? Well defined, deeply
erythematous plaques,
usually symmetrical on
extensors
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? Silvery (because of airtrapped between
scales), micaceous
scale
Psoriasis
--- Content provided by FirstRanker.com ---
? Grattage test (Auspitzsign)
? Koebner's
phenomenon
? Wornoff's ring
--- Content provided by FirstRanker.com ---
Guttate psoriasis
? Small raindrop like <1 cm
sized plaques,
symmetrically distributed
on trunk
--- Content provided by FirstRanker.com ---
? Comes in crops? Associated with
Streptococcal sore throats
? Mainly in children
? Antibiotic (erythromycin)
--- Content provided by FirstRanker.com ---
treatment is indicatedPustular psoriasis
? Generalized (von Zumbusch):
? Acute, widespread, severe, life-
threatening, emergency
--- Content provided by FirstRanker.com ---
? characterized by lakes of pus? precipitated by WITHDRAWL of
SYST SEROID and others
? Rx:
? DOC: pustular psoriasis is oral
--- Content provided by FirstRanker.com ---
retinoid = acitretin? Methotrexate
? PUVA
Nail psoriasis: (10-50%)
? Pitting (random, irregular, deep
--- Content provided by FirstRanker.com ---
and large)=Thimble pittingOther causes of nail pitting;
? Alopecia areata (patterned pits),
Nail biting and trauma, eczema
? Onycholysis and oil-drop sign
--- Content provided by FirstRanker.com ---
? Subungual hyperkeratosisArthropathic psoriasis: 5-10%
? HLA B-27
? Asymmetrical oligoarthritis:
MC. One or few joints of the
--- Content provided by FirstRanker.com ---
hand and feet leading tosausage digits.
? Distal IP joint disease: most
characteristic but not most
common.
--- Content provided by FirstRanker.com ---
? Arthritis Mutilans:destructive arthritis of fingers
and toes with "opera glass
deformity" or "pencil in
cup" deformity.
--- Content provided by FirstRanker.com ---
Psoriasis: Histology
? HK with PK
? Munro's microabcess
? Hypogranulosis
? Acanthosis and
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papillomatosis withrounding and elongation
of rete ridges
? Spongiform pustules of
Kogoj
--- Content provided by FirstRanker.com ---
? Suprapapillary thinning? Upper dermal vessel
dilatation and tortusity
with mononuclear
infiltrate
--- Content provided by FirstRanker.com ---
Lichen Planus
? Idiopathic
inflammatory disease
of skin with
significant MUCOSAL
--- Content provided by FirstRanker.com ---
and NAILinvolvement
? CMI mediated
autoimmune disease
with possible
--- Content provided by FirstRanker.com ---
association with HCV? KOEBENERIZATION
is characteristic
Lichen Planus
? 5 P's: pruritic, purple or
--- Content provided by FirstRanker.com ---
violaceous, polygonal,plane topped, papules &
plaques
? White reticualte lines:
Wickham striae: Tyndall
--- Content provided by FirstRanker.com ---
effect due to focalhypergranulosis
? Flexor aspect of wrist, lumbar
area, scalp, penis, oral
mucosae and shins
--- Content provided by FirstRanker.com ---
? Possible nail involvementLichen Planus
Mucosal LP:
? 50% of pt
? Net-like white,
--- Content provided by FirstRanker.com ---
non-removable,reticular
pattern is
most
characteristic
--- Content provided by FirstRanker.com ---
? More chronicLichen Planus
Nail LP:
? 10-25% of pt
? Longitudinal
--- Content provided by FirstRanker.com ---
ridging andgrooving and
scarring leading to
dorsal pterygium
formation,
--- Content provided by FirstRanker.com ---
? Difficult to treatLichen Planus
Scalp LP: Lichen
planopilaris or
follicular LP
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? follicular LPpapules with
atrophic scarring
alopecia.
? Difficult to treat
--- Content provided by FirstRanker.com ---
Lichen Planus
Histology
? Hyperkeratosis without
PK
? focal wedge shaped
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hypergranulosis? irregular acanthosis (saw
toothing)
? Civatte or colloid
bodies (Apoptotic),
--- Content provided by FirstRanker.com ---
? basal cell degeneration(BCD),
? MAX-JOSEPH space
? band-like infiltrate of
lymphocytes at the DEJ.
