عملي

Borders of lesions

* Diagnosis?
Psoriasis vulgaris
Clinical characteristics?
Elbow
Psoriatic plaques usually are: Bright red Well-demarcated Thick white-silvery scales

* Psoriasis vulgaris

Diagnosis?
White-silvery colour Thick micaceous scales (Mica-like or asbestos-like)
Characteristic of scales?
Elbow


* Psoriatic plaques Bright red Well-demarcated Bilateral symmetrical Thick white-silvery scales Auspitz sign positive
Clinical characteristics of psoriatic plaques?

* Scalp psoriasis usually does not cause hair loss

Diagnosis ?
Scalp psoriasis
Does it cause hair fall ?
The scalp is covered with thick scales and the erythematous plaques are extending to the forehead

* Predilection sites of Psoriasis ?

Scalp Elbows & knees Extensor extremities Nails Sacral region Palms & soles Penis and scrotum Gluteal cleft Umbilicus

* Diagnosis ?

Psoriasis vulgaris
Severity ?
Severe plaque type involving >20% of the surface area of the body

* Diagnosis ?

Psoriasis vulgaris of the scalp
Characteristic finding ?
Erythematous plaques covered with white-silvery scales extending on the forehead. This is called Corona psoriatica


* Enumerate 3 D.Dx. of this rash
Seborrhoeic Dermatitis Psoriasis Contact dermatitis
Most probable diagnosis?
Seborrhoeic Dermatitis

*

Lichen planus on the dorsal surface of the hand. Wickham’s striaecan be easily identified in the upper lesion. Note the flat-topped nature of thelesions and the post-inflammatory hyperpigmentation

* Diagnosis?

Pruritic Purplish Polygonal Plane-topped Papules
Characteristics?
Lichen planus

* Characteristics?

Violaceous shiny polygonal papules covered with Wickham’s striae Diagnosis?
LP
Type of LP?
Classical LP (Chronic localized)

* Diagnosis?

Classical LP
Areas of Predilection ?
Wrist flexure/ Extensor limbs/ Oral mucosa/ Genitalia

* Diagnosis?

LP
Commonest age affected?
Adults 30-60 year-old

* Diagnosis?

LP Notice Koebner Phenomenon

* Close up

Describe
Diagnosis?
Hypertrophic LP
Erythematous thick (Hypertrophied) Plaques On the anterior aspects of the legs

Lacy pattern on cheek mucosa

Note the nail thinning with longitudinal ridging and fissuring.

* What is the arrowed lesion ?

Herald patch (PR)
What is Herald patch ?
Oval patch or plaque 2-10 centimeters in diameter with its longitudinal axis is parallel to the rib lines. A collarate scale is seen on the periphery of the patch. It usually occurs on the trunk or proximal parts of the extremities.

* Pityriasis rosea

Primary rash is the Herald patch Secondary rash appears few days after the onset of the herald patch. It has similar morphology but smaller in size than the Herald patch. It has Christmas tree distribution.


Pityriasis alba: rounded or oval scaly hypopigmented plaques involving chiefly the face and also the neck or upper arms. The lesions are asymptomatic and self-limiting usually disappear within months.

exanthem of pityriasis rosea with the herald patch

Flat-topped, polygonal, sharply defined papules of violaceous color, grouped and confluent. Surface is shiny and upon close inspection or a hand lens, reveals fine white lines (Wickham's striae)

Acne vulgaris, with comedones, on the chin.

What is the diagnosis?
Acne vulgaris
Types


Acne vulgaris: papulopustular A spectrum of lesions is seen on the face of a 17-year-old male: comedones, papules, pustules, and erythematous macules and scars at site of resolving lesions


Papulopustular acne. All early stages of acne are seen in this young woman who has an oily appearing face, multiple comedones and inflammatory papules some of which are topped with a pustule


Papulopustular acne occurs not only in the face but also on the back, the shoulders and the anterior chest. Lesions are identical to those seen in the face and are coalescing in the midline forming cysts


In this case of papulopustular acne the lesions are more advanced and the inflammatory papules become nodular and thus represent early stages of nodulocystic acne

Nodulocystic acne

Acne vulgaris: acne conglobata Inflammatory nodules and cysts have coalesced forming abscesses and even leading to ulceration.

Management

:Mild Acne Topical antibiotics (clindamycin and erythromycin( Benzoyl peroxide gels Topical retinoids (tretinoin, adapalene(
Moderate Acne: Oral antibiotics are added to the above regimen
Severe Acne: In addition to the topical treatment outlined above, systemic treatment with isotretinoin is indicated for cystic or conglobate acne or for acne refractory to treatment

Acne vulgaris: nodulocystic Inflammatory nodules, cysts, and pustules

after a course of oral isotretinoin

Variants of acne

Infantile acne. The cheeks and periorbital regions of this six week old infant are studded with closed comedones some of which have transformed into inflammatory papulopustular lesions. The condition healed spontaneously



Multiple papulopustular lesions on the cheek of a eight week old infant. These lesions are relatively asymptomatic but often lead to great anxiety on the part of the parents.

Acne cosmetica. In this young woman the entire forehead is studded with closed and open comedones and some papular pustules. It was due to the application of a comedogenic cosmetic. This type of acne responds particularly well to the topical application of tretinoin


Acne mechanica. There is a flare of preexisting papulopustular acne in this young woman, a student, which was localized exclusively to the right side of the face and resulted from the fact that when studying this young woman propped her face on her right hand !!


Steroid acne. A monomorphous eruption of papular pustules without comedones in a young woman receiving glucocorticoids


Acne scars. Sunken, atrophic and pitted scars in a 25-year-old woman who had had cystic acne


Acne scars. Hypertrophic scars following nodular acne in a 20-year-old male. The lesions are hard, red, dome-shaped and have firm consistency and are of major cosmetic concern to the patient


Extensive depigmentation of the central face. Involved vitiliginous skin has convex borders,

Vitiligo repigmentation A follicular pattern of repigmentation due to PUVA therapy occurring in a large vitiliginous macule



Melasma. Well-demarcated, hyperpigmented macules are seen on the cheek, nose, and upper lip