Show Summary Details
Page of

Papulosquamous disease 

Papulosquamous disease

Chapter:
Papulosquamous disease
Author(s):

Christopher Griffiths

DOI:
10.1093/med/9780199204854.003.2305_update_001

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

Update:

Minor editorial amendments.

Updated on 31 May 2012. The previous version of this content can be found here.
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy).

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 Dithranol has been one of the main topical treatments for many years, but is now largely superseded by vitamin D3 analogues, e.g. calcipotriol.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.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.