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Transcript of EPS-OS
ERYTHRO PAPULOSQUAMOUS ERUPTION
Erythro-Papulo-Squamous (EPS)
CHARACTERIZED BY ERYTHEMA,
PAPULES OR PLAQUES AND SCALLING
TRUE EPS & EPS-LIKE
A. TRUE EPS1. PSORIASIS
2. P. ROSEA
3. SEBORRHEIC DERMATITIS
4. ERYTHRODERMA
5. PARAPSORIASIS
6. PITYRIASIS RUBRA PILARIS
7. LICHEN PLANUS
8. LICHEN STRIATUS
9. LICHEN NITIDUS
B. EPS - LIKE
1. DERMATOFITOSIS
2. T. VERSIKOLOR
3. DRUG ERUPTION
4. SYPHILIS II
5. LUPUS ERYTHEMATOSUS
6. MORBUS HANSEN
7. MYCOSIS FUNGOIDES
PSORIASISPSORIASIS
* IS A COMMON PAPULO SQUAMOUS DISEASE
* E/ ?
* SHOWING WIDE VARIATION IN SEVERITY & IN
DISTRIBUTION
* CHRONIC
EPIDEMIOLOGY :
- PSORIASIS IS FOUND ALL OVER THE WORLD
- MALES FEMALES
- THE ONSET OF THE DISEASE IS LESS COMMON
IN THE VERY YOUNG & THE ELDERY
ETIOLOGY & PATHOGENESIS
AT THE CELLULAR LEVEL IT IS ACCEPTED THAT
PSORIATIC KERATINOCYTE DIFFERS FROM THE
NORMAL KERATINOCYTE GENETICALLY IN ITS
RESPONSE TO VARIOUS STIMULI
ENDOGENOUS & EXTERNAL STIMULI
CLINICAL MANIFESTATIONS
- A SHARPLY DEFINED BORDER, A BRIGHT RED
COLOR & A SILVERY - WHITE SCALE DELINEATE
THE LESION OF PSORIASIS
- SITES OF PREDILECTION: THE ELBOWS &KNEES,
THE SCALP & LUMBO SACRAL SKIN
- SUBTLE DISTORTIONS OF NAILS, MUCOSAL
CHANGES, ISOMORPHIC PHENOMENON
CLINICAL FORMS OF PSORIASIS
- COMMON PLAQUE OR NUMULAR PSORIASIS
- INVERSE OR FLEXURAL PSORIASIS
- GUTTATE PSORIASIS
- FOLLICULAR PSORIASIS
- PALMAR PSORIASIS
- PUSTULAR PSORIASIS
- EXFOLIATIVE PSORIASIS
- PSORIATIC ARTHRITIS
HISTOPATHOLOGY
- ACANTHOSIS WITH ELONGATION OF THE RETE RIDGES
- ELONGATION OF THE DERMAL PAPILLAE
- PARAKERATOSIS
- MUNRO’S MICROABSCESSES
TREATMENT
- TOPICAL : * SALICYLIC ACID
* TARS : LCD
* CORTICOSTEROIDS
* SUN - UV LIGHT THERAPHY
ANTHRALIN GOECKERMAN TECHNIQUE
& THE INGRAM TECHNIQUE
* PUVA/ NARROW BAND UVB
* CALCIPOTRIOL
* TACROLIMUS
* PIMECROLIMUS
- SYSTEMIC : * ANTIMITOTIC AGENTS : METHOTREXATE
* ETRETINATE
* CYCLOSPHORIN
- DIALYSIS
PROGNOSIS QUO AD VITAM TYPE OF PSORIASIS
QUO AD FUNCTIONAM AD BONAM
QUO AD SANATIONAM DUBIA AD MALAM
SEBORRHEIC DERMATITISSEBORRHEIC DERMATITIS
CHRONIC DERMATOSIS CHARACTERIZED BY
REDNESS & SCALING
ITS OCCURS IN THE AREAS OF THE SKIN IN WHICH
THE SEBACEOUS GLANDS ARE MOST ACTIVE:
FACE, SCALP, IN THE BODY FOLDS, PRESTERNAL REGION
ETIOLOGY ?
