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Dermatology and Venereology 007 Erythema, papule, and scaly skin disease
Dermatology and venereology mind map of erythema, papules, and scaly skin diseases, summarizing the causes, pathology, clinical manifestations, Treatment etc.
Edited at 2024-03-25 22:56:49- One Hundred Years of Solitude Character Relationship Chart
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
- One Hundred Years of Solitude Character Relationship Chart
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
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Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
Dermatology and Venereology 007 Erythema, papule, and scaly skin disease
- One Hundred Years of Solitude Character Relationship Chart
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
- One Hundred Years of Solitude Character Relationship Chart
One Hundred Years of Solitude is the masterpiece of Gabriel Garcia Marquez. Reading this book begins with making sense of the characters' relationships, which are centered on the Buendía family and tells the story of the family's prosperity and decline, internal relationships and political struggles, self-mixing and rebirth over the course of a hundred years.
- Project Management Process Template
Project management is the process of applying specialized knowledge, skills, tools, and methods to project activities so that the project can achieve or exceed the set needs and expectations within the constraints of limited resources. This diagram provides a comprehensive overview of the 8 components of the project management process and can be used as a generic template for direct application.
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- Outline
Chapter 7 Erythema, Papules, and Squamous Skin Diseases
Section 1 Psoriasis
[Cause] Genetic theory (determinant of susceptibility), infection theory (such as streptococci → guttate psoriasis), immune dysfunction, psychoneuroendocrine factors, metabolic abnormalities (such as DM), drug factors (such as lithium preparations, Beta-blockers, indomethacin, tetracycline, chloroquine, etc. can aggravate psoriasis), tobacco and alcohol, trauma, cold and damp
[Classification] Common type (psoriasis vulgaris) (>99%), unusual type
【pathology】
1. Features: Accelerated proliferation of keratinocytes in the basal layer of the epidermis (shortened mitosis cycle, shortened epidermal replacement time)
2. Manifestations: The usual type shows hyperkeratosis with parakeratosis (Munro microabscesses can be seen), the granular layer is significantly reduced, the spinous layer is thickened, the epidermal processes extend downward neatly, the spinous layer above the dermal papilla is thinned, and the capillaries are dilated. Tortuous, lymphocyte/neutrophil infiltration can be seen in the periphery; erythrodermic type shows more obvious telangiectasia in the papillary dermis; pustular type shows Kogoj microabscess
[Clinical manifestations]
Ordinary type
It usually occurs on the scalp, the extensor sides of the joints of the limbs, and the sacrococcygeal area, and is symmetrical.
Typical manifestations: initially appear as red corn-to-mung bean-sized papules/maculopapular rashes, gradually expanding into well-defined red plaques (drop-shaped, plaque-shaped, coin-shaped, map-shaped, oyster-shell-shaped), covered with a thick layer of silver-white scales ; When the uppermost layer of scales is scraped, it can be observed that the scales are layered, like scraping wax drops (wax drop phenomenon). After scraping off the scales, a red shiny film will be revealed (film phenomenon). If the scales are scraped off again, small dewdrop-like bleeding will appear. Spots (spot-like bleeding phenomenon, the essence is that the tortuous and expanded capillaries on the top of the dermal papilla are scratched), the above three are collectively called Auspitz's sign; patients often feel itchy to varying degrees
Different parts have different performances
Face: Red spots and patches due to frequent scrubbing, few/no scales
Scalp: The scales are thick and often extend beyond the hairline; the hair gathers into bundles toward the center of the rash (bundled hair)
Folds (such as armpits, groin): prone to maceration, erosion, and chapped
Palms and soles: keratinized light yellow spots/dark red patches, covered with adhesive multiple layers of silvery white scales, often cracked
Oral mucosa: gray-white annular spots
External genitals: dark red patches with clear borders, no scales
A: The nail plate is dot-like sunken (thimble nail), and the yellowing, thickening, and destruction of the nail plate may appear on the brown-yellow spots under the nail.
Course of disease: long course, sometimes self-healing but easy to relapse; usually severe in winter and mild in summer
∎ Progressive stage: Old skin lesions do not subside, new skin lesions continue to appear, and the infiltration and inflammation of the skin lesions are obvious. There may be redness and thick scales around the lesions; Koebner phenomenon/isomorphic reaction often occurs
Koebner phenomenon: caused by trauma or other harmful stimulation factors, skin lesions with the same characteristics are induced around the original skin lesions; it is more common in advanced psoriasis, and can also be seen in vitiligo and lichen planus.
