Papulosqumaous disorder

Papulosqumaous disorder

DR.MIHERETU(MD+DV)

Cont…

Psoriasiform

psoriasis

seborrheic dermatitis

parapsoriasis/mycosis fungiodes

pityrasiform

Pityrasis rosea

secondary syphilis

Pityriasis rosea

Cont…

Tinea versicolor

LICHENOIDS

lichen planus

Drug induced lichen planus

ANNULAR

Tinea

ERYTHRODERMA

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

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

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

Epidemiology

is universal in its occurrence

The worldwide incidence varies considerably

with race, geography, and environmental

factors

prevalence 2% of the population

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

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.

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

Cont…

Skin

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

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.

Cont…

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Palm and sole psoriasis

Cont..

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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

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.

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

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

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

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.

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

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.

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

Cont…

Clincal presentation :

1)configuration

anular and linear

2)morphology

atrophic ,hypertrophic, vesiculobollus, erosive

and ulcerative, lichen planopilaris and,lichen

pigmentosum

3)Anatomic site

Cont…

Six ps :

purple/pink

Polygonal

Pruritic

Papule

Plaque

planar

Cont…

actinic

Cont..

Cont..

Diagnosis

histolopatology

lichenoid interface dermatitis

hypergranulosis

pigment inconitnence

Colloid bodies

Bands of lymphocyte infiltration

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.

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.

Pityriasis rosea

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Papulosqumaous disorder

Health & Medicine

Transcript of Papulosqumaous disorder