Chapter 053. Eczema and Dermatitis (Part 6)

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Psoriasis (Table 53-2) Psoriasis is one of the most common dermatologic diseases, affecting up to 1% of the world's population. It is a chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques, covered by silvery micaceous scale. The skin lesions of psoriasis are variably pruritic. Traumatized areas often develop lesions of psoriasis (Koebner or isomorphic phenomenon). Additionally, other external factors may exacerbate psoriasis including infections, stress, and medications (lithium, beta blockers, and antimalarials). Table 53-2 Papulosquamous Disorders Clinical Features Other Notable Features Histologic Features Psoriasis Sharply demarcated, May be aggravated Acanthosis, by vascular erythematous plaques certain with mica-like scale; infection; predominantly elbows, severe knees,...

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Chapter 053. Eczema and Dermatitis (Part 6) Psoriasis (Table 53-2) Psoriasis is one of the most common dermatologic diseases, affecting up to 1% of the world's population. It is a chronic inflammatory skin disorder clinically characterized by erythematous, sharply demarcated papules and rounded plaques, covered by silvery micaceous scale. The skin lesions of psoriasis are variably pruritic. Traumatized areas often develop lesions of psoriasis (Koebner or isomorphic phenomenon). Additionally, other external factors may exacerbate psoriasis including infections, stress, and medications (lithium, beta blockers, and antimalarials).
Table 53-2 Papulosquamous Disorders Clinical Other Histologic Features Notable Features Features Psoriasis Sharply May be Acanthosis, demarcated, aggravated by vascular erythematous plaques certain drugs, proliferation with mica-like scale; infection; predominantly elbows, severe forms knees, and scalp; seen associated atypical forms may with HIV localize to intertriginous areas; eruptive forms may be associated with infection
Lichen planus Purple Certain Interface polygonal papules drugs may dermatitis marked by severe induce: pruritus; lacy white thiazides, markings, especially antimalarial associated with drugs mucous membrane lesions Pityriasis rosea Rash often Variable Pathologic preceded by herald pruritus; self- features often patch; oval to round limited nonspecific plaques with trailing resolving in 2– scale; most often 8 weeks; may affects the trunk, and be imitated by eruption lines up in secondary skin folds giving a "fir syphilis tree"-like appearance; generally spares palms and soles
Dermatophytosis Polymorphous KOH Hyphae appearance depending preparation and neutrophils in on dermatophyte, may show stratum corneum body site, and host branching response; sharply hyphae; culture defined to ill- helpful demarcated scaly plaques with or without inflammation; may be associated with hair loss The most common variety of psoriasis is called plaque-type. Patients with plaque-type psoriasis will have stable, slowly enlarging plaques, which remain basically unchanged for long periods of time. The most commonly involved areas are the elbows, knees, gluteal cleft, and the scalp. Involvement tends to be symmetric. Plaque psoriasis generally develops slowly and runs an indolent course. It rarely remits spontaneously. Inverse psoriasis affects the intertriginous regions including the axilla, groin, submammary region, and navel; it also tends to affect the scalp, palms, and soles. The individual lesions are sharply demarcated
plaques (see Fig. 52-7), but they may be moist and without scale due to their location.