Papulosquamous Diseases
General Information on Papulosquamous Diseases
- the papulosquamous diseases are generally scaly, like the eczematous diseases
- difference from the eczemas
1) epidermis is generall thicker
2) more clinically elevated scaly condition
3) better described as a plaque than a patch
4) eventually develop acanthosis and hyperkeratosis to a greater degree
5) more sharply defined
- some diseases may be both papulosquamous or eczematous depending on the stage
Specific Papulosquamous Diseases
Psoriasis
- familial disease involving 1% of the population
- may begin at any age; usually starts in adulthood
- sharply-demarcated plaques with a ham-red color and thick, heaped-up silvery scales
- lesions occur most commonly in areas of trauma – “Koebner phenomenon”
- involves elbows, knees, scalp, buttocks, and intergluteal cleft
- avoids areas like the face because the UV light helps retard the lesions
- associated sith severe nail changes
- 5% of patients develop psoriatic arthritis
- Biopsy: hyperkeratosis, acanthosis, parakeratosis, neutrophils in stratum corneum
- Treatment: topical tar, corticosteroids, UV light, topical anthralin (maybe methotrexate)
Lichen Planus
- idiopathic disorder
- less scaly than the other papulosquamous disorders
- Plaques have the 3 P’s
- purple
- polygonal
- very pruitic
- flat-topped plaques/ sharply-angulated straight edges resemble polygons
- covered with a fine, reticulated scale – Wickham’s striae
- Koebner phenomenon also seen as in psoriasis
- Mucus membrane involvement common
- Biopsy: bandlike infiltrate of lymphocytes and histiocytes
Lichen Simplex Chronicus (LSC)
- eczema that became elevated enough to be called papulosquamous
- less sharply-demarcated than the other papulosquamous diseases
- commonly occurs in rubbed areas – posterior neck, upper back, lower back, anterior legs, genitalia
- diagnosis implies no specific cause – only a scaly process that is being chronically rubbed
- try to determine the 1o cause – tinea, contact dermatitis, scabies, atopical dermatitis
Pityriasis Rosea
- acute, common disorder thought to be of viral origin
- occurs in young adults
- spontaneously resolves in 6 weeks
- plaques are oval to annular
- involve the trunk, proximal extremities, and rarely the face
- often – a single 2-6 mm lesion (herald patch) occurs prior to the onset of numerous others
- rule out 2osyphilis
- Treatment: symptomatic relief or pruitis with topical steroids or oral anti-histamines
Secondary (2o) Syphilis
- on the maculopapular, eczematous, and the papulosquamous list
- associated with: headache, fever, lymphadenopathy, and palmar/plantar lesions
- do Serology (RPR or VDRL)
Tags: Acanthosis, atopical dermatitis, Contact dermatitis, Hyperkeratosis, Koebner phenomenon, Lichen Planus, Lichen Simplex Chronicus, neutrophils in stratum corneum, Parakeratosis, psoriasis, psoriatic arthritis, scabies, tinea
