Psoriasis associated with -hemolytic streptococcal infection?
Ans. d (Guttate psoriasis) (Ref. IADVL Dermatology 2nd ed., 818; Harrison's medicine 17th ed., Ch 53).GUTTATE PSORIASIS Usually seen in children and follows upper respiratory tract infection and tonsillitis especially due to streptococci. Pinhead to pea sized 'raindrop like' erythematous papules erupt abruptly bilaterally symmetrical distribution all over body, especially on trunk. Palms and soles are spared. Prognosis is good and lesions resolve in a few weeks. May also occur in chronic plaque psoriasis when they are exacerbated. The most common variety of psoriasis is called plaque-type.PAPULOSQUAMOUS DISORDERS Clinical FeaturesOther Notable FeaturesHistologic FeaturesPsoriasisSharply demarcated, erythematous plaques with mica-like scale; predominantly elbows, knees, and scalp; atypical forms may localize to intertriginous areas; eruptive forms may be associated with infectionMay be aggravated by certain drugs, infection; severe forms seen associated with HIVAcanthosis, vascular proliferationLichen planusPurple polygonal papules marked by severe pruritus; lacy white markings, especially associated with mucous membrane lesionsCertain drugs may induce: thiazides, antimalarial drugsInterface dermatitisPityriasis roseaRash often preceded by herald patch; oval to round plaques with trailing scale; most often affects the trunk, and eruption lines up in skin folds giving a "fir tree"-like appearance; generally spares palms and solesVariable pruritus; self-limited resolving in 2-8 weeks; may be imitated by secondary syphilisPathologic features often nonspecificDermatophytosisPolymorphous appearance depending on dermatophyte, body site, and host response; sharply defined to ill-demarcated scaly plaques with or without inflammation; may be associated with hair lossKOH preparation may show branching hyphae; culture helpfulHyphae and neutrophils in stratum corneumAPPROVED SYSTEMIC THERAPY FOR PSORIASISADMINISTRATIONAgentMedication ClassRouteFrequencyAdverse Events (Selected)MethotrexateAntimetaboliteOralWeeklyHepatotoxicity, pulmonary toxicity, pancytopenia, potential for increased malignancies, ulcerative stomatitis, nausea, diarrhea, teratogenicityAcitretinRetinoidOralDailyTeratogenicity, osteophyte formation, hyperlipidemia, flare of inflammatory bowel disease, hepatoxicity, depressionCyclosporineCalcineurin inhibitorOralTwice dailyRenal dysfunction, hypertension, hyperkalemia, hyperuricemia, hypomagnesemia, hyperlipidemia, increased risk of malignanciesEducational Points:CLASSICAL FEATURES OF PSORIASIS# Silver mica scales# Auspitz sign# Candle grease sign# Grattage sign# Koebner's phenomenon# Thimble pitting of nails# Onycolysis# Oil-drop nails# Arthritis mutilans# Warnoff ring# Munro microabscesses# Suprapapillary thinning# Parakeratosis PUVA therapy is useful in:# Psoriasis# Vitiligo# Mycosis fungoides# Alopecia# Atopic dermatitis# Eosinophilic folliculitis# Pityriasis lichenoid chonica
Psoriasis vulgaris
Erythrodermic psoriasis
Pustular psoriasis
Guttate psoriasis
Papulosquamous Disorders