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Papulosquamous disease 

Papulosquamous disease

Papulosquamous disease

Christopher Griffiths


May 29, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.


Minor editorial amendments.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 23 April 2017

Papulosquamous diseases are typically characterized by well-demarcated areas of papules and scale, typically on an erythematous background. The differential diagnosis includes psoriasis, lichen planus, mycosis fungoides, discoid lupus erythematosus, eczema/dermatitis, drug eruptions, tinea, pityriasis versicolor, secondary syphilis, and pityriasis rosea.

The presence of significant pruritus is a useful marker to help with the differential diagnosis: lichen planus and discoid eczema are typically pruritic, whereas others, such as psoriasis, are less so. The distribution is also key to making the diagnosis, with psoriasis often showing characteristic symmetrical involvement of the extensor surfaces, scalp, and nails. Histology can be essential to reach a diagnosis and plan an appropriate approach to management.

The most common form of psoriasis is chronic plaque psoriasis, which often first affects the scalp. The nails are affected in about 50% of cases. There is no cure. Topical corticosteroids are the most commonly used treatment worldwide, but they should not be used continuously for more than 2 weeks. Dithranol has been one of the main topical treatments for many years, but is now largely superseded by vitamin D3 analogues, e.g. calcipotriol. Phototherapy and photochemotherapy can be effective. Systemic treatments are only required in the most refractory cases.

Lichen planus is characterized by purple (violaceous) flat-topped polygonal papules that vary in size, most commonly on the flexor aspects of the wrists, the lower back, and the ankles. About 50% of patients have involvement of the mucous membranes. The skin disease is usually self limiting.

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