Dermatology: Psoriasis

Typical areas of elbows, knees, scalp, nails, usually sparing PALMS AND SOLES AND FACE-can be small papules to large plaques-Chronic and recurrent course

-Acute posratic eruption, with tear drop shaped lesions, occuring 1-2 weeks after URT infections with Streptococcus-Obtain throat culture and anti-streptolysin O titers-Treatment with Abx and rapid resolution of lesions

-a tender pustular eruption of the palms and soles where pustules come to the surface and desquamate, but DO NOT RUPTURE-Higher prevalence in smokers-Very resistant tot standard therapy

Aka: Acrodermatitis contnuaClinically: localized form of psoriasis, found on the finger with tender, eroded, and fissured surface-very resistant to standard therapy

Aka: pustular psoriasis of von ZumbuschClinically: Rare, serious disease with tiny sterile pustules coalescing into lakes of pus. -Pt is febrile, toxic, and elevated WBCTx: wet dressing, topical sterioids, but may require oral therapy with etretinate, MTX, or cyclosporine

-SEvere diseas usually occuring in previous psoriatic patients where precipitating factors, such as illness or stress, has lead to worsening state-Tx: cool compresses, oatmeal baths, systemic therapy with etretinate or MTX

Aka: psoriasis inversusClinically: intertiginous psoriasis( gluteal fold, groin, diaper area, etc) characterized by red, smooth plaques that commonly fissure at base of body crease

-Nail pitting->MOST COMMON and well known cause of nail pitting-Onycholyis-> lifting of nail plate offf of the nail bed-subungal hyperkaratosis-> scale under the nail plate-Nail deformity, if nail matrix involved

General Info:a. Rheumatoid factor NEGATIVEb. 5% of psoriatic have true psoriatic arthritis, and usually have more extensive cutaneous involvmentc. Tx is with NSAIDs, Gold, and MTX and azathioprine-most commononly is assymetic-"sausage fingers and toes"

Less than 20% involved-Topical Steroids(in pulse doses)-Calcipotriol(Dovonox)-Antrhalin-Tar-UVB and lubricating agents or Tar-Tape of occlusive dressing-intralesional steroids

-UVB and tar-PUVA-Systemic Tx: MTX, HYDREA, etretinate, cyclosporine*, hospitalization in severe cases

General: rare, chronic disease characterized by thickened and yellow palms and soles, erythroderma(red skin), "islands of sparing"Etiology: unknown, onset in adulthood or childhoodClinically:1. starts w/ red scaling plaque on face or upper body that enlarge over days to weeks with thickening of palms and soles2. skip areas of redness occur and follicular paupules on elbow and knee develop. NO ITCHING3. Other features: thickened nails, ectropion4. duration of disease is 3 years in 80% of pt5. Childhood PRP-> red to orage keratotic plaques confined to elbows and knees with longer chronic courseTX: lubricants, vit D3, retinoids,(accutane, etretinate) MTX

General: A common, chronic papulosquamous diseaseEtiology: possible overgrowth of a yeast, Pityrosporum ovaleclinically: 1. cradle cap: infants with greasy scale on scalp; treat with topical steroid lotions and daily shampooing2. tinea amantacea: dense plaques of adherent scale on scalp of children or teenagers-usually Hx of cradle capTx: scale removing type shampoos(tar, sal. acid and topical steroid solutions3. Seborrheic Blepharitis: seb derm of eyelid skin-Tx w/ lid scrubs and baby shampoo4. classic adult Seborrheic Dermatitis: white, dry scale of the scalp, eyebrows, ears, post auricular areas, beard area, chest axillae, groin, and inframammary-VERY COMMON in Parkinson's patients and AIDS patients

Scalp involvement:- nizoral shampoo, tar shampoo, sal acid, -steroid lotions of solutionsSkin involvement:-nizoral cream-zinc or selenium soaps-low potency steroids

General info: eruption on 2nd-3rd decade of life, winter and spring commonEtiology: unknown, thought to be viralclinically: Starts with single lesion "heral patch" usually on trunk resembling "ringworm" and 1 or 2 weeks generalized secondary eruption; the entire process remits spontaneously in 6 weeks without therapy-Pruritus absent 25% of time, mild 50% of time-Eruption is characterized by bright red, oval papules and plaques with fine collarette scale at periphery3.distribution: characterisic pattern "Christmas Tree pattern" on trunk and proximal aspect so arms and legs. rarely faceTx: self limited-tx the symptoms-antihistamines if itchy