PITYRIASIS ROTUNDA. (PITYRIASIS CIRCINATA).
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Skin diseases are an essential part of primary care medicine. Most dermatologic care is delivered in an outpatient setting. The initial evaluation is usually performed by the primary care physician. Women account for nearly 60% of all visits for dermatologic complaints.
We review the spectrum of papulosquamous disorders in the setting of infection with the human immunodeficiency virus (HIV). Included is a discussion of xerosis generalisata, seborrheic dermatitis, psoriasis, pityriasis rosea-like eruption, keratoderma blennorrhagicum, acquired ichthyosis, and erythroderma. Mechanisms of pathogenesis, including possible common pathways and relationships to underlying immunosuppression, are emphasized.
A large proportion of children seen by primary care pediatricians involve problems related to the skin. In this chapter, the importance of history and, particularly, physical examination in the diagnosis of various skin disorders is discussed. The ability to describe a rash using proper terminology will help narrow the differential and enable one to communicate what is seen to other physicians. The various primary and secondary lesions that may be present will be described along with various dermatoses as examples. Four common skin disorders that often fool the primary care physician are also discussed.
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Three cases are presented with a rash due to captopril which, on histology, showed a lichenoid pattern of bandlike upper dermal infiltrate of lymphocytes and histiocytes, together with hydropic degeneration of the basal layer of the epidermis producing Civatte bodies and pigmentary incontinence. The rash presented either as a pityriasis rosea-like picture which appeared about three to six months after the onset of treatment in patients taking low doses, or alternatively, as lichenoid plaques which appeared three to six months after commencement of medication in patients taking high doses. Although both clinical patterns produced a "saw tooth" pattern of the epidermal rete ridges, hypergranulosis and acanthosis were seen only with the lichenoid plaques.
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