EPS-OS

ERYTHRO PAPULOSQUAMOUS ERUPTION

Erythro-Papulo-Squamous (EPS)

CHARACTERIZED BY ERYTHEMA,

PAPULES OR PLAQUES AND SCALLING

TRUE EPS & EPS-LIKE

A. TRUE EPS1. 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

CLINICAL MANIFESTATIONS

- A SHARPLY DEFINED BORDER, A BRIGHT RED

COLOR & A SILVERY - WHITE SCALE DELINEATE

THE LESION OF PSORIASIS

- SITES 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

HISTOPATHOLOGY

- ACANTHOSIS WITH ELONGATION OF THE RETE RIDGES

- ELONGATION OF THE DERMAL PAPILLAE

- PARAKERATOSIS

- MUNRO’S MICROABSCESSES

TREATMENT

- TOPICAL : * SALICYLIC ACID

* TARS : LCD

* CORTICOSTEROIDS

* SUN - UV LIGHT THERAPHY

ANTHRALIN GOECKERMAN TECHNIQUE

& THE INGRAM TECHNIQUE

* PUVA/ NARROW BAND UVB

* CALCIPOTRIOL

* TACROLIMUS

* PIMECROLIMUS

- SYSTEMIC : * ANTIMITOTIC AGENTS : METHOTREXATE

* ETRETINATE

* CYCLOSPHORIN

- DIALYSIS

PROGNOSIS QUO AD VITAM TYPE OF PSORIASIS

QUO AD FUNCTIONAM AD BONAM

QUO AD SANATIONAM DUBIA AD MALAM

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

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 ROSEAPROBABLY 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

“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

HERALD PATCH

ERYTHRODERMAERYTHRODERMAREACTION 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 UNIVERSALIS

SKIN IS RED, THICKENED & SCALY

LABORATORY & HISTOPATHOLOGY ~ ETIOLOGY

TREATMENT ~ ETIOLOGY

- THE PATIENT SHOULD BE HOSPITALIZED

- TOPICAL : EMOLLIENTS

- SYSTEMIC : CORTICOSTEROID

PROGNOSIS ~ ETIOLOGY

TRUE EPS

PITYRIASIS RUBRA PILARIS

PARAPSORIASIS EN PLAQUES

PARAPSORIASIS

LICHEN PLANUS

LICHEN PLANUS

LICHEN NITIDUS

LICHEN STRIATUS

EPS - LIKE

TINEA CORPORIS

TINEA CORPORIS

TINEA VERSICOLOR

MORBUS HANSEN

Drug eruption(erythema multiforme)

Maculopapular drug eruption e.c ampicillin

THANK YOU