Max. Joseph's space is a histopathological feature of
Max Joseph space/cleft is a histological feature of lichen planus . It is an idiopathic chronic inflammatory condition affecting the skin, mucous membrane and appendages. The 6Ps of lichen planus are purple, papule, pruritic, polygonal, plaque, plane/flat-topped. Delicate white striae - Wickham's striae seen due to focal thickening of granular cell layer. The finding is enhanced by applying oil or by using dermoscopy. Positive Koebner's phenomenon -linear distribution of lesions following trauma. Classic form is the most common variant Nail findings- diffuse nail ridging and dorsal pterygium twenty nail syndrome (trachyonychia)-nail roughness caused by excessive longitudinal ridging may involve all 20 nails Diagnosis: Histological features -compact hyperkeratosis,wedge-shaped hypergranulosis,irregular acanthosis,sawtoothing of rate ridges and vacuolar damage to basal cell layer, degenerated keratinocytes in the upper dermis called civatte bodies or colloid bodies. Interface inflammation causes a small separation between epidermis and dermis called max joseph space/cleft Associated conditions -HCV association is very impoant alopecia areata vitiligo DLE Diabetes mellitus Ulcerative colitis First line therapy is topical coicosteroids Ref Harrison 20th edition pg 1278
Psoriasis vulgaris
Lichen's planus
Pityriasis rosea
Parapsoriasis
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