This ppt include Pityriasis rosea,Papular pruritic gloves and socks syndrome,Torch infection,gianotti crosti syndrome,Measles from text book of Rook's dermatology

1. Presented by dr maria saeed
PGR dermatology

3.  Definition and
nomenclature
 Epidemiology (Age,Sex)
 Pathophysiology
 Clinical features
 Investigations
 Management

4. Pityriasis rosea is a viral rash.
It is an acute ,self‐limiting exenthematous disease
EPIDEMIOLOGY
Incidence and prevalence:estimated
annual incidence is 170 cases per 100,000
persons per year.
Age:occur between the ages of 10 and
35.
Sex:slightly more common in females

5. Predisposing
factors
• oral corticosteroids
• after bone marrow
transplantation
• With several other
drugs e.g
ACEI,B-blocker,aspirin
etc.
Pathology
• In the epidermis:
spongiosis, vesicles and
patchy parakeratosis are
common.
• Some apoptotic
keratinocytes may be seen
in the upper epidermis.
• papillary oedema and a
mononuclear cell
perivascular infiltrate can
be seen on epidermis
• Subcorneal pustules may
also present

7. The herald patch is a
single plaque that appears 1–
20 days before
the generalised rash of
pityriasis rosea. It is an oval
pink or red plaque 2–5 cm in
diameter, with a scale trailing
just inside the edge of
the lesion like a collaret.
PRIMARY RASH

8.  A few days after the appearance of the herald
patch, more scaly patches (flat lesions)
or plaques (thickened lesions) appear on the
chest and back.
 A few plaques may also appear on the thighs,
upper arms and neck but are uncommon on the
face or scalp.
 These secondary lesions of pityriasis rosea tend
to be smaller than the herald patch. They are
also oval in shape with a dry surface. Like the
herald patch, they may have an inner collaret
of scaling. Some plaques may be annular (ring-
shaped).

9.  Pityriasis rosea plaques
usually follow the relaxed skin
tension lines or cleavage lines
(Langer lines) on both sides of
the upper trunk.
 The rash has been described
as looking like a fir tree. It
does not involve the face,
scalp, palms or soles.
Pityriasis rosea may be very
itchy, but in most cases, it
doesn't itch at all

10. With Herald patch

11.  Seborrhoeic dermatitis
 Secondary syphilis
 Guttate psoriasis
 pityriasis lichenoides
 Tinea corporis
Causative organism: associated
with HHV 6 and HHV 7

12. Complications and
co‐morbidities
Pityriasis rosea occurring in the first trimester of
pregnancy maybe associated with a higher than
normal risk of spontaneous abortion or premature
delivery of an infant
Disease course and prognosis
The skin lesions commonly fade after 3–6 weeks, but some
clear in 1 or 2 weeks and a few persist for as long as 3
months. Second attacks of pityriasis rosea occur in about
2% of cases after an interval of a few months or many
years.

13. INVESTIGATIONS
Diagnosis is usually made on clinical
grounds, but where there is
uncertainty, skin biopsy may help.
MANAGEMENT
common asymptomatic and self‐limiting cases require
no treatment ,if there is severity than
•A 7-day course of high-dose aciclovir
•A 2-week course of oral erythromycin
•Topical steroid cream or ointment; this may reduce the
itch while waiting for the rash to resolve.
•Phototherapy

15. Introduction and general description
Papular-purpuric gloves and socks syndrome
is a distinctive viral rash characterised by
painful redness and swelling of the feet and
hands. It is sometimes abbreviated PPGSS.
Epidemiology
Incidence and prevalence
Usually occurs as an isolated case but has been
reported in families
[3].
Age
Mainly young adults. Less commonly in children

16. Epidermal acanthosis and patchy basal cell
degeneration with
subepidermal oedema

17. Presentation
The hands, wrists, feet and ankles
are intensely pruritic
 macular and papular erythema
with edema
purpura and rarely petechiae
oral inflammation
with petechiae, vesicopustules and
ulceration.
Malaise and fever
lymphadenopathy

18. Clinical variants
eruption can involve the perioral and perianal or other
flexural skin
Unilateral or more generalized eruptions
are occasionally seen
Disease course and prognosis
rash and associated features settle within 1–2 weeks
in children ,eruption may last a month.
Skin clearance usually involves desquamation.
Causative organisms
Parvovirus B19 infection is the most commonly
associated infection
In children, EBV or CMV may be more common .

20. INVESTIGATIONS
Parvovirus serology: IgG, IgM. This test is reported in
about seven days.
Parvovirus PCR is more sensitive. This test is reported in
about three days.
In situ hybridisation
or immunohistochemistry on biopsy specimens
Management
Treatment is supportive.

22. •acquired congenitally or perinatally from the mother
Skin abnormalities of jaundice, purpura and petechiae are most
common.
Vesicles and mucosal ulceration may occur with herpes
infection.

