Pityriasis and psoriasis lecture

1. Dr BASSAM ALDRASSI

2. ‫اعداد‬
‫الحمادي‬ ‫بلقيس‬
‫التهامي‬ ‫التزام‬
‫سلوى‬
‫الكينعي‬
‫عال‬
‫معياد‬
‫التام‬ ‫تيسير‬
‫رفيدا‬
‫الجماعي‬
‫ب‬
‫عبده‬ ‫غداد‬
‫البخيتي‬ ‫ماريا‬

3. PITYRIASIS
ROSEA
LICHEN
PLANUS
CONTENTS
:
psoriasis

4. ❀PITYRIASIS ROSEA

5. *DEFINITION
❀Pityriasis rosea
This is an acute, self-limiting, rash, probably of infectious
origin, which mainly affects young adults

6. Epidemiology
❀The incidence is 170 cases per 100,000 persons per
year.

7. Clinical features
➸The first lesion to appear, or ‘herald patch’is larger than
the subsequent oval pink scaly patches that appear several
days later in crops over subsequent weeks.
➸ These mainly affect the trunk and proximal limbs in a
Christmas tree pattern
➸There may be mild pruritus.
➸ Spontaneous
resolution usually occurs within 6 weeks and recurrences
are rare

8. DIFFERENTIAL
DIAGNOSIS
➸Seborrhoeic dermatitis
➸guttate psoriasis
➸lichen planus
➸pityriasis lichenoides
➸tinea corporis,
➸drug reactions,
➸secondary syphilis.

9. Investigation
➪None are routinely necessary.
➸ In atypical cases,
■
■ skin scrapings should be taken for mycology and
serological tests for secondary syphilis considered.

10. Treatment
➸An emollient and moderate potency topical corticosteroid
may be prescribed if pruritis is troublesome.

13. Psoriasis

14. Causes
Definition
Types
Clinical features
Differential Diagnosis
Investiagation
Treatment

15. Definiton
Psoriasis is a common chronic inflammatory
Papulosqamous eruption with a predilction for
the extensor of limbs ,scalp and nails.
Both sexes are equally affected

16. Causes
A stong genetic compenint
,Precipitating factor include trauma
Streptococcam emfaction
Smoking ,stress, alcohol
Drugs example beta blocking agent, antimalarials,Lthium.

17. Types
The comminest for.
by well demarcated, thickend,de Characterized
by silvery scale. plaque surmounted Deep red
■ Accours in the extenser aspects of limbs,knee,elbow ,
scalp,and ears.

18. Rupioid Psoriasis
Is term giving to grossly hyperkeratotic limpet
Like plaques

19. Guttate Psoriasis
■ Following a streptococcal throat infaction
■ Red, oval or round plaque appears on the trunk and
proximal limbs

20. Pustular Psoiasis
May be localized or generalized
Localized called palmoplamtar pustulosis
Occurs in adults as crops of ,sterile yellow pustules on the palms
and soles.
Generalized is an unstaple,severe form of psoriesis
Appear at any sit
Fever and malaise are common

22. Erythrodermic psoriesis is a widespread sever with generelized
erythema.it is associated with systemic symptoms if unteated.
Patients ae at risk of fluid and potein loss,poor tempretue control
and infection.

23. Clinical Features of
Psoriasis
to Thick white scale adhering Scalp psorasis
the scalp and hair shaft.
Nail changs are common .
Skin modified by site involvement of flexures .

26. Differential Diagnosis
Chronic plaque psoiasis confined to the palms or soles may closely
to eczema or tinea .
Facial psoiasis difficult to distinguish from seborrhocic eczema .
Guttate psoriasis can simulate pityriasis rosea,pityriasis lichenoides
and secondary
syphilis.
Flexural psoriasis is often misdiagnosed as chronic intetrigo.

27. Investigation
investigations are routinely necessary NO
Unless the diagnosis un clear ;
skin biopsy
patch testing or mycology of skin
scrapings.

28. Treatment
But we can use Psoasis is incurable disease
Many methods to alleviation pain;
Use ceams that contains
CORTICOSTEOIDS
SALICYLIC ACID
Carbamide
Use Methotrexte
Use UVB and PUVA phototheapy

29. LICHEN
PLANUS

30. PLAY-nus) is a condition that can cause swelling and irritation in
the skin, hair, nails and mucous membranes.
DEFINITION

31. TYPES OF LICHEN
PLANUS:
The clinical presentation of lichen planus
has several forms: actinic (in sun-exposed
areas), annular, atrophic, erosive,
follicular, hypertrophic, linear, pigmented,
and vesicular/bullous

32. Annular atrophic lichen
planus
Hypertrophic lichen
planus

33. CLINICAL
FEATURES
polygonal flat-topped papules . On
clearing, these characteristi- cally leave
post-inflammatory hyperpigmenta- tion .
All races and ages are susceptible,
although the greatest incidence is from 20
to 50 years of age. The cause is unknown
though an immunological basis is
suggested. Some drugs can induce LP-like
eruptions (e.g. antimalarials, heavy metals,
antituberculous therapy). An asso- ciation
with hepatitis C infection has also been
reported in some countries.

34. LP can affect any part of the body but is most commonly seen
symmetrically on the flexor surfaces of the wrists, forearms,
ankles, and lower back. White streaks (Wickham’s striae)
overlie the lesions and are frequently observed on the buccal
mucosa where they form a lacy pattern (Unlike candidiasis,
these cannot be removed by gentle wiping with a swab.
CLINICAL FEATURES

35. oral lichen planus

36. Lesions on the lower leg and palmoplantar surfaces are frequently
hyperkeratotic and share features with chronic lichenified eczema () and
scalp involvement produces scarring alopecia. Nail involvement causes
longitu- dinal ridges, variable atrophy, and permanent scarring (pterygium)
Lesions occur at sites of trauma (Köbner phenomenon) Annular lesions
may occur, especially on the penis . Spontaneous recovery is usual within 9
months, but hypertrophic lesions can persist for many years, especially on
the lower legs. An uncommon variant affecting the oro-genital mucosa
typically runs a recalcitrant course. Lichen nitidus is an uncommon variant
of LP which presents with multiple minute grouped papules that typically
affect the forearms, penis, torso, and buttock. It affects children and young
adults

39. DIFFERENTIAL
DIAGNOSIS
Oral lesions may be confused with
candidiasis and frictional hyperkeratosis.
Hyperkeratotic lesions on the palmo-plantar
skin and legs may resemble chronic
eczema.

40. INVESTIGATIO
NS
Histology of active lesions shows lichenoid inflammation
and supports the diagnosis.SPECIAL POINTSA drug
history is important in patients with atypical lichenoid
eruptions to exclude drug- induced disease.

41. TREATMENT
Potent topical, intralesional, or occasionally systemic
corticosteroids are helpful in reducing pruritus. Hypertrophic
lesions may benefit from occlusive dressings. Widespread
acute LP may occasionally require a reducing course of oral
corticosteroids. Other second-line treatments which are used
for severe cutaneous or mucosal LP include acitretin,
phototherapy, and ciclosporin.

42. Thank
you