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/ papulosquamous diseases
PSORIASIS
PITYRIASIS ROSEA
PITYRIASIS RUBRA PILARIS
LICHENOID ERUPTION
PITYRIASIS LIKHENOIDES and PARAPSORIASIS
DERMATITIS EKSFOLIATIVA/ERYTHRODERMIA
Transfering the concept in basic science (ie:
immunology) in to a clinical competence
IMMUNOLOGIC PROCESS
Triggering factors
ENVIRONMENTAL FACTORS
emotional stress
PHYSICS,BIOLOGIC AND season
EMOTIONAL trauma
drugs
infection
race
Schematic representation of generating psoriasis inflammatory lesion from
normal psoriatic skin. Starting from activation of native APC’s to the
maintenance of psoriatic lesion
KERATINOCYTE HYPERPROLIFERATION
FUNGSIONAL CHANGES
ABNORMALITIES
• DIFFUSE PARAKERATOSIS,
THINING OF SUPRA
PAPILARY EPIDERMIS,
• MICRO ABSES MUNRO,
• REGULER ACANTHOSIS,
• FINGER LIKE DERMAL
PAPILLAE
• EDEM OF DERMAL
PAPILLAE,
• SPARSE PERIVASCULAR
LYMPHO HISTIOCYTIC
INFILTRATRATION
CLINICAL MANIFESTATION
PSORIASIS VULGARIS
COMMONEST FORM ,
SPECIFIC
ERYTHROSQUAMOUS
PLAQUE OVER
PROMINENCE AREA
OF THE SKIN
FLEXURAL / INVERSE PSORIASIS
SPECIFIC PLAQUE
AT FLEXURAL
AREA
SEBORIASIS -
PSORIASIS
SEBORHEIC
GUTTATE PSORIASIS
ERUPTIVE
MULTIPLE, SMALL SIZE
DROP LIKE LESIONS
>> IN CHILDREN AS NEW
LESIONS
PUSTULAR PSORIASIS
SUPERFICIAL PUSTULES, VARIED IN SIZE, FLAT , TEND TO
COALESCENCE “LAKE OF PUSTULE”
GENERALIZED PUSTULAR
PSORIASIS (von zumbusch)
generalized steril pustules, which
are eruptive accompanied high fever,
WBC > 20.000/ML
DECREASE [Ca++] serum
PSORIASIS PUSTULAR
PALMOPLANTAR
Pustular Eruption limitted at
palmoplantar , recurrence
some time happen together
with the plaque type
PSORIASIS ARTHROPATHY
arthritis seronegative
•predilection: small joint
•persisten
•specific Radiologic pattern
Psoriasis of the nail
>>hand nails
pitting nail
yellowish
discoloration
subungual
hyperkeratosis
lateral onycholysis
Psoriasis erythrodermia
• reactive psoriasis
•exfoliation > 75% body surface
BEFORE TREATMENT
Auspitz sign
pin point bleeding when pull off
the scale
MANAGEMENT
BASIC MEDICAMENTAION
TOPICAL : TAR, SALICYLIC ACID,
STEROID,TACROLYMUS
SYSTEMIC : CYTOSTATIC AGENT (Cy-A, Mtx) ,
ISOTRETINOIN, “steroid”
COMBINATION : Irrad UV-B + tar ( Reg.Gaukerman)
irrad UV-A + psoralen (PUVA)
Drug considerance
diseases severity ( PASI score )
treatment history including
medication side effects
patient situational status
Social/holistic approach
Sosialization of the illness to the patient
and family
DERMATITIS EXFOLIATIVA (DE)
An eruptive skin disease as whole body erythema and
scaling.
MANAGEMENT
DEPEND ON DESEASE BACK GROUND
Clinical manifestation:
Herald patch ----> smallest lesion surrounding
spread all-over body but face and palm/sole
Full blown on the back ---> tree form appearance
Lesions tend to distribute on clothed area.
• RARE
• SPECIFIC :
ERYTHROSQUAMOUS
PAPULES, ACCUMINATE,
FOLLICULAR, TEND TO
COALESCE/
CONFLUENCY
• OLD LESION LEAVE
SMALL ISLANDS OF
HEALTHY SKIN
ETIOLOGY
• FAMMILIAL (Aut.Domin)
• VIT.A DEFFICIENCY ?
LESION ON THE PALM AND SOLE
Yellowish colour
Keratotic sandal
CLINICAL MANIFESTATION
New Lesion : erythro squamous patches on the head (seborrhoiformis)
start with follicular erythematous papules.
Coalescence of lesions
In the palm and sole thick, luminence wax yellow colored
(keratodermic -sandal)
Old lesions : islands of normal skin between the plaque
Eruptive form: similar with dermatitis exfoliative of any cause
HISTOPATHOLOGY
• NOT DIAGNOSTIC BUT SPESIFIC
• HYPERKERATOSIS, PARAKERTOSIS ALTERNATING/FOLIKULER
• EUGRANULOSIS
TREATMENT
TOPICAL : STEROID
TAR + UV-B
SYSTEMIC: RETINOIC ACIOD
LICHEN PLANUS
A COMMON CHRONIC INFLAMATORY SKIN DISEASE
WITH SPECIFIC CLINICAL AND HISTOPATHOLOGICAL
MANIFESTATION, UN KNOWN CAUSE
CLINICAL VARIATION
ERYTHRO SQUAMOUS, VESICO BULLOUS, HYPER-
TROPHIC,
ATROPHIK, ANULAR, FOLLICULAR, ACTINIC OR
ERYTHEMATOUS
ETIOPATHOGENESIS
INFECTION -PSYCHOGEN-GENETIC
ENZYMATIC IMMUNOLOGIC
CLINICAL MANIFESTATION
SINGLE LESION : FLAT TOPPED PAPULE,
POLYGONAL WITH WICKHAM STRIAE, DEEP
PURPLE HUE
DISCRETE
OLD LESION VARIED
MUCOSAL LESION :
WHITISH PLAQUE
(LACY WHITE APPEARANCE)
Koebner sign
Close up
LICHEN STRIATUS
4CLINICALLY SPECIFIC
4SPONTANEOUS
HEALING 6 12 MONTHS
4>> CHILDREN
4ERYTHEMATOUS
PAPULE, PURPLE,
DISCRETE, --->
CONFLUENCE -->
LINEAR PLAQUES AT
LATERAL ASPECT OF
EXTREMITIES
PITYRIASIS LICHENOIDES
AND
OTHER PARA PSORIASIS
8PITYRIASIS LICHENOIDES et
VARIOLIFORMIS ACUTA (PLEVA)
8PITYRIASIS LICHENOIDES CHRONICA
(PLC)
8SMALL PLAQUE PARAPSORIASIS
(GUTATTE P.P.)
8PARAPSORIASIS en PLAQUE
PLEVA
•new lesion papule
eritem --> central
vesiculations
•crusting ---> ulceration -
--> clear ----> cicatrix
0LD LESIONS
Pityriasis lichenoides chronica (PLC)
• Thin Papules with fine scale, erythematous
base
Sunardi radiono
Dept. of dermatol. and venereol.