What is the characteristic feature of psoriasis of the scalp?
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Massive compaction of horny material on the entire scalp.
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What is the characteristic feature of psoriasis of the scalp?
Massive compaction of horny material on the entire scalp.
What is the characteristic appearance of plaques in inverse psoriasis?
Macerated, bright red, and fissured, usually not scaly.
What are the distribution types of Pityriasis rubra pilaris?
Types 1, 2, 3, 5, and 6.
What are the characteristics of PLC lesions?
Scaling papules of reddish-brown color with a central mica-like scale.
What distinguishes lesions in LPP (ICD10: L41.4) from SPP?
Lesions in LPP are oval or irregularly shaped patches and >5 cm, with minimal scaling, with and without atrophy, and may be poikilodermatous.
What is the characteristic appearance of acrodermatitis continua of Hallopeau?
Acral pustule formation, subungual lakes of pus, and destruction of nail plates, which may lead to permanent loss of nails and scarring.
What are the symptoms of Generalized Acute Pustular Psoriasis (Von Zumbusch)?
Burning, fiery-red erythema topped by pinpoint sterile yellow pustules, spreading rapidly over the entire body, with fever, malaise, and leukocytosis.
How is localized psoriasis managed?
With topical fluorinated glucocorticoid covered with plastic wrap, and glucocorticoid-impregnated tape.
What is the most effective therapy for Pityriasis Rubra Pilaris?
Methotrexate (MTX) and systemic retinoids.
What is the distribution pattern of pityriasis rubra pilaris types 1, 2, 3, 5, and 6?
Generalized, classically beginning on the head and neck, then spreading caudally.
What is the distribution pattern of pityriasis rubra pilaris type 4?
Localized orange plaque.
What is the chronic form of pityriasis lichenoides?
Pityriasis lichenoides chronica (PLC).
What are the characteristics of scalp psoriasis?
Plaques with thick adherent scales, often very pruritic, and does not lead to hair loss.
What are the characteristics of psoriasis on the scalp?
Plaques are sharply marginated with thick adherent scales, often very pruritic, and do not lead to hair loss.
What are the periarticular involvements associated with Psoriatic Arthritis?
Enthesitis, tenosynovitis, dactylitis ('sausage' digit), bone erosions, osteolysis, or ankylosis.
What are the differential diagnoses for Inverse Psoriasis?
Tinea, candidiasis, intertrigo, extramammary Paget disease.
How can inverse psoriasis be distinguished from intertrigo, candidiasis, and contact dermatitis?
Sharp demarcation of the plaques.
What is important to note about large plaque parapsoriasis?
These lesions must be carefully followed, and repeated biopsies are necessary to detect mycosis fungoides. It may be considered as a prestage of mycosis fungoides but not all patients progress to MF.
What are the characteristics of lesions in SPP (ICD10: L41.3)?
Small (<5 cm), round to oval, or linear mostly on the trunk, slightly infiltrated, yellowish, or fawn-colored patches with minimal scaling, asymptomatic, or mild pruritus.
What are the characteristics of psoriasis on palms and soles?
Massive silvery white or yellowish hyperkeratosis, sharply demarcated inflammatory plaque, cracking, painful fissures, and bleeding.
What are the characteristics of palmar pustulosis?
Creamy yellow pustules that are partially confluent on the palm, sterile, pruritic, and become painful when larger.
What is psoriatic arthritis?
A type of arthritis with the ICD10 code L40.5.
What is the age of onset for Pityriasis Rosea?
Ten to 43 years, but can occur rarely in infants and old persons.
What is the recommended treatment for scalp psoriasis with superficial scaling?
Tar or ketoconazole shampoos followed by betamethasone valerate, 1% lotion.
What is the ICD10 code for Pityriasis Rubra Pilaris?
L44.4.
What is the most effective therapy for generalized plaque psoriasis?
Combination therapy with 311nm UVB or PUVA.
What is the course and prognosis of Pityriasis Rubra Pilaris?
A socially and psychologically disabling condition. Long duration; type 3 often resolves after 2 years; type 4 may clear. Type 5 has a very chronic course. Type 6 may respond to highly active antiretroviral therapy (HAART).
How is Pustular Psoriasis characterized?
