Papulosquamous Diseases

Papulosquamous Diseases-

-Drug Eruptions-

-Exact mechanism is unknown but likely a delayed hypersensitivity reaction
-In a previously sensitized patient, eruption starts within 2-3 days of given the drug
-Peak incidence is approximately 9 days after administration of the medication
-Very pruritic lesions and painful
-Macules and papules on lower legs and may progress to the whole body
-Lesions are bright red color
-Meds that can cause:  penicillins, sulfa, NSAIDS, Barbiturates, Nitrofurantoin, Isoniazid, Benzodiazepines, Phenothiazines, Carbamazepine, Allopurinol, Gold Salts
-Need to stop the medication
-Oral antihistamines
-Oral or IV Glucocorticoids
-Potent Topic Glucocorticoids can help prevent the spread of the rash
-Label patient as allergic to that medication and or class of medications


-Lichen Planus-

-idiopathic in most cases
-Also caused by drugs (gold), or infection (HCV) results in cell mediated immunity
-Lesions last months to years
-The 5 P’s of Lichen Planus-
-Purple
-Polygonal
-Papules
-Pruritic
-Planar

-Topical corticosteroids or intra-lesional injection with triamcinolone
-Cyclosporin mouth wash may be helpful for those with oral lesions
-Systemic corticosteroids or cyclosporin for severe cases
-Systemic retinoids & PUVA if needed


-Pityriasis Rosea-

-Herald patch precedes the exanthem phase
-Fine papules and plaques dull tawny oval exanthem that are scattered
-Christmas tree pattern
-Etiology unknown but Herpes 7 is suspected
-May last 6-12 weeks
-Oral antihistamines and topical glucocorticoids
-Short course of glucocorticoids may help


-Psoriasis-

-there is an overproduction of epidermal cells by 28 times normal
-Salmon pink papules and plaques sharply marginated with silvery scale
-Can be bilateral and symmetrical
-Psoriatic arthritis incidence 5-8%
-Topical treatment with fluorinated glucocorticoids in ointment base
-Small plaques triamcinolone aqueous suspension
-Vitamin D Analogues
-Topical retinoid Tazarotene
-When there is >10% TBSA PUVA or UVB therapy is indicated
-Scalp-Clobetasol lotion
-Methotrexate for more severe cases and cyclosporin or immune modulators