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14
Jun

A 43-year-old man with diffused silvery scales adherent entire scalp and salmon-pink papules on forehead and face

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Case Presentation

A 43-year-old man was seen in the clinical centre because of silvery scales covering his entire scalp, and scattered salmon-pink papules on the face and forehead. The patient had been well until approximately 1.5 years earlier, when silvery scales developed, first on his scalp, and then gradually covering his entire scalp.

Approximately 1 year before presentation, the patient had seen a physician who administered frequent shampooing with formulations containing 2.5 percent selenium sulfide, imidazoles, zinc pyrithione, benzoyl peroxide, salicylic acid, coal tar. Initially the scales could be removed by shampooing, but afterwards, scales developed with some reddish papules spread over his forehead.

On examination, the psoriatic scales appeared powdery, with a silvery sheen involving the entire scalp (Fig.1-A). There were discrete small papules on the forehead (Fig.1-A) and face, no hair loss and no diarrheal; the patient disclosed that his father suffered from psoriasis.

case_4_ps_scalp

Serum investigation in the laboratory revealed no abnormal findings: temperature was 37.2°C, his medication records shown no topical corticosteroid use. The patient was prescribed a monotherapy of Tangs Psoria Capsule 1440mg thrice dauly. He responded well thereafter (Fig.1-B,C), and within three months of , the psoriatic scalp completed cleared. We thoroughly reviewed the patient’s file and compared fetails with other psoriasis patients treated previously, and found that this patient had had no history of immunosuppressive therapy (corticosteroid, MTX, acitretin, etretinate, etc.). The Tangs Psoria formula stimulates the yang (from the Chinese concept of Yin & Yang) component of the human body’s immune system, stimulating blood circulation and facilitating the detoxification processes. Itt adopted a therapeutic method which is the reverse of immunosuppressive approach: therefore patients who previously did not treated by immunosuppressants (corticosteroid, MTX, acitretin, etretinate, etc.) experienced total recovery in three months.

Differential Diagnosis

Other skin disorders, such as scalp seborrheic dermatitis (Fig.2), may look similar to psoriasis, but there are differences. Scalp psoriasis scales appear powdery with a silvery sheen, while seborrheic dermatitis scales often appear yellowish and greasy. Despite these differences, the two conditions can be easily confused.

Signs and symptoms
Scalp psoriasis Seborrheic dermatitis of the scalp
  • Red patches of skin covered with silvery scales
  • Dry, cracked skin that may bleed
  • Itching, burning or soreness
  • Patchy scaling or thick crust on the scalp
  • Yellow or white scales that may attach to the hair shaft
  • Red, greasy skin covered with flaky white or yellow scales
  • Small, reddish-brown bumps
  • Itching or soreness
  • Skin flakes or dandruff

 

PSORIASIS and SEBOPSORIASIS

In patients (particularly adults,) with a psoriatic predisposition, seborrheic dermatitis is said to evolve into psoriasis. The term sebopsoriasis is sometimes used for these overlapping conditions. Sebopsoriasis is one of the clinical patterns of psoriasis skin presentation. It should be used with caution because psoriasis, especially of the scalp, is clinically and histopathologically almost indistinguishable from seborrheic dermatitis. A common clinical entity, sebopsoriasis, presents with erythematous plaques with greasy scales localized to seborrheic areas (scalp, glabella, nasolabial folds, perioral and presternal areas, and intertriginous areas). In the absence of typical findings of psoriasis elsewhere, distinction from seborrheic dermatitis is difficult. Sebopsoriasis may represent a modification of seborrheic dermatitis by the genetic background of psoriasis, and is relatively resistant to treatment.

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