--- Content provided by FirstRanker.com ---
MOST CH.PITYRIASIS ROSEA:
? Etiology: ? (HHV7).
? C/F:
? herald patch is followed
--- Content provided by FirstRanker.com ---
in a few days to weeksby eruption of multiple
smaller lesions
following skin lines in a
"fir tree" pattern with
--- Content provided by FirstRanker.com ---
typical peripheralcollarette scale
? Course: Spontaneous
resolution after 4-8
weeks.
--- Content provided by FirstRanker.com ---
? Differential Diagnosis:Secondary syphilis is
an important differential
Pemphigus vulgaris ? Clinical appearance
Nikolsiky sign
--- Content provided by FirstRanker.com ---
Pemphigus vulgaris
? Tzanck smear:
characteristic
acantholytic cells.
? Skin biopsy: Fresh
--- Content provided by FirstRanker.com ---
blister (<48hr)shows Suprabasal
cleavage,
acantholysis with
row of tombstone
--- Content provided by FirstRanker.com ---
appearance.Pemphigus vulgaris
? Skin biopsy for Direct
Immunofluroscence
(DIF): Perilesional
--- Content provided by FirstRanker.com ---
skin shows thepresence of
intercellular IgG and
C3 deposition within
the epidermis in a
--- Content provided by FirstRanker.com ---
Fish Net Pattern.HAILEY-HAILEY DISEASE: (FAMILIAL
BENIGN PEMPHIGUS)
? AD disease
? minute vesicles, erosions,
--- Content provided by FirstRanker.com ---
crusting, fissures and foulsmell in the intertriginous
areas
? caused by a defect in calcium
pump of cadherin junctions
--- Content provided by FirstRanker.com ---
(desmosomes) of epidermalcells leading to acantholysis
(ATPase2C1).
? It can be confused with
intertrigo, candidiasis & tinea
--- Content provided by FirstRanker.com ---
cruris.? (IMP: Histologically
appearance is likened to a
"dilapidated or crumbling
Brick-wall")
--- Content provided by FirstRanker.com ---
Bullous pemphigoid
? Prototype of subepidermal
blistering dis
? commoner than pemphigus
vulgaris & occurs in old age (i.e.
--- Content provided by FirstRanker.com ---
>60)? autoantibody reacting with
basement membrane zone: major
& minor bullous pemphigoid
antigens (BP AG 1&2 with 230
--- Content provided by FirstRanker.com ---
&180 KD respectively)? autoantibodies localize to the
epidermal side (ROOF) of
NaCl split skin
Bullous pemphigoid
--- Content provided by FirstRanker.com ---
? Tzanck smear:No acantholytic
cells, many
eosinophils, few
neutrophils
--- Content provided by FirstRanker.com ---
? Histology:subepidermal
blisters i.e. intact
epidermis forms
the roof, with
--- Content provided by FirstRanker.com ---
mixed dermalinfiltrates,
especially
eosinophils.
Bullous pemphigoid
--- Content provided by FirstRanker.com ---
? DIF: lineardeposition of C3 +/-
IgG at DEJ
? Salt split IF:
antibodies in the roof
--- Content provided by FirstRanker.com ---
of salt splitLINEAR IGA DISEASE
? Clinical Picture
LINEAR IGA DISEASE
? Histology:
--- Content provided by FirstRanker.com ---
the pictureresembles DH
or BP.
? DIF:
Characterized
--- Content provided by FirstRanker.com ---
by linear IgAdeposition in
basement
membrane
zone (BMZ).
--- Content provided by FirstRanker.com ---
DERMATITIS HERPETIFORMIS
? Intense itching
? Grouped paulovesicles
which are usually excoriated
and scabbed and needs to be
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differentiated from Scabiesand acute atopic dermatitis.
? The sites of predilection are
elbows and knees,
buttocks, upper back and
--- Content provided by FirstRanker.com ---
face.? Intact vesicles seldom seen
since they are ruptured by
self scratching. Lesions heal
with no scarring.