By pustules, not papules, arising on normal or inflamed, erythematous skin.
What are the characteristics of large plaque parapsoriasis lesions?
Asymptomatic, well-defined, rounded, slightly scaly, thin plaques or patches. They can be larger than 10 cm and are light red-brown or salmon-pink. Atrophy may be present in some areas.
What is the characteristic progression of Pityriasis rubra pilaris?
Generalized, classically beginning on the head and neck, then spreading caudally.
Describe the presentation of psoriasis vulgaris on the soles.
Erythematous plaques with thick, yellowish, lamellar scale and desquamation on sites of pressure, with a sharp demarcation of the inflammatory lesion on the arch of the foot.
When does the exanthem of pityriasis rosea typically appear after the herald patch?
One to two weeks after the herald patch.
What is the most effective treatment for psoriasis?
Systemic administration of MTX or retinoids.
What is the characteristic morphology of the herald patch in Pityriasis Rosea?
Oval, slightly raised plaque or patch 2 to 5 cm, salmon-red, with fine collarette scale at the periphery.
What is the classical manifestation of chronic stable plaque psoriasis?
Multiple large scaling plaques on the trunk, buttock, and legs. Lesions are round or polycyclic and confluent forming geographic patterns.
What are the differential diagnoses for Scalp Psoriasis?
Seborrheic dermatitis, tinea capitis.
What is the distribution pattern of Pityriasis Rosea on the back?
It forms a 'Christmas tree' pattern on the back.
What can differentiate Onychomycosis?
KOH examination.
What are the differential diagnoses for multiple small scaling plaques?
Drug eruptions, secondary syphilis, guttate psoriasis, small plaque parapsoriasis, erythema migrans, erythema multiforme, and tinea corporis.
What is the usual course of Pityriasis Rosea?
Spontaneous remission in 6 to 12 weeks or less, with uncommon recurrences.
What is the association between sudden onset of psoriasis and human immunodeficiency virus (HIV) infection?
Sudden onset of psoriasis may be associated with HIV infection.
What are the characteristics of digitate dermatosis (small plaque parapsoriasis)?
Asymptomatic, yellowish or fawn-colored, very thin, well-defined, slightly scaly, and superficially wrinkled patches. Oval in shape, following the lines of cleavage of the skin, often reaching more than 5 cm in length.
What are the characteristics of PLEVA lesions?
Randomly arranged bright red edematous papules, vesicles, central necrosis with hemorrhagic crusting.
What is the characteristic appearance of generalized acute pustular psoriasis (von Zumbusch)?
Showers of creamy-white coalescing pustules on a fiery-red base.
What are the components of topical therapies for psoriasis?
Emollients, keratolytic agents, vitamin D3 (calcipotriol), glucocorticoids, and vitamin A analogs (tazarotene).
Where are the lesions usually confined to in pityriasis rosea?
Trunk and proximal aspects of the arms and legs, rarely on the face.
What is the pathogenesis of Generalized Acute Pustular Psoriasis (Von Zumbusch)?
Unknown, but fever and leukocytosis result from the release of cytokines and chemokines into circulation.
What topical treatment is recommended for localized psoriasis?
Topical fluorinated glucocorticoid covered with plastic wrap.
What are the skin symptoms associated with chronic stable plaque psoriasis?
Pruritus is relatively common, especially in scalp and anogenital psoriasis.
What are the potential side effects of oral MTX therapy for psoriasis?
Hepatic toxicity, especially in patients with diabetes and/or obesity.
Where are the lesions generally found in acute guttate type psoriasis?
Disseminated, generalized, mainly on the trunk.
What is the recommended dose for cyclosporine treatment for psoriasis?
3 to 5 mg/kg per day.
What should all patients be screened for before starting monoclonal antibodies and fusion proteins treatment for psoriasis?
Tuberculosis, consider HIV.
What is the treatment for large plaque PP (LPP)?
Topical glucocorticoids, phototherapy, narrowband 311nm UV phototherapy, and PUVA.
How are the scales in chronic psoriasis of the perianal and genital regions different from typical psoriasis?
They are usually not scaly but macerated, bright red, and fissured.
What are the characteristics of large plaque parapsoriasis?
