Arthur, 34 years old, Highly inflammatory scales

Written with the participation of FDVF (Future Dermatologists and Venereologists of France) interns.

Quiz

15 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

True

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.