--- Content provided by FirstRanker.com ---
DERMATITIS HERPETIFORMIS
? Histology: Neutrophilic
Microabscess in dermal
papillary tip is
characteristic.
--- Content provided by FirstRanker.com ---
? DIF: It shows granularIgA deposition in BMZ.
? Screening for the
presence of celiac
disease.
--- Content provided by FirstRanker.com ---
? Provocation test: iodidesin diet or patch.
EPIDERMOLYSIS BULLOSA ACQUISITA (EBA)
? An acquired
IMMUNOBULLOUS disease
--- Content provided by FirstRanker.com ---
mimicking BP? Bullae tend to occur at sites
of trauma.
? The IgG in these patients
binds to the anchoring fibrils
--- Content provided by FirstRanker.com ---
(COL 7A1) attached to theLamina densa.
? EBA can be differentiated
from BP on a salt-split DIF
only (here in BASE of split)
--- Content provided by FirstRanker.com ---
EPIDERMOLYSIS BULLOSA CONGENITA
? Gentetically inherited
? No AUTOANTIBODIES
? MECHANOBULLOUS
Trauma prone sites
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? 3 main types:? EB simplex: K-5/14: split thru
basal layer without much
sequale
? EB junctionalis: Laminin 5,
--- Content provided by FirstRanker.com ---
6 4 integrins: split thru laminalucida with significant scarring
? EB dystrophicans: split thru
lamina densa/ sublamina densa
(defective Collagen 7)
--- Content provided by FirstRanker.com ---
severe scarring mainly in ARform
Irritant CD
Commonest
irritants:
--- Content provided by FirstRanker.com ---
Water (MC), soaps,solvents, alkalis,
acids, feces and
urine
Napkin
--- Content provided by FirstRanker.com ---
dermatitis,detergents, solvents
and vegetables etc
Housewives'
eczema.
--- Content provided by FirstRanker.com ---
ACD
? Individual susceptibility
? Requires sensitization or
priming
? Latency
--- Content provided by FirstRanker.com ---
? Memory T cells areinvolved
? delayed hypersensitivity
reaction (Type IV)
? Patch test
--- Content provided by FirstRanker.com ---
? MC: NickelACD
? Airborne allergic
contact dermatitis
(ABCD):
--- Content provided by FirstRanker.com ---
? Airboene allergens? Exposed sites
? May spread to all over body
? Parthenium
hysterophorus
--- Content provided by FirstRanker.com ---
(congress grass) iscommonest cause of
ABCD in India.
? Sesquiterpene lactone
ATOPIC DERMATITIS
--- Content provided by FirstRanker.com ---
Phases of AD:? Infantile: Face &
flexures, trunk f/b
extensors when
crawling
--- Content provided by FirstRanker.com ---
? Children: Flexures? Adults: Flexural
ATOPIC DERMATITIS
ATOPIC STIGMATA:
? The lateral thinning of
--- Content provided by FirstRanker.com ---
the eyebrows istermed "Hertoghe's
sign".
? A deep fold (Dennie-
Morgan-fold) can be
--- Content provided by FirstRanker.com ---
found under the lowerlid
ATOPIC DERMATITIS
ATOPIC STIGMATA:
? Hyperlinear palms
--- Content provided by FirstRanker.com ---
? P. Alba:? white area (alba) with
scaling (pityriasis.),
? common in children, atopics,
dry skin and malnutrition.
--- Content provided by FirstRanker.com ---
? Usually multiple ill-definedpatches on face, neck upper
trunk
? Keratosis pilaris:
Antenna sign
--- Content provided by FirstRanker.com ---
ATOPIC DERMATITIS
ATOPIC STIGMATA:
? Increased incidence of
infections: Eczema
herpeticum or
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Kaposi's varicelliformeruption: severe
widespread HSV infection
Seborrheic dermatitis
?
--- Content provided by FirstRanker.com ---
distinctive morphology: Redlesions covered with
yellowish, greasy scales
?
distinctive distribution:
--- Content provided by FirstRanker.com ---
(scalp, face and upper trunk)which are areas rich in
sebaceous glands.
?
infants: Scalp (Cradle
--- Content provided by FirstRanker.com ---
Cap)?
