ERYTHRO PAPULO

SQUAMOUS
ERUPTION

Erythro-Papulo-Squamous (EPS)
CHARACTERIZED BY
ERYTHEMA,
PAPULES OR PLAQUES
AND SCALLING
TRUE EPS & EPS-LIKE

A. TRUE EPS
1. 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

PSORIASIS
* 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
- MUNROS 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 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 MADE

AS 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 : LEINERS 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 ROSEA
PROBABLY 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

ERYTHRODERMA

REACTION 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