occur as a manifestation of • 1.Secondary syphilis • 2.Drug reaction • 3.Internal malignancy(stomach)
  9. 9. TREATMENT • Since self limiting ,no active treatment required • Application of bland oils and avoidance of soap may relieve itching • Severe itching -Oral antihistamines ,antipruritic lotions
  10. 10. PITYRIASIS LICHENOIDES • Divided into two • 1.Pityrisis lichenoides chronica • 2.Pityriasis lichenoides et varioliformis acuta (PLEVA) or Muscha-Habermann disease • They are two types of Parapsoriasis,other than parapsoriasis en plaque
  11. 11. PARAPSORIASIS • Includes a group of chronic,asymptomatic,maculopapular scaly eruptions of slow evolution • Resistant to treatment
  12. 12. 1.PITYRISIS LICHENOIDES CHRONICA • Common type of parapsoriasis • Seen in children • Consists of discrete,scaly,erythematous • 1.Macules • 2.Papules • Papule shows a single layer of brownish scale • Removel of scale spoty hypopigmented oval macule
  13. 13. Distribution – Bilaterally on sides of trunk and on thighs and upper arms
  14. 14. • Difference from psoriasis • 1.When one tries to remove the brownish scale,it comes out as a wholeand not in layers • 2.Auspitz sign absent
  15. 15. Auspitz sign • When scales are scrapped off completely in psoriasis patient ,the basement membrane is exposed and is seen as moist red surface • Through which dilated capillaries are seen as red spots • On further scrapping these capillaries at tips of elongated papillae are torn leading to multiple bleeding points(auspitz sign)
  16. 16. TREATMENT • No active treatment indicated • Bland emollient application beneficial • Oral Tetracycline and PUVA therapy has been reported effective
  17. 17. 2.Pityriasis lichenoides et varioliformis acuta (PLEVA) • Abrupt onset • Consists of erythematous macules,papules,necrotic lesions,and few vesicles • Eythematous papules tend to • 1.Crusting • 2.Necrosis • 3.Hemorrhage
  18. 18. • Distribution- trunk,flexor surface of upper extremities and the axillae
  19. 19. Histological features • Dense lymphocytic perivascular infilitration in supficial dermis • Erythrocytes trapped within epidermis • Lesions heal leaving depressed varioliform (resembling smallpox) scar • New lesions may erupt and disease can be chronic or subacute
  20. 20. TREATMENT • Methotrexate • Tetracycline • Erythromycin • PUVA- May give relief in some patients

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