• cradle cap (infant), dandruff (adult)
• chronic dermatosis, more in man.
• predisposing factors: hereditary, HIV
• pathogenesis: pityrosporum ovale
• worse in winter or summer, flares w/sunlight.
• pruritus-orange-pink, macules and papules
• distribution: regions with a lot sebaceous glands. hairy area, face, trunk, body folds, genitalia.
• maybe a manifestation of Leiner's disease if associate with diarrhea.
• Treatment: topical therapy (selenium sulfide, ketoconazole shampoo, tar shampoo; low potency glucocorticoid), cradle cap (remove crust with warm compresses followed by baby sampoo +/- HC 2.5% cream or ketoconazole cream.

• Hereditary disorder
• constant flaking, difficult to treat.
• Nonpustular (psoriasis Vulgaris, psoriatic erythroderma)
• Pustular (pustular psoriasis of von zumbusch, pustulosis palmaris, pustular psoriasi annular type, acrodermatitis continua, impetigo herpetiformis)

Triggering factors:

• Koebner's phenomenon-rubbing and scratching stimulate psoriatic proliferation.
• Infections (streptocccus-precipitates guttate psoriasisacute type)
• stress, drug, HIV
• Pathogenesis: shorten keratinization cycle, excessive T cell in psoriatic lesion.
• chronic plaque: hereditary, salmon-pink, round, oval, removal of scale lead to bleading (Auspitz sign).
• favors elbow, knees, scalp, lumbosacral areas.

• Psoriasis Vulgaris of the Scalp: DDx-seborrheic dermatitis, tinea capitis.
• Difficult to trat: tar shampoo, salicylic acid, topical steroid, sunlight doesnt work.
• Psoriatic arthritis: Interphlangeal joint (asymetrically). Nail itting, subungual, hyperkeratosis, onycholysis, oil spots.
• Psoriasis Vulgaris: Eruptive Guttate Psoriasis. Tear drops like. test: ASO titer for strep. VDRL for syphilis. 
• psoriasis vulgaris (palmoplantar): white silvery hyperkeratosis and scaling, crack and painful fissures and bleeding.
• Psoriasis Vulgaris: perianal, genital and body fold.

• pustule, not papules
• rising on normal or inflammed skin
• palmoplantar type
• generalized type-von zumbusch: can be life threatening, abrupt onset of fever, malaise, WBC. didnt form crust or scales, form erosion--> susceptible to erosion.

• special type: impetigo herpetiformis

• chronic recurrent pustulation of the nail folds, bed, and distal fingers resulting in the loss of nails.

• high potency topical steroid +/- occulsion
• calcipotriene cream
• tar therapy, anthralin,
• phototherapy with emollients
• methotrexte, retinoids, cyclosporine, or combination therapy.
• new biologic therapy.

• hereditary disorder, excessive accumulation of cutaneous scale.
• ichthyosis vulgaris: AD, keratin retain lead to thickening of stratum corneum, hyperkeratosis, fish-like scale, keratosis pilris, perifollicular hyperkeratosis, eczema. Tx: emollients moisturizer, keratolytic (exfoliate, smooth out skin)
• X-linked ichthyosis: dirty brown scale on neck, trunk, extremity
• lamellar ichthyosis: collodium membrane at birth sheds and form sales over entire body.
• epidermolytic hyperkeratosis: blistering occurs after birth, then resolves and areas become thick and warty.

Cutaneous T cell Lymphoma (CTCL)

mycosis Fungoides (MF)

• malignancy of T helper cell
• involve lymphoreticular system (lympth nodes and internal organs)
• preceded by psoriasis, eczema, or large plaque parapsoriatic. 

• nodular stage
• tumor stage
• leonine facies (massive nodule infiltration)
• Sezary Syndrome: leukemic form consist of : erythrodema (red man syndrome), lymphadenopathy, elavated WBC, atypical lymphocytes (Sezary cells) in skin and blood.

Pityriasis Lichenoides eruption of unknown etiology

PLEVA vs PLC

• PLEVA=pityriasis lichenoides et variliformis acuta-acute form, papules, crusts.
• PLC= pityriasis lichenoides chronica- chronic form, scaly red/brown papules.

• life threatening reaction pattern of skin
• redness and scaling
• associate with lymphadenopathy and fever
• acute form-rapid onset of erythema, fever
• chronic form-skin and nail thickens alopecia (hair loss)
• preexisting skin disorders include: psoriasis, eczema, drug rxn, lymphoma

• acute or chronic inflammatory dermatosis involves skin and mucus membrane
• etiology: idiopathic (dont know what caused it), drugs, hepatitis C, baterial infection, chemical exposure. 

purple, polygonal, pruritic, planar and papule

• flat topped, violaceous, shiny papules w/ white lines (Wickham's striae)
• wrists, flexors, lumbar spine, shins, scalp, glans penis, mouth, nails affected, 
• koebner.

• hypertrophic: large, thick, hyperkeratotic plaques
• follicular: keratotic follicular papules and plaque that could lead to cicatricial alopecia, "Graham little syndrome"
• linear

• acute exanthematous eruption
• occurs in psirng and fall
• PE: Herald patches- a single plaque with fine scale on periphery develops usually on trunk, then 2-21 days later a generalized eruption w/scaling, papules and plaques in christmas tree distribution
• confined to trunk and proximal extremities along skin lines. 

Dx and Tx of supeficial fungal infection

Dx: KOH prep, fungal culture, wood lamp

Tx: prevention-keep area dry and clean, topical antifungal (lotrimin), systemic antifungal Lamisil), selenium sulfide shampoo

• C. albicans
• affected: moist area, and erosio interdigitalis
• polycyclic erode patch with satellite pustules
• Dx: KOH prep and culture
• DDX: inverse psoriasis, erythrasma
• TX: topical nystatin, systemic anticandidal