Papulosquamous Disorders : Types and Treatment
Feb 13, 2023
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PSORIASIS
Histology
Treatment
LICHEN PLANUS
Isomorphic/ Koebner's phenomenon
Histology
Treatment
PITYRIASIS ROSEA
Previous Year Questions
Papulosquamous disorders are a group of skin conditions characterized by the presence of papules and/or scaly patches on the skin. They are considered an important topic for the NEET PG exam.
There are several types of papulosquamous disorders, including psoriasis, pityriasis rosea, seborrheic dermatitis, and others. Each type of papulosquamous disorder has its own set of clinical features, causes, and treatments.
This blog covers some important details on Papulosquamous disorders. Read on and elevate your Dermatology preparation for the NEET PG exam.
PSORIASIS
- HLA -CW6 association seen in juvenile psoriasis.
- HLA- B27- psoriatic arthritis, reactive arthritis.
- Most common type is P. vulgaris.
- Erythematous plaque with silvery white like scaling.
- Extensors are commonly involved.
- Inverse Psoriasis flexors are involved.
- Guttate Psoriasis is seen in children after URTI.
- Erythrodermic psoriasis- presence of erythematous papules.
- Pustular psoriasis- presence of pus-filled lesions.
- In pregnancy, it is called impetigo herpetiformis.
- Nail changes - Pitting seen which is irregular & deep
- Clinical Sign
- Auspitz sign - PinPoint bleeding spots in rubbing the lesion
- Woronoff ring & Berkeley membrane is seen
Histology
- Tortuous & Dilated blood vessels in dermis.
- T cell infiltration in dermis.
- Absence of stratum granulosum & thickening of stratum spinosum (acanthosis).
- Dermal papillae enlarged with supra papillary thinning.
- Munroe's microabscess & kogoj pustules seen.
Treatment
- Systemic - Methotrexate, Cyclosporine, Acitretin
- Topical drugs - Corticosteroid
- Keratolytic agent - Salicylic acid, Coal Tar
- Phototherapy
- Biological
- Secukinumab (Anti IL-17A)
- Ustekinumab (Anti IL-12/23)
- TNFα inhibitors - Infliximab, Etanercept, Adalimumab
- Drug of Choice
- Psoriatic arthritis - Methotrexate
- Erythrodermic psoriasis - Methotrexate
- Pustular psoriasis - Acitretin
- In pregnancy - Corticosteroids > Cyclosporine
Important Information
- MC joint is psoriatic arthritis- DIP (Distal interphalangeal joint).
- MC type of psoriatic arthritis- asymmetrical oligoarticular type.
- X-Ray findings- pencil in cup deformity.
Dermatology Related Articles:
LICHEN PLANUS
- Autoimmune
- Skin - 5 P’s i.e. plane (flat-topped), purple, polygonal, pruritic, papules/plaques.
- Mucosa – White Lacy pattern /Reticulate pattern
- Nails - Pterygium
- Hair - Scarring alopecia /cicatricial alopecia
- Skin lesions have a reticulate pattern k/a Wickham's striae.
- Associated with HCV
- Isomorphic/ Koebner's phenomenon seen
Isomorphic/ Koebner's phenomenon
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Histology
- Basal cell degeneration
- Civatte/colloid bodies seen
- Saw toothed appearance
- Max-Joseph space
- Thickening of stratum granulosum (wedge shaped Hypergranulosis)
- Thickening of stratum spinosum (Irregular Acanthosis)
Treatment
- Steroids (topical/systemic/intralesional)
- Generalized cases - phototherapy
PITYRIASIS ROSEA
- Associated with HHV 6 & 7
- 1stpatch is k/a Herald/Mother patch
- Lesions - Fir tree pattern seen on trunk
- Common in females
- Self-limiting
- Cigarette paper scales/collarette of scale seen
- Hanging curtain sign seen
Previous Year Questions
Q. Psoriatic plaques responded to steroids but on withdrawal, the following presentation occurred. Diagnosis? (AIIMS NOV 2019)
- Staph infection
- Pustular dermatosis
- Pustular psoriasis
- Sub-corneal pustulosis
Q. Auspitz sign seen in? (FMGE August 2020)
- Pemphigus vulgaris
- Psoriasis vulgaris
- Pustular psoriasis
- DLE
Q. Patient suffering from chronic plaque psoriasis with >50% of BSA involved, which of the following is not used in the treatment? (INICET Nov 2020)
- NB UVB
- Coal tar
- Cyclosporine
- Prednisolone
Q. Which is a true association? (AIIMS NOV 2019)
- Lichen planus and malignant melanoma
- Melasma and malignant melanoma
- Psoriasis and metabolic syndrome
- Vitiligo and metabolic syndrome
Q. A lady with bilateral buccal involvement having lacy white pattern, unable to scrape the white. Pain increases on spicy food intake. There is no history of tobacco but having history of amalgam dental filling on 3rd molar tooth. The likely diagnosis is? (FMGE June 2021)
- Lichen planus
- Erythroleukoplakia
- Leukoplakia
- Candida
Q. Identify the phenomenon shown in the image? (NEET PG Jan 2020)
- Isomorphic phenomenon
- Reverse isomorphic
- Gottron papules
- Nikolsky sign
Q. Max Joseph Space is a histopathological feature? (JIPMER MAY 2019)
- Psoriasis vulgaris
- Lichen planus
- Pityriasis rosea
- Parapsoriasis
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