Asymptomatic, well-defined, rounded, slightly scaly, thin plaques or patches. Light red-brown or salmon-pink in color, can be larger than 10 cm, and may show atrophy in some areas.
What are the predilection sites for psoriasis?
Bilateral, often symmetric; often spares exposed areas.
What is the differential diagnosis for PLEVA?
Varicella, guttate psoriasis, and lymphomatoid papulosis.
What is observed in the palms and soles in type 1 of Pityriasis rubra pilaris?
Diffuse, waxy, yellowish/orange hyperkeratosis.
What is psoriatic erythroderma?
A condition where psoriasis involves the entire skin.
What are the special types of Generalized Acute Pustular Psoriasis (Von Zumbusch)?
Impetigo herpetiformis, Annular type, Psoriasis cum pustulatione, Acrodermatitis continua of Hallopeau.
What is the treatment for chronic stable plaque psoriasis in the given case?
Cleared by acitretin /PUVA combination treatment within 4 weeks.
What are the long-term side effects of PUVA treatment?
Keratoses and squamous cell carcinomas in some patients.
What serious disease can be mistaken for Inverse Psoriasis?
Glucagonoma syndrome.
What is the highly effective therapy for generalized plaque psoriasis?
Combination of 311nm UVB or PUVA (rePUVA).
What is the course and prognosis of Acute Guttate Psoriasis?
It appears rapidly, sometimes disappears spontaneously, and more often evolves into chronic plaque psoriasis.
What is the incidence of Palmar Pustulosis compared to psoriasis vulgaris?
Low.
How is the diagnosis of acute guttate psoriasis made?
On clinical grounds.
What is the progression pattern of pityriasis rubra pilaris types 1, 2, 3, 5, and 6?
Progression to erythroderma (except for types 2 and 4).
What is the acute form of pityriasis lichenoides?
Pityriasis lichenoides et varioliformis acuta (PLEVA).
How does psoriasis appear in people with darker skin tones?
Lacks bright red color, lesions are brown to black with similar morphology as in lighter skin.
What is the ICD10 code for Psoriatic Erythroderma?
L40.
What is the characteristic of Psoriatic Arthritis included among the seronegative spondyloarthropathies?
It can present as distal arthritis, asymmetric oligoarthritis, symmetric polyarthritis, arthritis mutilans, sacroiliitis, and spondylitis.
What factors influence the selection of treatment for psoriasis?
Age, type of psoriasis, site and extent of involvement, previous treatment, and associated medical disorders.
What examination is mandatory for diagnosing Tinea corporis, particularly in single lesions?
Potassium hydroxide (KOH) examination.
What are the common nail changes associated with Pityriasis Rubra Pilaris?
Distal yellow-brown discoloration, nail plate thickening, subungual hyperkeratosis, and splinter hemorrhages.
What is the recommended treatment for acute, guttate psoriasis?
Treat streptococcal infection with antibiotics, narrowband UVB phototherapy (311 nm) is very effective.
What are the treatment options for Psoriatic Arthritis?
Methotrexate (MTX) and biologics.
What are the topical therapies for Pityriasis Rubra Pilaris?
Emollients, keratolytic agents, vitamin D3 (calcipotriol), glucocorticoids, and vitamin A analogs (tazarotene).
What are the nail changes seen in psoriasis of the fingernails?
Pitting, oil spots, and onycholysis.
What is the significance of increased serum uric acid in psoriasis?
It is increased in 50% of patients, usually correlated with the extent of the disease, and there is an increased risk of gouty arthritis.
What are the characteristics of papules in darker skin tones in pityriasis rubra pilaris?
Papules are brown.
What are the two forms of Pityriasis Lichenoides (PL)?
Acute form (PLEVA) and chronic form (PLC).
What is the appearance of the herald patch in pityriasis rosea?
An erythematous (salmon-red) plaque with a collarette scale on the trailing edge of the advancing border.
How is the scalp affected in Pityriasis rubra pilaris?
Similar to psoriasis, often leading to asbestoslike accumulation of scale.
What is the progression difference between SPP and LPP?
SPP does not progress to mycosis fungoides (MF), while LPP exists on a continuum with patch-stage MF and can progress to overt MF.
