By Paul K. Buxton
This is often an advent to dermatology that assumes a normal figuring out of drugs, yet no expert wisdom. The booklet presents the basic middle of data to which extra distinctive info should be additional. it may be used for reference by way of basic practitioners and medical professionals in different specialties. The dialogue of universal stipulations ahead of introducing extra advanced illnesses makes it very compatible for instructing scientific and nursing scholars.
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In guttate psoriasis the lesions are more sharply defined and smaller (0·5–1·0 cm) and have waxy scales. 30 Perioral dermatitis Pityriasis rosea—herald lesions Characteristics of pityriasis rosea Clinical features of psoriasis Possible family history Sometimes related to stress Itching—rare Extensor surfaces and trunk Well defined, raised lesions Hyperkeratosis Scaling, bleeding points beneath scales Köebner’s phenomenon Nails affected Scalp affected Mucous membranes not affected Clinical features of eczema Possible family history Sometimes worse with stress Usually itching Flexor surfaces and face Poorly demarcated lesions Oedema, vesicles, lichenification Secondary infection sometimes present Rashes with epidermal changes Pathology Histological changes are non-specific, showing slight inflammatory changes in the dermis, oedema, and slight hyperkeratosis.
Careful intralesional injections may be effective in persistent lesions. In very extensive, severe lichen planus systemic steroids may be indicated. 28 • • • • • • • Flexor surfaces Mucous membranes affected Itching common Violaceous colour Wickham’s striae Small discrete lesions Lichenified Rashes with epidermal changes Pathology of lichen planus Hyperkeratosis As expected from the clinical appearance, there is hypertrophy and thickening of the epidermis with increased keratin. The white streaks seen clinically occur where there is pronounced thickness of the granular layer and underlying infiltrate.
There is no constant relation to stress. Unlike psoriasis, there is no family history. Itching is common. The distribution is on the flexor aspects of the limbs, particularly the ankles and wrists, rather than on the extensor surfaces, as in psoriasis. It also occurs on the trunk. However, localised forms of lichen planus can occur on the shin, palm, and soles or elsewhere. Nail involvement is less common than in psoriasis. There may be thinning and atrophy of part or all of a nail and these often take the form of a longitudinal groove, sometimes with destruction of the nail plate.