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Orbit/Oculoplastics Quiz 19
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Sandra Rocio Montezuma, M.D. | Massachusetts Eye and Ear Infirmary

July 15, 2006
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Eyelid Lesion
Eyelid Psoriasis

Case History
A 55 year old woman presents with a flat red lesion located in the left lateral periorbital area which has been present for six months. She had periods of exacerbation and remission. The lesion had been increasing in size over the last 3-4 weeks, and was associated with itchiness and dry skin.

Questions and Answers
Diagnosis: Eyelid Psoriasis
1. What is the differential diagnosis?
Answer: Atopic dermatitis, Contact dermatitis, contact urticaria, rosacea, seborrhea and psoriasis.

2. What is the typical lesion in this condition?
Answer: Skin plaque that thicken, redden, and become covered with silvery scales.

3. What is the clinical course of this condition?
Answer: Chronic disease, with periodic exacerbations and remissions.

4. What is the histopathology?
Answer: An accelerated epidermal proliferation results in hasty abnormal maturation and premature keratinization. Epidermal hyperproliferation, inflammation and capillary dilatation characterize psoriasis.

5. What other parts of the body are affected in this condition?
Answer: The lesions most often occur on the elbows, knees, scalp, lower back, face, palms, and soles of the feet. The disease also may affect the fingernails, toenails, and the soft tissues inside the mouth and genitalia.

6. What other eye problems can be present in this condition?
Answer: Ectropion , conjunctivitis, superficial punctate keratitis, corneal opacities, trichiasis, symblepharon, dry eyes and anterior uveitis are reported complications.

7. What other systemic problems can be present?
Answer: Psoriatic arthritis.

8. What are the treatment options?
Answer: Topical low potency, nonfluorinated corticosteroids, such as 1% hydrocortisone.
Ultraviolet B phototherapy is infrequently used, but may be considered for treatment of moderate to severe involvement.

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