Eczematous and Squamous Lesions

Abstract

Eczematous lesions, namely erythematous, scaly (squamous), crusted and sometimes oozing lesions are not only seen in contact dermatitis, but also in other diseases with different etiologies. In some diseases scales are more prominent. The superficial types of pemphigus including pemphigus foliaceus (Fig. 3.1) and pemphigus seborrheicus (Fig. 3.2) may present with eczematous patches on the nose. These lesions are more commonly observed in adult patients. While pemphigus foliaceus often causes disseminated lesions, pemphigus seborrheicus presents with localized ones. In these entities, intact bullae are not usually present. Instead, scales and crusts on an erythematous base intermingled with small eroded areas are commonly observed. Therefore, some patients may be misdiagnosed and mistreated as contact dermatitis for a long time. Pemphigus seborrheicus may sometimes resemble systemic lupus erythematosus due to symmetrical involvement, seen on the cheeks and nose in a butterfly-like pattern. Mucosal involvement is rare and response to treatment is better when compared to pemphigus vulgaris. On the other hand, some of the untreated pemphigus vulgaris lesions located on the nose may also become eczematized over time (Fig. 3.3).