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13.7 Papulosquamous Disorder

Table of Contents

13.7.1. Psoriasis

It is an inherited inflammatory condition of the skin

Diagnostic Criteria

  • Thick, silvery white scaly plaques affecting mainly scalp, sacral region and extensor body surfaces
  • Usually symmetrically distributed, with a chronic relapsing course.

Note: Exclude precipitating factors e.g. alcohol, deficiencies of B12 or folate, stress, infections

Non-Pharmacological Treatment

Sun exposure to the lesions for half an hour or one hour daily may be of benefit

Pharmacological Treatment

C: Crude Coal tar 5% in Vaseline in the morning


C: Salicylic acid 5% in Vaseline to de-scale ,apply at night


C: Betamethasone ointment 0.025% in the evening.


B: Dithranol 0.1% once a day

Note: Systemic steroids are discouraged in this condition due to their rebound effect. If not responding well, refer to higher level facility for possible specialist care including use of systemic treatments (with methotrexate, cyclosporine, azathioprine etc).

13.7.2. Lichen Planus

It is an extremely pruritic chronic inflammatory skin condition.

Diagnostic Criteria

  • Primary lesions are violaceous, shiny flat-topped papules
  • Coalesce and evolve into scaly plaques
  • Distributed over inner wrists, arms and thighs as well as sacral area.
  • Post inflammatory hyperpigmentation is common.
  • Scarring alopecia may result from lichen planopilaris (severe)

Pharmacological Treatment

A: Chlorpheniramine (PO) 4mg 6 hourly for 2 weeks


C: Betamethasone valerate ointment 0.1% 12hrly for 2–4 weeks


D: Clobetasol propionate ointment 0.05%–0.1% twice daily for 2–4 weeks.

Note: In severe case refer to specialist for systemic corticosteroid and topical application under occlusion

13.7.3 Acne

Acne is a multifactorial disease primarily of teenagers with follicular plugging and inflammation. It presents with polymorphic lesions including, papules, and lesions involving the face, chest, shoulders and back.

Diagnostic Criteria

  • Open and closed comedones
  • Pustules
  • Nodular and cystic lesions involving the face, chest, shoulder and the back

Non-Pharmacological Treatment

  • Avoid underlying precipitating factor e.g. stress, nuts, chocolate, overuse of ointments on skin, steroids, anticonvulsant drugs etc.
  • Encourage a healthy lifestyle – exercise, sunshine exposure, etc.
  • Use ordinary soap (harsh antibacterial cleansers or iodine-containing preparations may aggravate the acne)

Pharmacological Treatment

Mild to moderate acne without scarring


A: Benzoyl peroxide 2.5%–5% once nocte


A: Retinoid 0.05% once nocte

Moderate acne with scarring

A: Doxycycline 100mg daily for 1–3 month


A: Erythromycin 250mg 6 hourly for 1–3 month


B: Benzoyl peroxide or topical retinoid as above.

Nodulocystic and/or conglobate acne

D: Isotretinoin (PO) 0.025–0.5mg/kg for at least 3–6 months

Acne fulminans

D: Isotretinoin (PO) 0.025–0.5mg/kg for at least 4–6 months

B: Prednisolone (PO) 45mg start then 5mg reduction daily up to 0.

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