CHARACTERIZED BY ERYTHEMA, PAPULES OR PLAQUES AND SCALING

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

PSORIASISPSORIASIS

* 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

Mekanisme terjadinya Psoriasis

CLINICAL MANIFESTATIONS

- A SHARPLY DEFINED BORDER, A BRIGHT RED

COLOR & A SILVERY - WHITE SCALE DELINEATE

THE LESION OF PSORIASIS

- SITE 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

Chronic Plaque psoriasis

Guttate psoriasis

Flexural psoriasis

Scalp psoriasis

Palmoplantar psoriasis

Nail psoriasis

Pustular psoriasis

Erythrodermic psoriasis

HISTOPATHOLOGY

- ACANTHOSIS WITH ELONGATION OF THE RETE RIDGES

- ELONGATION OF THE DERMAL PAPILLAE

- PARAKERATOSIS

- MUNRO’S MICROABSCESSES

TREATMENT

- TOPICAL : * SALICYLIC ACID

* TARS

* CORTICOSTEROIDS

* SUN - UV LIGHT THERAPHY

ANTHRALIN GOECKERMAN TECHNIQUE

AND THE INGRAM TECHNIQUE

* PUVA

- SYSTEMIC : * CORTICOSTEROIDS

* ANTIMITOTIC AGENTS

* ETRETINATE

* AROXMATIC RETINOIDS

- DIALYSIS

PROGNOSIS QUO AD VITAM TYPE OF PSORIASIS

QUO AD FUNCTIONAM AD BONAM

QUO AD SANATIONAM DUBIA AD BONAM

SEBORRHEIC DERMATITISSEBORRHEIC 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 MADEAS 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

Seborrhoeis dermatitis

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 ROSEAPITYRIASIS 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 IN A

“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

ERYTHRODERMAERYTHRODERMA

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 :

SKIN IS RED, THICKENED & SCALY UNIVERSALIS

LABORATORY & HISTOPATHOLOGY ~ ETIOLOGY

TREATMENT ~ ETIOLOGY

- THE PATIENT SHOULD BE HOSPITALIZED

- TOPICAL : EMOLLIENTS

- SYSTEMIC : CORTICOSTEROID

PROGNOSIS ~ ETIOLOGY