25.  Gianotti–Crosti is a characteristic,
self‐limiting
 cutaneous reaction usually to a viral
infection, in which erythematous
 papules appear on the limbs and face,
occurring mainly
 Age:affects children between the ages of
6months and 12 years

26. Pathology
 The epidermis shows
spongiosis with some
acanthosis and
parakeratosis.
 There is a patchy,
perivascular, mainly
lymphocytic infiltrate
in the dermis.
 These features are
more marked in
vesicular lesions
Causative organisms
 Hepatitis B infection
 Epstein Barr
virus (EBV)
 Cytomegalovirus
 Enterovirus infections
 Echoviruses
 Respiratory syncytial
virus
 SARS-CoV-2 (COVID-
19)

27. course of 3 or 4 days
profuse eruption of dull
red, flat topped papules
papules develops first on
the thighs and buttocks
may extend down the legs
distribution is often
asymmetrical
5–10 mm in diameter
Generalized
lymphadenopathy
PRESENTATION

28. Clinical variants
Lesions may be vesicular.
Differential diagnosis
•Lichenplanus
• lichenoid drug eruptions
•scabies
• erythema multiforme.
Complications and
co‐morbidities
In the hepatitis B cases, liver
involvement with jaundice and
hepatomegaly.
Disease course and
prognosis
The eruption fades in 2–8 weeks
with mild desquamation.
Recurrence has been reported
rarely with infection or
immunization

30.  Blood count
 Liver function
 Viral serology or PCR.
 There is no specific treatment for papular
acrodermatitis of childhood. A
mild topical steroid cream or emollient may
be prescribed for the itch.

32. Measles, also known as English measles, rubeola or
morbilli, is a highly contagious
viral infection causing fever and a rash.
Introduction and general description
maculopapular
eruption
With 3 C’s
prodromal cough,
coryza and
conjunctivitis
ROUTE OF
TRANSMISSION:
Via droplet
infection

33. Before widespread immunisation against measles in industrialised
countries, measles was a very common childhood disease that
carried a high death rate.
Nowadays in countries where measles is part of an immunisation
programme, the risk of exposure and incidence of actual disease
cases is low. A recent trend by some parents not to immunise their
children has led to an increase in the number of cases of measles,
and its complications.
In developing countries, measles still occurs frequently and is
associated with a high rate of complications and death. It remains
a common disease even in some developed countries of Europe and
Asia.

34. Predisposing factors
 The disease is highly
contagious and contact of
a non‐immune person with
a person with measles
infection or with their
secretions is likely to
result in infection.
Pathology
 prodromal period infection in
the reticuloendothelial system
 lymphoid hyperplasia with
fused multinucleate giant cells
 Cells in the Koplik spots also
contain viral nucleocapsids.
 macular eruption on the fourth
day is the result of the
cell‐mediated immunity
depression of the T‐cell
mediated immune responses
 produces subacute sclerosing
encephalitis

35. Measles develops through distinct clinical stages
Incubation period
 Ranges from 7–14 days (average 10–11 days).
 The patient usually has no symptoms.
 Some may experience symptoms
of primary viral spread (fever, spotty rash,
and respiratory symptoms due to virus in the
bloodstream) within 2–3 days of exposure.

36. Prodrome
 Generally begins 10–12 days after exposure.
• Presents as fever, malaise, and loss of appetite,
followed by conjunctivitis (red eyes), cough, and
coryza (blocked or runny nose).
• 2–3 days into the prodromal phase, Koplik spots
appear. These are blue-white spots on the inside of the
mouth opposite the molars, and occur 24–48 hours
before the exanthem (rash) stage.
•Prodromal symptoms usually last for 2–5 days but in
some cases may persist for as long as 7–10 days.

37. Exanthem (rash)
Flat red spots ranging from 0.1–1.0cm in diameter appear on
the 4th or 5th day following the start of symptoms.
This non-itchy rash begins on the face and behind the ears.
Within 24–36 hours it spreads over the entire trunk and
extremities (palms and soles rarely involved).
The spots may join together, especially in areas of the face.
The onset of the rash usually coincides with a high fever of at
least 40C.
The rash begins to fade 3–4 days after it first appears. It fades
first to a purplish hue and then to brown/coppery
coloured lesions with fine scales.

39. Recovery
A cough may persist for 1–3 weeks.
Measles-associated complications may be the cause of
persisting fever beyond the 3rd day of the rash.
Measles exanthem

40. Clinical variants
In very severe forms, the rash may be haemorrhagic.
An extensive bullous eruption may rarely develop during the
acute stage of measles.
In some cases, this eruption has the features of Stevens–
Johnson syndrome,
but in others it resembles epidermal necrolysis.
Differential diagnosis
•Dengue
• Kawasaki disease
• toxic shock syndrome

41. The greatest risk for severe measles and its
complications is seen in:
 Malnourished individuals (particularly children
who are deficient in vitamin A)
 Those with an underlying immune deficiency
 In Pregnant women leads to spontaneous
abortions and premature delivery
INVESTIGATIONS
•Serolgy
•PCR
•Viral culture in
immunocompromised mainly

42. Prevention
• Passive protection is possible using normal human
immunoglobulin given within 5 days of exposure
• ACTIVE immunization with live attenuated vaccine.
First line
Symptomatic treatment.
Antibiotics .
Second line
vitamin A (two doses of 200 000 IU).
Third line
Measles pneumonia may be helped by ribavirin

43. THANK YOU