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

- 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 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 : 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 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 LINE

S 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 & ASS
OCIATED 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