Severe course with HIV and
Parkinsonism. Also
associated with
--- Content provided by FirstRanker.com ---
Cerebrovascular accidents.?
Rx: topical antifungals,
selenium sulfide and steroids
ASTEATOTIC ECZEMA (XEROTIC ECZEMA,
--- Content provided by FirstRanker.com ---
ECZEMA CRAQUELE)? elderly and people
with dry skin
? winter
? reduction of in skin
--- Content provided by FirstRanker.com ---
surface lipid? Extensor
extremities dry,
slightly scaly and
criss-crossed on the
--- Content provided by FirstRanker.com ---
surface (crazy-paving) to produce
a reticulate pattern
with minimal
inflammation
--- Content provided by FirstRanker.com ---
LICHEN SIMPLEX (CIRCUMSCRIBED
NEURODERMATITIS)
? circumscribed
area of
lichenification
--- Content provided by FirstRanker.com ---
? Chronic itchingand rubbing
? Idiopathic
? Easily acessed
sites: wrists,
--- Content provided by FirstRanker.com ---
elbows, ankles,back of neck,
genetilia
Nummular dermatitis (Discoid Eczema)
? circular or oval
--- Content provided by FirstRanker.com ---
plaques of eczemawith a clearly
demarcated margin.
? coin-shaped, 1 to 5
cm in diameter itchy
--- Content provided by FirstRanker.com ---
plaques.? There are
commonly
distributed on the
extremities
--- Content provided by FirstRanker.com ---
? Usually symmetricalPopmpholyx or Dishydriotic eczema
? vesicular palmo-plantar
dermatitis
? deep-seated Tapioca or
--- Content provided by FirstRanker.com ---
sago-grain like vesicles onpalms and soles and sides of
fingers,
? Etiology: Idiopathic, allergic
contact reactions (nickel),
--- Content provided by FirstRanker.com ---
atopy,? Dyshidriosis is NOT a must.
? Management:
? self resolving in 2-4 weeks
? topical corticosteroids, on
--- Content provided by FirstRanker.com ---
occasion short course ofsystemic corticosteroids
CHANCRE
? Clinical
picture
--- Content provided by FirstRanker.com ---
CHANCROID
? Chancroid
? Giant Chancroid
Herpes genitalis
? Primary HG
--- Content provided by FirstRanker.com ---
Recurrent HGLGV ? Sign of
Groove
Granuloma Inguinale (Donovanosis)
? Clinical picture
--- Content provided by FirstRanker.com ---
Syphilis
SECONDARY SYPHILIS:
? Systemic: fever,
malaise, anorexia
? Skin: (in 75%):. The
--- Content provided by FirstRanker.com ---
lesions are symmetrical,polymorphic (never
Vesico-bullous);,
asymptomatic affecting
palms and soles.
--- Content provided by FirstRanker.com ---
? Buschke Olendroffsign (BO sign)+:
rebound tenderness
Syphilis: S2
? Generalized
--- Content provided by FirstRanker.com ---
lymphadenopathy? Mucosal
involvement ( in
1/3rd): over genitalia
and mouth:
--- Content provided by FirstRanker.com ---
? Mucous patches:? Snail-track ulcer:
? Condylomata lata
Infectivity: Mucous patches> C lata > Chancre > S2 skin lesions
URETHRAL DISCHARGE: Gonorrhea
--- Content provided by FirstRanker.com ---
? Neisseria gonorrhoeae(gonococcus) GNDC
? Incubation period: 1-10
days
? MALES:
--- Content provided by FirstRanker.com ---
? acute gonococcal urethritisburning micturition, frequency,
purulent discharge per-urethra
? NOT ALWAYS frankly purulent
and patient may be
--- Content provided by FirstRanker.com ---
asymptomatic.? complicated by Tysonitis,
periuretheral abscess, littritis,
cowperitis, prostatitis, seminal
vesiculitis and epididymitis.
--- Content provided by FirstRanker.com ---
URETHRAL DISCHARGE
DIAGNOSIS:
? Gram's staining. Presence of GNDC
inside the PMN's is diagnostic of
Gonorrhoea. (95% sensitive and specific
--- Content provided by FirstRanker.com ---
in males while sensitivity is less incervical, rectal, oropharyngeal cases
Do a culture.)