MANY HYPOTHESES HAVE BEEN MADEAS TO ITS CAUSE
- SEBORRHEA
- PITYROSPORUM OVALE INFECTION
- INFECTION BY CANDIDA OR STAPHYLOCOCCI
- EMOTIONAL RESPONSES TO STRESS OR FATIQUE
- ABNORMAL DIET
EPIDEMIOLOGY
- AGE : * INFANCY
* PUBERTY
* > 50 YEARS
- SEX : MALES
- INCIDENCE : VERY COMMON
- PREDISPOSING FACTOR : OFTEN A GENETIC DIATHESIS
CLINICAL MANIFESTATIONS
INFANCY * CRADLE CAP
* GLABROUS : FLEXURAL, DIAPER AREA & TRUNK
* GENERALIZED : LEINER’S DISEASE
ADULTS
* SCALP: PITYRIASIS SICCA
* FACIAL, FLEXURAL & TRUNCAL
* GENERALIZED: ERYTHRODERMA
LABORATORY FINDINGS
HISTOPATHOLOGY
DIFFERENTIAL DIAGNOSIS :
- ATOPIC DERMATITIS
- ALLERGIC AND IRRITANT CONTACT DERMATITIS
- PITYRIASIS ROSEA
- DERMATOPHYTE INFECTION
- CANDIDIASIS
TREATMENT :* CONSERVATIVE
- SHAMPOO
- EMOLLIENTS & CREAMS
* INTENSIVE
- KETOCONAZOLE CREAM
- TOPICAL STEROIDS
- TAR PREPARATIONS
PROGNOSIS:
QUO AD VITAM: AD BONAM QUO AD FUNCTIONAM: AD BONAM QUO AD SANATIONAM: DUBIA AD BONAM
PITYRIASIS ROSEAPITYRIASIS ROSEAPROBABLY CAUSED BY AN INFECTIOUS AGENT
AGE : 10 - 35 YEARS
DURATION OF LESIONS :
- A “ HERALD PATCH “ PRECEDES THE
EXANTHEMATOUS PHASE
- THE EXANTHEMATOUS PHASE DEVELOPS OVER A
PERIOD OF 1 TO 2 WEEKS
PHYSICAL EXAMINATION :
-SKIN SYMPTOMS : PRURITUS
ABSENT, MILD OR SEVERE
- SKIN LESIONS
* HERALD PATCH 2 - 5 CM, BRIGHT RED, SCALE
* FINE SCALING MACULES AND PAPULES WITH MARGINAL COLLARETTE
CHARACTERISTIC PATTERN OF THE LESIONS:
THE LONG AXES OF THE LESIONS FOLLOW THE
LINES OF CLEAVAGE
“CHRISTMAS TREE “ DISTRIBUTION
TRUNK & PROXIMAL OF THE ARMS & LEGS
DIFFERENTIAL DIAGNOSIS
- DRUG ERUPTIONS
- T. CORPORIS
- SECONDARY SYPHILIS
- T. VERSICOLOR
TREATMENT
- TOPICAL : * POWDER
* CREAM ( CORTICO STEROID )
- SYSTEMIK : ANTIHISTAMINES
PROGNOSIS :
QUO AD VITAM : AD BONAM
QUO AD FUNCTIONAM : AD BONAM
QUO AD SANATIONAM : AD BONAM
SPONTANEOUS REMISSION IN 6 - 12 WEEKS
HERALD PATCH
ERYTHRODERMAERYTHRODERMAREACTION PATTERN OF THE SKIN CHARACTERIZED BY
GENERALIZED, CONFLUENT REDNESS, SCALING &
ASSOCIATED WITH SYSTEMIC SYMPTOMS
AGE ~ ETIOLOGY
ETIOLOGY
- EXTENSION OF PREEXISTING DERMATOLOGIC
DISEASE
PSORIASIS, ATOPIC DERMATITIS, SEBORRHEIC
DERMATITIS
- DRUGS REACTIONS
- SEZARY SYNDROME
- EXTENSION OF SYSTEMIC DISEASE
LUPUS ERYTHEMATOSUS
SKIN LESION UNIVERSALIS
SKIN IS RED, THICKENED & SCALY
LABORATORY & HISTOPATHOLOGY ~ ETIOLOGY
TREATMENT ~ ETIOLOGY
- THE PATIENT SHOULD BE HOSPITALIZED
- TOPICAL : EMOLLIENTS
- SYSTEMIC : CORTICOSTEROID
PROGNOSIS ~ ETIOLOGY
TRUE EPS
PITYRIASIS RUBRA PILARIS
PARAPSORIASIS EN PLAQUES
PARAPSORIASIS
LICHEN PLANUS
LICHEN PLANUS
LICHEN NITIDUS
LICHEN STRIATUS
EPS - LIKE
TINEA CORPORIS
TINEA CORPORIS
TINEA VERSICOLOR
MORBUS HANSEN
Drug eruption(erythema multiforme)
Maculopapular drug eruption e.c ampicillin
THANK YOU