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Rovner

INFLAMMATORY DISORDERS

  1. ECZEMA--Dermatitis

    2. Acute--"juicy" red ill defined plaques with or without vesiculation; pruritus

    Chronic-lichenification--scaling thickened pink plaques with increased skin markings; pruritus

    1. Contact--unusual configuration and distribution limited to areas of contact
      1. Allergic--
        1. specific sensitivity, not dose dependent
        2. eg: poison ivy, Nickel, fragrances,
        3. preservatives, Neomycin
      2. Irritant--non specific
        1. dose dependent
        2. eg: soaps, lye
    2. Seborrheic--"dandruff"
      1. scalp, central face, chest ("oily" areas)
      2. ill defined, greasy, yellow scaling pink plaques
      3. Pityrosporum ovale
    3. Dyshidrotic--"Pompholyx"
      1. palms, soles
      2. "tapioca" vesicles
    4. Stasis--shins - edema, with diffuse erythema, scaling and purpura
    5. Xerotic--"dry" skin
    6. Atopic--asthma
      1. flexural fold involvement
      2. food allergies (milk, eggs, nuts, wheat, citrus)--RAST testing
      3. familial
      4. cataracts
    7. Treatment: identification and avoidance of offending agent(s)--patch test
      1. steroids-topical and systemic
      2. antihistamines
      3. moisturizers
      4. antibiotics (Staph aureus)
  2. PSORIASIS

    3. 3% of American population

    Etiology unknown--increased cell turnover

    Polygenic inheritance

    1. Vulgaris
      1. well defined pink plaques with "micaceous" scales
      2. distribution
        1. elbows, knees
        2. gluteal cleft
        3. scalp
        4. nails--pitting, oil staining
        5. sites of trauma--"Koebner phenomenon"
    2. Pustular
      1. sterile pustules, lakes of pus with diffuse erythematous background
      2. palms and soles most frequent sites
      3. eruptive (von Zumbusch)--generalized involvement, often steroid induced
    3. Guttate
      1. Wide spread, small "raindrop spattered" plaques
      2. post Strep, viral infections
    4. Psoriatic arthritis--occurs in 3-5% of psoriasis patients
      1. mono-articular--most common
      2. mutilans (distal interphalangeal, "pencil in cup")--pathognomonic
    5. Treatment:
      1. topical steroids
      2. tar
      3. UVB
      4. PUVA
      5. Methotrexate
      6. Retinoids
      7. vitamin D
      8. cyclosporine
  3. LICHEN PLANUS
    1. Flat topped violaceous polygonal plaques with white lacy striae (Wickham's)
    2. ankles, wrists
    3. oral (buccal mucosa)
    4. nails (pterygium)
    5. extreme pruritus