What is the usual association of psoriasis on the face?
Uncommon but usually associated with a refractory type of psoriasis.
What is the most probable cause of Pityriasis Rosea?
Reactivation of human herpesvirus 7 (HHV7) and HHV6.
What can scaling plaques indicate as an initial stage?
Mycosis fungoides.
What treatment is recommended for palmoplantar pustulosis?
PUVA soaks and glucocorticosteroids are effective, systemic treatment for recalcitrant cases.
What should be recognized early in order to prevent bone destruction?
Psoriatic Arthritis.
What are the atypical patterns of Pityriasis Rosea?
Scalp and face involvement in children, inverse pattern in axillary and inguinal areas, purpuric, papular, urticarial, and vesicular variants.
What should be monitored during cyclosporine treatment for psoriasis?
Blood pressure and serum creatinine due to the known nephrotoxicity of the drug.
What are the management options for Pityriasis Rosea?
Oral antihistamines, phototherapy, topical glucocorticoids for relief of pruritus, oral erythromycin, and acyclovir if prescribed early in the course.
What are the differential diagnoses for acute guttate psoriasis?
Any maculopapular drug eruption, secondary syphilis, pityriasis rosea.
What distinguishes inverse psoriasis from intertrigo, candidiasis, and contact dermatitis?
Sharp demarcation and the absence of scales.
Why are repeated biopsies necessary for large plaque parapsoriasis lesions?
To detect mycosis fungoides.
What is the progression in type 4 of Pityriasis rubra pilaris?
Localized orange/red plaques.
What is the characteristic appearance of annular pustular psoriasis?
Expanding ring-like micropustular eruptions on a highly inflammatory base, resulting in a collarette-like scaling at the margin.
What is the presentation of psoriasis of the scalp?
Massive compaction of horny material on the entire scalp, with thick asbestoslike scales compacting hairs but not leading to alopecia, and involvement of the forehead.
What is the ICD10 code for Pityriasis Rosea?
L42.
What is the recommended management for psoriasis?
By a dermatologist.
What are the characteristics of palm in Type 1 Pityriasis Rubra Pilaris?
Diffuse, waxy, yellowish/orange hyperkeratosis.
What are the characteristics of acute guttate type psoriasis?
Salmonpink papules (guttate: Latin gutta, “drop”), 2.0 mm to 1.0 cm with or without scales. Scales may not be visible but become apparent upon scraping.
What are the differential diagnoses for Pityriasis Rubra Pilaris?
Psoriasis, follicular ichthyosis, erythrokeratodermia variabilis, and ichthyosiform erythrodermas.
What are the distribution and predilection sites for chronic stable type psoriasis?
Single lesion or lesions localized to one or more predilection sites: elbows, knees, sacral gluteal region, scalp, and palm/soles. Sometimes only regional involvement (scalp), often generalized.
What are the common findings in dermatopathology for Pityriasis Rosea?
Patchy or diffuse parakeratosis, absence of granular layer, slight acanthosis, focal spongiosis, microscopic vesicles, occasional dyskeratotic cells, edema of dermis, and perivascular infiltrate of mononuclear cells.
What are the characteristics of dermatopathology in psoriasis?
Marked overall thickening of the epidermis, increased mitosis of keratinocytes, fibroblasts, and endothelial cells, parakeratotic hyperkeratosis, and inflammatory cells in the dermis and epidermis.
What conditions may be indistinguishable from small scaling plaques of psoriasis?
Seborrheic dermatitis, lichen simplex chronicus, psoriasiform drug eruptions, and tinea corporis.
What nail changes are frequently observed in psoriasis?
Pitting, subungual hyperkeratosis, onycholysis, and oil spots (yellowish-brown spots under the nail plate).
What are the characteristics of psoriasis vulgaris on the palms?
Adherent scales with fissures, erythematous base, and sharp margin on the wrist.
Describe the distribution pattern of the lesions in pityriasis rosea.
Oval, scattered, with characteristic distribution following the lines of cleavage in a “Christmas tree” pattern.
What is the treatment of choice if oral antibiotics fail for Pityriasis Lichenoides?
Ultraviolet radiation (natural sunlight or broadband UVB), 311nm UVB, and PUVA.
