Psoriasis – Pemphigus

1. Introduction

Psoriasis is a chronic, non-contagious skin disease caused by an overproduction of skin cells. It commonly manifests as red, thick patches of skin covered with silvery scales, causing itching and discomfort.

Pemphigus is a specific form of psoriasis that often occurs in people with darker skin tones.

2. Types of Pemphigus

Pemphigus can be categorized into four main types:

2.1 Pemphigus Plaque-Type, Small:

• Characteristics:
  • Small red plaques with thin scales, frequently appearing on the back, chest, and limbs.
  • The patches are typically 2-5 cm in size.
  • Appear in a symmetrical pattern on both sides of the body.
• Treatment:
  • Topical corticosteroid creams, moisturizers.
  • Phototherapy (light therapy).

2.2 Pemphigus Plaque-Type, Large:

• Characteristics:
  • Large, thick, red plaques with thick scales, often appearing on the buttocks and thighs.
  • Patches are usually 10-20 cm in size.
• Treatment:
  • Topical corticosteroid creams.
  • Oral retinoids, methotrexate.

2.3 Lichen Planus:

• Characteristics:
  • Flat-topped papules, resembling grains of rice, with a reddish-brown color and thin scales.
  • The papules often appear on the back, chest, limbs, and can coalesce into larger plaques.
  • Brocq’s sign (+): Scales come off but adhere partially on one side.
• Treatment:
  • Topical corticosteroids.
  • Immunosuppressant medications.

2.4 Lichen Planus with Acute Papulovesicular Exanthem:

• Characteristics:
  • In addition to lichen planus characteristics, small deep-seated blisters resembling chickenpox appear.
  • Hemorrhagic (bleeding) blisters may occur.
• Treatment:
  • Antibiotics, antiviral medications.
  • Topical corticosteroid creams.

3. Differential Diagnosis

3.1 Pemphigus Plaque-Type, Small:

• Dry Eczema: Dry, thick patches with thin scales, often appearing in dry areas like the forearms and lower legs.
• Erythema Multiforme: Red patches with thin scales, commonly appearing in areas exposed to sunlight.
• Tinea Corporis (Ringworm): Red patches with thick scales, typically appearing in areas in contact with fungi.

3.2 Pemphigus Plaque-Type, Large:

• Lupus: Red patches with thin scales, commonly appearing on the face, ears, and neck.
• Pityriasis Rubra Pilaris: Dry, dark patches, commonly appearing in areas exposed to sunlight.
• Mycosis Fungoides: A type of skin cancer that can be confused with early-stage pemphigus plaque-type, large.
  • Distinguishable by the presence of firm papules, thick scales, and a reddish-brown color. Papules can ulcerate and drain.
  • Mycosis Fungoides can also cause skin atrophy, while pemphigus plaque-type, large does not.

4. Key Points

• Accurate Diagnosis: Consultation with a dermatologist is crucial for accurate diagnosis and appropriate treatment.
• Long-term Management: Pemphigus is a chronic condition requiring ongoing treatment to manage the disease.
• Managing Risk Factors: Control risk factors such as stress, smoking, and unhealthy eating habits to prevent relapse.

5. Conclusion

Pemphigus is a chronic skin condition that can cause significant inconvenience in daily life. By understanding the different types of pemphigus, differential diagnosis, and key considerations, patients can receive effective treatment and manage the disease better.