? Culture: on Thayer-Martin medium.
Transport on Stuart's medium]
--- Content provided by FirstRanker.com ---
? There is no useful serological test forgonorrhoea.
TREATMENT:
? Cefixime or ceftriaxone
? V.V. IMP: Syndromic approach
--- Content provided by FirstRanker.com ---
advocates ADDING drug for ChlamydiaFor all cases of uretheral discharge:
Cefixime 400 mg stat + Azithromycin 1 g
stat.
GENITAL WARTS: CONDYLOMA
--- Content provided by FirstRanker.com ---
ACUMINATA? HPV: 6, 11 most commonly; Types
16, 18, 31, 33, and 35 are strongly
associated with genital dysplasia and
carcinoma.
--- Content provided by FirstRanker.com ---
? C/F: Multiple, soft, filiform papules,discrete with some coalescing to
raspberry-like lesions, on the glans
penis and prepuce or perianally.
? Diagnosis:
--- Content provided by FirstRanker.com ---
? primarily clinical;? Acetowhitening:
? Pap smear All women should have an
annual Pap smear.
TT
--- Content provided by FirstRanker.com ---
Skin lesions? Number: 1-3
? Symmetry: Localized
? Size: Large
? Borders: Regular: Well-
--- Content provided by FirstRanker.com ---
defined raised borderand depressed center
(saucer right side up)
? Sensation: Total
anesthesia
--- Content provided by FirstRanker.com ---
? Hair: Total loss? Surface: Dry and scaly
BT
Skin lesions
? Number: Single or few (3-10)
--- Content provided by FirstRanker.com ---
? Symmetry: Localized? Size: Large
small
? Borders: Well-defined but with
areas of poor definition
--- Content provided by FirstRanker.com ---
(Serrated); Satellitelesions near margins
? Sensation: Significant
hypesthesia
? Hair: Significant loss
--- Content provided by FirstRanker.com ---
? Surface: Significantly Dry +/-scaly
Skin lesions
? Number: Several (10-30):
BB
--- Content provided by FirstRanker.com ---
? Symmetry: Asymmetrical? Size: small> large
? Borders:
?
Both well defined and ill
--- Content provided by FirstRanker.com ---
defined lesions coexist(polymorphic) in equal
number
?
Bizarre geographical
--- Content provided by FirstRanker.com ---
lesion?
Annular lesions
?
Swiss cheese
--- Content provided by FirstRanker.com ---
orpunched out lesions are
characteristic
? Sensation: Mild-moderate
hypesthesia
--- Content provided by FirstRanker.com ---
? Hair: mild loss? Surface: dry/ shiny
Skin lesions
LL
? Number: Numerous,
--- Content provided by FirstRanker.com ---
uncountable? Symmetry: B/L
symmetrical
? Size: small
? Borders: Ill-defined
--- Content provided by FirstRanker.com ---
? Sensation:Normoaesthetic
? Hair: normal
? Surface: shiny
LL: Other Imp Details
--- Content provided by FirstRanker.com ---
? oil-smeared appearance? shiny and succulent
nodules.
? infiltration of the facial
skin especially over the
--- Content provided by FirstRanker.com ---
forehead, the zygoma, thechin, and the earlobes
? lateral madarosis
? depressed nasal bridge
? leonine facies.
--- Content provided by FirstRanker.com ---
? Nasal symptoms(stuffiness, crusts &
epistaxis)
earliest
symptoms.
--- Content provided by FirstRanker.com ---
LL: VARIANTS
? LUCIO LEPROSY (lepra bonita or beautiful leprosy):
? Shiny, thickened skin, loss of body hair, and widespread
sensory loss without distinct leprosy lesions on skin.
? variety of LL Hansen's disease.
--- Content provided by FirstRanker.com ---
? Usually in Mexico, central America? HISTOID LEPROSY:
? firm, succulent papules or
nodules ON rather than within
the skin.
--- Content provided by FirstRanker.com ---
? relapse, primary dapsoneresistance and rarely de novo
also in LL.
? They have a characteristic
histology of bundles of
--- Content provided by FirstRanker.com ---
spindle cells a ladermatofibroma
? highly bacillated
but
WITHOUT globi.