What are the treatment options for SPP and LPP?
Topical glucocorticoids, phototherapy, narrowband 311nm UV phototherapy, PUVA.
What are some previous treatments for psoriasis?
Ionizing radiation, systemic glucocorticoids, photochemotherapy (PUVA), cyclosporine (CS), and methotrexate (MTX).
How can scratching be prevented in localized psoriasis?
By using hydrocolloid dressing left on for 24 to 48 hours.
What are the six types of Pityriasis Rubra Pilaris (PRP)?
Type 1: Classic Adult, Type 2: Atypical Adult, Type 3: Classic Juvenile, Type 4: Circumscribed Juvenile, Type 5: Atypical Juvenile, Type 6: HIV Associated.
What is the appearance of scales in acute guttate type psoriasis?
Scales are lamellar, loose, and easily removed by scratching. Removal of scale results in the appearance of minute blood droplets (Auspitz sign).
What are the histopathological findings suggestive of Pityriasis Rubra Pilaris?
Hyperkeratosis, acanthosis with broad short rete ridges, alternating orthokeratosis, and parakeratosis. Keratinous plugs of follicular infundibula and perifollicular areas of parakeratosis. Prominent granular layer may distinguish PRP from psoriasis. Superficial perivascular lymphocytic infiltrate.
What is the etiology and pathogenesis of Pityriasis Rubra Pilaris?
Unknown.
What are the effective tumor necrosis factor-alpha (TNF-α) antagonists for psoriasis?
Infliximab, adalimumab, etanercept, and certolizumab.
What is the recommended culture for acute guttate psoriasis?
Throat culture for group A β hemolytic streptococcus infection.
What are the characteristics of chronic stable plaque psoriasis?
Multiple large scaling plaques on the trunk, buttock, and legs. Lesions are round or polycyclic and confluent forming geographic patterns.
What is the treatment for psoriasis involving oral ingestion of 8MOP and exposure to UVA?
Oral PUVA treatment.
What are the associated conditions with different types of Pityriasis Rubra Pilaris?
Ichthyosiform lesions on legs in type 2, sclerodermalike appearance of hands and feet in type 5, acne conglobata, hidradenitis suppurativa, and lichen spinulosus in type 6.
What are the proximal aspects of the body where Pityriasis Rosea is commonly found?
Proximal aspects of the arms and legs.
What comorbidities is psoriasis associated with?
Increased morbidity and mortality from cardiovascular events, metabolic syndrome, hypertension, and hyperlipidemia.
What are the clinical manifestations of Pityriasis Rubra Pilaris?
Insidious and rapid onset, skin lesions including follicular hyperkeratotic papules of reddish-orange color, and a psoriasiform, scaling dermatitis with sharply demarcated islands of unaffected skin.
What are the two types of parapsoriasis en plaques (PP)?
Small plaque PP (SPP) and large plaque PP (LPP).
What conditions can be mistaken for scalp psoriasis?
Seborrheic dermatitis and tinea capitis.
What is the recommended dosing for oral MTX therapy?
Once-weekly dosing starting at 5 to 7.5 mg.
What is Acrodermatitis Continua Hallopeau associated with?
Oral retinoids as in von Zumbusch pustular psoriasis; MTX, CS, and biologics are other treatment options.
What is the most effective treatment for Pityriasis Rubra Pilaris?
Systemic administration of MTX or retinoids (both as in psoriasis). In type 6: HAART. The anti-TNF agents, for example, infliximab and etanercept, are effective.
What is the mechanism of action of Ustekinumab in psoriasis treatment?
It is a human IgG1 κ monoclonal antibody that binds to the common p40 subunit of human IL12 and IL23, preventing its interaction with its receptor.
What conditions should be considered in the differential diagnosis of large geographic plaques in psoriasis?
Tinea corporis and mycosis fungoides.
What is the significance of increased antistreptolysin titer in acute guttate psoriasis?
It indicates an antecedent streptococcal infection.
What are the differential diagnoses for inverse psoriasis?
Tinea, candidiasis, intertrigo, extramammary Paget disease, glucagonoma syndrome, Langerhans cell histiocytosis, and Hailey–Hailey disease.