Skin Disorders Guide

Pityriasis Rubra Pilans (PRP) is a disease that looks very much like psoriasis in presentation. In PRP, however, the scalp is diffusely involved, the palms and soles are markedly thickened, and small follicular papules are noted on the dorsal surface of the hands and fingers. The plaques of PRP are huge, and the entire trunk is often covered with disease. The treatment is similar to that given for psoriasis. Reiter’s syndrome consists of a migratory pauciarticular arthritis of the large joints, inflammatory disease of the eyes, urethritis, balanitis, and psoriatic-like lesions on the palms and soles. The degree of overlap with psoriasis is considerable, and at times a distinction between the two diseases cannot be made. The course of the disease is chronic but is characterized by exacerbation and remissions. Methotrexate therapy is indicated in the more severe cases.

Bowen’s disease and superficial basal cell carcinoma (both representing malignancy confined entirely to the epidermis) present as sharply marginated, slightly scaling, erythematous plaques. These lesions range from 2 to 6 cm in diameter. Such lesions are usually singular, but on occasion several may be present. Any solitary papulosquamous plaque, claimed by the patient to have been present and unchanged for years, should be biopsied with the possibility of one or another of these types of carcinoma in situ kept in mind. Bowen’s disease was at one time thought to be an indicator for an increased likelihood of internal carcinoma, but newer data no longer support this belief. Mutations suppressor gene are found in Bowen’s disease just as is true for actinically induced squamous cell carcinoma.

Daner’s disease is a familial condition characterized by the presence of large, red-brown, scaling plaques with peripheral, satellite papules. The lesions occur primarily in a seborrheic distribution, involvement of the scalp, face, and anterior chest is characteristic. Small keratotic papules are often present on the palms. Nail dystrophy may be present, and mucosal involvement is possible. Biopsy is diagnostic.