Arthur, 34 years old, Highly inflammatory scales
Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.
Related topics
- Other
- Male with no particular history
- Recent inflammatory erythematosquamous dermatosis but has already had plaques on the elbow
- Little or no pruritus +/- dry skin
- Family and friends: NTR
- No animals
- No family history of atopy
No family history of atopy
Quiz
4 respondents
Question of 1
What is your diagnosis? (only one correct response)
Pityriasis rosea Gibert
Wrong answer!
It was psoriasis.
Let’s rule out differential diagnoses:
- Pityriasis Rosea Gibert:
Rash often limited to the trunk +- roots of the limbs: “Christmas tree” pattern with a medallion.
Viral: spontaneously heals within 6 to 8 weeks.
- Seborrhoeic dermatitis:
Location of the sebaceous areas: scalp, eyebrows, nostrils, ears, sternum, greasy scales, dandruff.
But the two can be combined: borderline types!
- Contact eczema:
Location related to an allergen, +- vesicular, and more pruritic, more difficult when chronic or nummular.
Seborrhoeic dermatitis
Wrong answer!
It was psoriasis.
Let’s rule out differential diagnoses:
- Pityriasis Rosea Gibert:
Rash often limited to the trunk +- roots of the limbs: “Christmas tree” pattern with a medallion.
Viral: spontaneously heals within 6 to 8 weeks.
- Seborrhoeic dermatitis:
Location of the sebaceous areas: scalp, eyebrows, nostrils, ears, sternum, greasy scales, dandruff.
But the two can be combined: borderline types!
- Contact eczema:
Location related to an allergen, +- vesicular, and more pruritic, more difficult when chronic or nummular.
Contact eczema
Wrong answer!
It was psoriasis.
Let’s rule out differential diagnoses:
- Pityriasis Rosea Gibert:
Rash often limited to the trunk +- roots of the limbs: “Christmas tree” pattern with a medallion.
Viral: spontaneously heals within 6 to 8 weeks.
- Seborrhoeic dermatitis:
Location of the sebaceous areas: scalp, eyebrows, nostrils, ears, sternum, greasy scales, dandruff.
But the two can be combined: borderline types!
- Contact eczema:
Location related to an allergen, +- vesicular, and more pruritic, more difficult when chronic or nummular.
Psoriasis
Psoriasis
It is indeed psoriasis.
Let’s rule out differential diagnoses:
- Pityriasis Rosea Gibert:
Rash often limited to the trunk +- roots of the limbs: “Christmas tree” pattern with a medallion.
Viral: spontaneously heals within 6 to 8 weeks.
- Seborrhoeic dermatitis:
Location of the sebaceous areas: scalp, eyebrows, nostrils, ears, sternum, greasy scales, dandruff.
But the two can be combined: borderline types!
- Contact eczema:
Location related to an allergen, +- vesicular, and more pruritic, more difficult when chronic or nummular.
- Progression: Flare-up often related to stress or affecting an area of friction (Koebner phenomenon)
- Lesions: The patient has typical lesions with +- thick, +- inflammatory micaceous scales with a map-like appearance.
- History: The patient has a family history of psoriasis
- Other elements: Typical topography: elbows, knees, legs, lumbar region, scalp, palms of hands/soles of feet, +- nails
- No additional examinations to be performed in general. The diagnosis is clinical.
- Inflammatory comorbidities mostly affect young patients with severe psoriasis.
- Remember to investigate psoriatic rheumatism or the possibility of medication being used: Beta–, ACE inhibitor, lithium, etc.
Evaluate the severity and impact of the psoriasis
Dermatological treatment:
First line: local treatments
- Topical corticosteroid therapy, vitamin D derivatives, topical retinoids, juniper oil, Ichthyol, etc.
- Combining a topical corticosteroid + calcipotriol provides increased efficacy.
- Phototherapy, acitretin, methotrexate, ciclosporin or even biotherapy for severe forms.
Dermo-cosmetic support:
Use of emollients once a day: moisturises and eliminates the need for cortisone.
Parent education:
- Relieve pruritus with a soothing spray
- Avoid microtraumas as much as possible
- For the scalp, use a creamy shampoo for scaly scalps 3 times a week, during the 3 weeks of initial treatment
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