Papulosquamous Disorders : Types and Treatment - NEET PG Dermatology

Papulosquamous disorders are a group of skin conditions characterized by the presence of papules and/or scaly patches on the skin. They are considered an important topic for the NEET PG exam.

There are several types of papulosquamous disorders, including psoriasis, pityriasis rosea, seborrheic dermatitis, and others. Each type of papulosquamous disorder has its own set of clinical features, causes, and treatments.

This blog covers some important details on Papulosquamous disorders. Read on and elevate your Dermatology preparation for the NEET PG/NExT exam.

PSORIASIS

• HLA -CW6 association seen in juvenile psoriasis. 
• HLA- B27- psoriatic arthritis, reactive arthritis.
• Most common type is P. vulgaris.
• Erythematous plaque with silvery white like scaling.
• Extensors are commonly involved. 
• Inverse Psoriasis flexors are involved.
• Guttate Psoriasis is seen in children after URTI. 
• Erythrodermic psoriasis- presence of erythematous papules.
• Pustular psoriasis- presence of pus-filled lesions. 
• In pregnancy, it is called impetigo herpetiformis.

• Nail changes - Pitting seen which is irregular & deep 
• Clinical Sign
  • Auspitz sign - PinPoint bleeding spots in rubbing the lesion 
  • Woronoff ring & Berkeley membrane is seen 

Histology 

• Tortuous & Dilated blood vessels in dermis. 
• T cell infiltration in dermis.
• Absence of stratum granulosum & thickening of stratum spinosum (acanthosis).
• Dermal papillae enlarged with supra papillary thinning.
• Munroe's microabscess & kogoj pustules seen.

Treatment 

• Systemic - Methotrexate, Cyclosporine, Acitretin 
• Topical drugs - Corticosteroid 
• Keratolytic agent - Salicylic acid, Coal Tar 
• Phototherapy
• Biological

• Secukinumab (Anti IL-17A)
• Ustekinumab (Anti IL-12/23) 

• TNFα inhibitors - Infliximab, Etanercept, Adalimumab 
• Drug of Choice 

• Psoriatic arthritis -  Methotrexate
• Erythrodermic psoriasis -  Methotrexate 
• Pustular psoriasis -  Acitretin 
• In pregnancy -  Corticosteroids > Cyclosporine

Also Read: Layers of Epidermis

LICHEN PLANUS 

• Autoimmune 
• Skin - 5 P’s i.e. plane (flat-topped), purple, polygonal, pruritic, papules/plaques. 
• Mucosa – White Lacy pattern /Reticulate pattern 

• Nails -  Pterygium 
• Hair - Scarring alopecia /cicatricial alopecia
• Skin lesions have a reticulate pattern k/a Wickham's striae. 
• Associated with HCV 
• Isomorphic/ Koebner's phenomenon seen 

Isomorphic/ Koebner's phenomenon

TRUE	FALSE
Immune mediated	Autoinoculation
Example Lichen planusPsoriasisVitiligo	Example Molluscum contagiosumViral warts

Histology 

• Basal cell degeneration
• Civatte/colloid bodies seen 
• Saw toothed appearance 
• Max-Joseph space 
• Thickening of stratum granulosum (wedge shaped Hypergranulosis) 
• Thickening of stratum spinosum (Irregular Acanthosis) 

Treatment 

• Steroids (topical/systemic/intralesional)
• Generalized cases -  phototherapy

PITYRIASIS ROSEA

• Associated with HHV 6 & 7 
• 1^stpatch is k/a Herald/Mother patch 
• Lesions -  Fir tree pattern seen on trunk 
• Common in females 
• Self-limiting 
• Cigarette paper scales/collarette of scale seen 
• Hanging curtain sign seen 

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