Scaly Skin Eruptions


  • Common Chronic skin inflammation affecting 2-4% of population
  • It can have variable severity and spread
  • It has several types the most common is Plaque Psoriasis
  • It can cause arthritis and it can affect the nails
  • Psoriasis carries increased risk for heart and kidney disease
  • Smoking makes it worse


  • Localized: Topical Vit. D and topical steroids
  • Severe (>10% of body surface)
  • Phototherapy
  • Immunosuppressive (Methotrexate and cyclosporine)
  • Newer agents targeting the inflammation mediators known as (Cytokines)
Nummular Eczema

Lichen Planus

  • It is a disease caused by T-Lymphocyte disorder
  • It affects 0.2 to 1% of population
  • It causes itchy flat scaly thick lesions with violet color
  • Location :ankles, elbows, mucous membranes and nails
  • It resolves spontaneously in 1-2 years
  • It occurs in Hepatitis C patients
  • Mucosal and some hypertrophic skin lesion can transform to squamous cell cancer

Treatment: limited—> topical steroids
                   Severe or oral lesions—> same as Psoriasis

Pityriasis Rosea

  • Common rash thought to be caused by reactivation of Herpes Virus 6 or 7
  • In 50% of cases it starts with a single large ring like patch (Herald patch) on the trunk and days later many more smaller lesions (skin colored) appears almost like “Christmas tree”
  • No treatment needed and it resolves spontaneously in weeks to months
  • Secondary syphilis may mimic this rash but syphilis affects the palms and soles too and it causes swollen lymph nodes
  • Macrolides, Acycolvir and/or phototherapy may be helpful

Seborrheic Dermatitis

  • It is characterized by greasy yellow scaly patches in oily skin area (scalp-dandruff , face, ears and upper chest)
  • It is caused by heightened sensitivity to oil living yeast (Malassezia)
  • More prevalent in immunosuppressed and HIV patients
  • Treatment: OTC Selenium sulfide or Zinc Pyrithione
Nummular Eczema

Miliaria (Heat Rash)

  • It is caused by occlusion and subsequent rupture of the sweat glands ducts
  • Overgrowth of Staph Epidermis may contribute to the disease

Miliaria Types:

  1. Miliaria Crystallina caused by occlusion near the skin surface and manifests by tiny pin head clear blisters
  2. Miliaria Pustulosa the blisters are not clear but rather turbid (infected)
  3. Miliaria Rubra caused by deeper occlusion of the sweat duct, it manifests by tiny red papules usually on the trunk

Treatment: supportive and removal of occluding agents or conditions. Low potency topical steroid may be of help.

Transient Acantholytic Dermatosis (Grover Disease)

  • This is a common disease affecting middle aged and elderly white.
  • It causes red bumps  on the truck some of which can be scaly
  • It may cause itching
  • It may cause seasonal flare ups in spring and winter
  • The cause is unknown
  • Risk factors include sun damage, eczema and psoriasis
  • It can be triggered by dry skin, sweating, sun exposure, medications and internal neoplasms
  • Diagnosis is by skin biopsy

Treatment: Emollients and Steroids