∎ Quiescent phase: The skin lesions are stable, no new skin lesions appear, inflammation is mild, and there are more scales
∎ Degenerative phase: skin lesions shrink/flatten, inflammation basically subsides, leaving pigmentation/hypopigmentation
Special type - acute guttate psoriasis/ eruptive psoriasis: common in young people, often with a history of streptococcal infection in the throat before the onset; the onset is sudden, and it can spread throughout the body within a few days, with skin Papules/maculopapular lesions of 0.3~0.5mm, flush in color, covered with a small amount of scales, with varying degrees of itching; can subside within a few weeks after appropriate treatment, and a few can become chronic
unusual type
Arthropathic psoriasis (psoriasis arthropathica): RF-negative but HLA-B27-positive arthritis, which can occur in all joints but is asymmetrical; has a high incidence in severe psoriasis; most arthritis symptoms and skin lesions are severe The degree is parallel, manifesting as joint swelling and pain, and limited movement, which may later recover or cause joint bone destruction and deformity.
Pustular psoriasis (psoriasis pustulosa)
Limitations
Palmoplantar pustulosis: The skin lesions are limited to the palms and soles and are symmetrically distributed; they appear as clusters of small pustules on the basis of erythema. After 1 to 2 weeks, the pustules rupture, crust, and desquamate, but new Pustules reappear; nail often affected
Acrodermatitis continua: rare; occurs on the fingers/toes, and scales and scabs can be seen after the pustules subside; the nails are often involved, and even cause the nail plate to fall off
Generalized: often acute onset, pinpoint to millet-sized light yellow/yellow-white sterile small pustules rapidly appear on psoriasis vulgaris lesions or normal skin, densely distributed, and may also merge into Flaky pus lake; skin lesions can rapidly spread throughout the body, accompanied by swelling and pain; systemic symptoms are often present; after 1 to 2 weeks, the pustules dry up and scab, and the condition resolves naturally, but it can recur periodically.
Erythrodermic psoriasis (psoriasis erythrodermica): mostly transformed from the vulgaris/pustular type. It can be induced by the use of strong irritating drugs, long-term use of antimalarial drugs, and irregular use of glucocorticoids; it manifests as systemic skin disease Diffuse flushing, infiltration and swelling, and a large amount of bran-like desquamation, with flakes of normal skin (skin islands) in between; hyperkeratosis of the palms and soles, thickening and peeling of the nail plate; systemic symptoms in the acute phase; the course of the disease can last from months to years
[Diagnosis] Pay attention to classification; histopathological findings have certain diagnostic value
【Differential Diagnosis】
1. Scalp seborrheic dermatitis: ill-defined erythema, covered with greasy scales; accompanied by follicular papules and scabs; no bundled hair
2. Tinea capitis: more common in children; the skin lesions are covered with gray-white bran-like scales, with hair breakage/hair loss, and fungi are easy to detect.
3. Pityriasis rosea: oval light red patches with a brown center, covered with thin bran-like scales; more common on the trunk and proximal limbs, with the long axis of the patches distributed along the skin lines; the course of the disease is self-limiting
4. Secondary syphilis rash: a history of unclean sexual intercourse and a history of chancre; typical skin lesions are copper-red, infiltrative macules/maculopapular rashes on the palms and soles; positive syphilis serum reaction
5. Lichen planus: The skin lesions are polygonal flat purple-red papules that can merge into scaly plaques; the mucosa is mostly affected
6. Chronic eczema: especially psoriasis with verrucous hyperplasia on the lower legs
【treat】
General treatment
Find and eliminate triggers (such as anti-infection, relieving mental stress, improving immunity); avoid the external use of strong irritating drugs and avoid mechanical irritation to the skin
Systemic drugs
Retinoic acid: various types of psoriasis
Immunosuppressants: suitable for unusual types; commonly used MTX Antibiotics: suitable for obvious infections and generalized pustular types
Glucocorticoids: generally not recommended for use in the usual type, mainly used in erythrodermic type, acute arthropathy type, and generalized pustular type
Traditional Chinese medicine treatment: clearing heat and cooling blood, cooling blood and activating blood circulation, activating blood circulation and removing blood stasis. Immunomodulator: suitable for those with low cellular immune function.
Biological agents: suitable for moderate to severe psoriasis and psoriatic arthritis; use with caution in tuberculosis
topical medications
Glucocorticoids (creams/creams); are effective, but attention should be paid to their adverse reactions (especially long-term use of powerful preparations over large areas can induce pustular/erythrodermic psoriasis after discontinuation)
Retinoic acid cream: commonly used concentration is 0.025~0.1%
Vitamin D3 derivatives: such as calcipotriol; but not suitable for use on the face and skin folds. Others: such as keratin promoters
physiotherapy
UVB is mostly used (especially narrow-band UVB, 311nm); photochemotherapy, 308nm excimer laser, hydrotherapy, and oxygen therapy can also be used
Section 2 Pityriasis rosea (pityriasis rosea)
[Definition] It is an inflammatory, self-limiting papulosquamous skin disease characterized by rose-colored macules and maculopapular rashes covered with bran-like scales.
