• Common, benign
• Usually asymptomatic
• Distinctive skin eruption that may be viral in origin

• Some evidence viral in origin
• Small epidemics have occurred in fraternity house and military bases
• 20% patients have a recent history of acute infection with fatigue, headache, sore throat, lymphadenitis and fever

• Herald Patch: a single 2 to 10 cm oval lesion most frequently located on the trunk
• Within 7-14 days, smaller lesions appear and reach their maximum number in 1-2 weeks
• Can be concentrated in lower abdomen

• Plaques are pink in Caucasian and dark brown in African Americans
• Plaques oriented along skin lines on the back look like drooping tree branches
• Number of lesions vary from a few to hundreds

• Secondary Syphillis (especially if herald's patch is missing)
• Tinea versicolor (can be ruled out with KOH examination)

• Disease clears spontaneously in 1-2 months
• Extensive cases with intense itching: responds to 1-2 week course of prednisone
• Direct sun exposure hastens solution

• Distinctive, inflammatory cutaneous and mucous membrance reaction
• Course is variable and unpredictable
• Itching is variable in intensity
• May occur as a generalized disease or may be secondary to drug
• Severe oral lichen planus may generate to squamous cell carcinoma (3%) of cases

• Primary lesion is 2-10mm, flat topped papule with an irregular, angulated border
• Surface has a lacy, reticular pattern of criss-crossed, whitish lines (Wickhams striae)
• 5 "P's": pruritic, planar (flat-topped), polyangular, purple, papules

• Located in flexor surfaces of the writs and forearms, legs immediately above ankles and then lumbar region
• Oral lichen planus: buccal mucosa

Anti-hepatic C virus antibodies are detected inabout 16% of patients with the cutaneous form and about 30% with the oral form

• Order a Hep-C test
• Order a LFT

• Psoriasis
• Pityriasis Rosea
• Leukoplakia
• Candidiasis

• Antihistamines for pruritis
• Group I-III topical steroids for initial localized disease
• Prednisone is administered for generalized disease
• Orabase (steroid and adhesive base)
• Azmacort

• Papulosquamous diseases
• Skin, nails and joints
• MANY forms: common presentation is scaly plaques involving the elbows, knees and scalp

• 1-3% of population worldwide
• Etiology unknown
• Genetic transmission
• Men and women equally affected
• Condition is lifelong and characterized by chronic, recurrent exacerbations and remissions

• Stress may precipitate an episode
• Can develop at a site of physical trauma
• Worse in dry winter weather
• Amount of pruritus varies
• Psoriatic arthritis occurs in 5-8% of population with psoriasis
• Precipitating drugs: Lithium, beta-blockers, anti-malarials and systemic steroids

• Begins at red, scaly, papule that forms into round to oval plaques
• Effects extensor surfaces (usually spares palms, soles, and face)
• Deep rich red color is a characteristic feature
• Scale is adherent and silvery white: when removed, "Auspitz's sign"

• Associated with Group A strep
• Sudden appearance of scaly papules

• Localized reccurent crops of small, sterile pustules evolve from the red base
• Often on palms and soles (palmoplantar pustulosis)

• Pitting, oncholysis (seperation of nail from nail bed)
• Nail dystrophy
• Oil spot lesion

• Eczema
• Seborrheic Dermatitis
• Syphillis
• Pityriasis Rosea

• Calcipotriol (Vitamin D)
• Topical steroids (fast but temporary)
• Tazorac gel

• Better, worse, stays the same
• Few times/week

• Indicated for >20% body surface
• Usually managed by a dermatologist
• Rotational approach to therapy minimizes the long term toxic effects
• MTX: gold standard (erythrodermic and generalized pustular psoriasis) -Needs folic acid cotx, CBC, LFT monitoring

• Cyclosporin (Neoral): Severe inflammatory psoriasis (BP monitoring, CBC, CR)
• Acitretin (Soriatane): generalized pustular and erythrodermic psoriasis (teratogenicity, hepatitis, pancreatitis)

• Infection with Treponema Pallidum
• Untreated can lead to 3 stages: Primary, Secondary, Latent or Rare 3 stage
• More common in males
• 20-40 Y/O

• 6 weeks after chancre (original painless sore) appears
• Mucucutaneous lesions, influencza like syndrome
• Stage lasts 2-10 weeks
• Syphilis in this stage is confused with numerous other lesions
• Color of lesion: coppery
• Lesions appear on palms or soles of feet in most cases

• Corkscrew-rotation motility of a small, spiral spirochete
• RPR, VDRL

• Pityriasis Rosea
• Guttate psoriasis
• Lichen Planus
• Tinea Versicolor

• Early disease: Benzathine penicillin G (2.4 million U IM)
• Late disease: as above but q week X 3
• Penicillin allergic: doxy or tetra
• Successful therapy: falling RPR titer

• Exceedingly pruritic, round lesions of eczematous inflammation
• Adults often affected
• Usually begins as few lesions then multiple with no particular pattern

Demarcated, scaling roundplaques

DDX: Psoriasis and tinea

• Topical Steroids: improve and then recur with steroid withdrawal
• Unpredictable
• One of most difficult forms to treat