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Toronto Notes 2019
Papulosquamous Diseases
Dermatology D17
Investigations
• consideraskinbiopsy
• hepatitisCserologyifpatienthasriskfactors
Management
• topicalorintralesionalcorticosteroids
• shortcoursesoforalprednisone(rarely)
• phototherapyororalretinoidsorsystemicimmunosuppressants(e.g.azathioprine,methotrexate,
cyclosporine) for extensive or recalcitrant cases
Pityriasis Rosea
Clinical Presentation
• acute,self-limitingeruptioncharacterizedbyred,ovalplaques/patcheswithcentralscalethatdoesnot extend to edge of lesion
• longaxisoflesionsfollowsskintensionlines(i.e.Langer’sLines)paralleltoribsproducing“Christmas tree” pattern on back
• varieddegreeofpruritus
• moststartwitha“herald”patchwhichprecedesotherlesionsby1-2wk
• commonsites:trunk,proximalaspectsofarmsandlegs
Etiology
• suspectedHHV-7orHHV-6reactivation
Investigations
• nonerequired
Management
• nonerequired;clearsspontaneouslyin6-12wk
• symptomatic:topicalglucocorticoidsifpruritic,coolcompresses,emollients
Psoriasis
Classification
1. plaque psoriasis 2. guttate psoriasis 3. erythrodermic psoriasis 4. pustular psoriasis 5. inverse psoriasis
Pathophysiology
• notfullyunderstood,geneticandimmunologicfactors
• shortenedkeratinocytecellcycleleadstoTh1-andTh17-mediatedinflammatoryresponse
Epidemiology
• 1.5-2%, M=F
• allages:peaksofonset:20-30yroldand50-60yrold
• polygenicinheritance:8%with1affectedparent,41%withbothparentsaffected
• riskfactors:smoking,obesity,alcohol,drugs,infections,physicaltrauma(Koebnerphenomenon)
Differential Diagnosis
• AD,mycosisfungoides(cutaneousT-celllymphoma),seborrheicdermatitis,tinea,nummular dermatitis, lichen planus
Investigations
• biopsy(ifatypicalpresentation,rarelyneeded)
1 . PLAQUE PSORIASIS
Clinical Presentation
• chronicandrecurrentdiseasecharacterizedbywell-circumscribederythematouspapules/plaqueswith silvery-white scales
• oftenworseinwinter(lackofsun)
• Auspitzsign:bleedsfromminutepointswhenscaleisremoved
• commonsites:scalp,extensorsurfacesofelbowsandknees,trunk(especiallybuttocks),nails,pressure
areas