[Cause] It is now believed to be related to viral (such as HHV-6/7) infection
[Clinical manifestations]
Typical performance
More common in women aged 15 to 40 years old; more common in spring and autumn; more common in the trunk and proximal limbs
It is initially an isolated rose-colored light red papule/macula, which can merge into an oval/annular shape, and can quickly expand to 2~3cm in diameter (larger than subsequent skin lesions), with clear borders, and the surface is covered with fine scales, which is called It is the precursor spot/mother spot, which usually lasts for 1 week; then the mother spot disappears and the skin lesions gradually spread, with a diameter of 0.2~1cm, often oval, and the edges are covered with thin scales with a collar-like free edge inward. The long axis and Parallel skin lines; often moderate itching
The course of the disease is self-limiting, usually 6 to 8 weeks; some cases may not recover for several years; there is generally no recurrence after recovery.
special performance
The skin lesions are limited to one place and merge into annular patches, similar to tinea corporis papule type: more common in children (especially those under 5 years old)
Purpuric type: manifests as petechiae and petechiae distributed along the neck, trunk, and proximal skin striae of the limbs
Oral lesions: uncommon; occur at the same time as skin lesions, manifesting as mucosal erythema, raised edges, and ulcers or ulcers in the center; no subjective symptoms
【Differential Diagnosis】
1. Seborrheic dermatitis: It usually occurs on the chest, between the shoulder blades and on the flexors of joints; it appears as gray scaly spots.
2. Tinea corporis: rare and widely distributed; mycological examination is possible for tinea versicolor
3. Syphilis rash: the rash is uniform in size, brown, has no/less scales, is not itchy, is accompanied by systemic lesions, and the serum test is positive
[Treatment] Purpose: Reduce symptoms and shorten the course of the disease
topical treatment
Ultraviolet (UVB) treatment, topical corticosteroids/calamine lotion
systemic treatment
Oral antihistamines; in severe cases, short-term oral/intramuscular corticosteroids
Section 3 Erythema multiforme (EM)
[Definition] It is an acute inflammatory syndrome characterized by the coexistence of two or more skin lesions such as erythema, papules, and blisters, which can involve the mucosa; the severity of the condition varies, and severe cases are also called Stevens-Johnson syndrome.
【Cause】
①Typical mild EM is mostly related to HSV infection (called herpes simplex-associated EM (HAEM)) and specific HLA (HLA-DQw3);
② Stevens-Johnson syndrome and EM without typical target damage are mostly caused by drugs, such as sulfonamides, certain antibiotics, allopurinol, and anticonvulsants;
③Mycoplasma infection and radiotherapy can also cause EM
【pathology】
① Necrosis of keratinocytes, liquefaction and degeneration of basal cells, and formation of subepidermal blisters;
② Edema and inflammatory cell infiltration in the upper dermis;
③ Immunofluorescence is non-specific, and IgM/C3 is deposited in granular form around the superficial vascular plexus of the dermis/focal dermoepidermal junction
[Clinical manifestations]
Features
More common in children and young women, with a predilection in spring and autumn; the onset is rapid and may have prodromal symptoms (chill, fever, headache, joint/muscle pain); the course of the disease is self-limiting and relapsing
Skin lesions are polymorphic
Types
Erythema-papule type
Common, the disease is mild and the systemic symptoms are not severe; it is more likely to occur on the extremities, face and neck, and is symmetrical; there is less mucosal damage
∎ Initially a round/oval edematous erythema of 0.5~1cm, with bright red color and clear border, gradually expanding to the periphery; typical manifestation is target lesion/iris lesion - divided into 3 Layer: The center is dim purpura with blisters, the periphery is an edematous raised pale ring, and the periphery is erythema; after fusion, it becomes a gyroscope/geographical shape; there is itching/mild burning sensation; it subsides in 2 to 4 weeks, and temporary pigment may remain. calm
Vesicular-bullous type
Mostly developed from erythema-papule type, with obvious systemic symptoms; except for the extremities, it can spread to the whole body centripetally; mucosal damage is common
The exudation is severe and often develops into serous blisters with a dark red halo around them.
Severe form (Stevens-Johnson syndrome)
Sudden onset, severe systemic symptoms; prominent mucosal damage (more than two places), manifested as oral and nasal mucosal erosion, conjunctival congestion, keratitis, vulvar/anal mucosal redness, swelling and erosion, bronchopneumonia, and gastrointestinal bleeding
The skin lesions are edematous erythema/ecchymosis, which may appear as atypical iris-shaped lesions; they rapidly expand, merge, and spread throughout the body, with blister in the center and positive Nissl sign.
It can be complicated by necrotizing pancreatitis, liver and kidney failure, and secondary infection can cause sepsis, with a mortality rate of 5 to 15%.
【treat】