--- Content provided by FirstRanker.com ---
Leprosy: Some Imp
Details
? Deformities are
major cause of
morbidity with
--- Content provided by FirstRanker.com ---
leprosy. Handdeformities include
mainly claw hand
(Ulnar nerve
paralysis). Foot drop
--- Content provided by FirstRanker.com ---
is commonestcomplication in foot.
? trophic ulcerations.
Type-1 Lepra Reaction
? erythema, edema, and
--- Content provided by FirstRanker.com ---
tenderness of the existingskin lesions without new
lesions
? In downgrading type some
new lesions may appear
--- Content provided by FirstRanker.com ---
? Resolving lesionsdesquamate
? Neuritis is the major
complaint and can lead to
significant deformities.
--- Content provided by FirstRanker.com ---
? Sometimes there is SILENTneuritis
Type-2 lepra reaction
? Systemic features are
SEVERE: fever, malise,
--- Content provided by FirstRanker.com ---
arthralgias, Myalgias? Cutaneous lesions: ENL:
multiple, symmetrical,
tender, erythematous,
S/C nodules in CROPS on
--- Content provided by FirstRanker.com ---
face, extremities andtrunk.
? They heal in 3-7 days
with bruise like changes
? Existing skin lesions
--- Content provided by FirstRanker.com ---
remain unchangedATYPICAL MYCOBACTERIAL CUTANEOUS
INFECTION:
? M. marinum: Swimming
pool granuloma or Fish
--- Content provided by FirstRanker.com ---
Tank Granuloma? C/F: Red-brown asymptomatic
papules which enlarge into
plaques with verrucous surface
at the site of inoculation
--- Content provided by FirstRanker.com ---
(extremities) in individualsworking with aquarium etc,
usually without LN
enlargement but sometimes
spread along lymphatics gives a
--- Content provided by FirstRanker.com ---
sporotrichoid pattern.? Rx: ATT poorly effective.
Minocycline is most effective
drug.
ATYPICAL MYCOBACTERIAL CUTANEOUS
--- Content provided by FirstRanker.com ---
INFECTION:? M. ulcerans: Buruli ulcer:
? Develops as a painless SC swelling
which ulcerates to form a painless,
deeply undermined grossly
--- Content provided by FirstRanker.com ---
necrotic ulcer with exposure ofunderlying fat usually present on
extremities and persisting for
years without LN enlargement
? Malnourished/ immunosuppressed
--- Content provided by FirstRanker.com ---
? Rx: ATT ineffective. Excision andgrafting may be required though
Rifampicin and TMP-SMX may be
effective.
Primary TB
--- Content provided by FirstRanker.com ---
TB Chancre :? 5% of Cutaneous TB (rare)
? Cut. analog of pulmonary
Ghon's complex (skin lesion
and draining lymph node)
--- Content provided by FirstRanker.com ---
? Well defined painless nodulebreaking down to a non-
tender ulcer with undermined
edges occurring on extremities
and face in mainly children
--- Content provided by FirstRanker.com ---
following a penetrating injuryassociated with regional LN
enlargement (3-8 weeks).
Secondary TB
Lupus
--- Content provided by FirstRanker.com ---
vulgaris? Usually solitary, asymptomatic, well defined, red-
brown annular plaque
? extends peripherally with central atrophy and
scarring and an advancing and a receding edge.
--- Content provided by FirstRanker.com ---
? Sentinel lesions? The lesion is soft on probing (gelatinous consistency)
and diascopy reveals apple-jelly nodules)
Secondary TB
TBVC
--- Content provided by FirstRanker.com ---
(Tuberculosisverrucosa cutis)
Syn: prosecutor's
wart, anatomist's
wart
--- Content provided by FirstRanker.com ---
? Secondary re-infection TB in a patient withgood immunity
? seen on exposed sites (feet > hand).
? Irregular, verrucous red-brown plaque with
rough horny surface and deep clefts and
--- Content provided by FirstRanker.com ---
fissures with crusting and purulent discharge.? LN spared unless secondarily infected.
Secondary TB
Scrofuloderma :
Syn: TB
--- Content provided by FirstRanker.com ---
Colliquativa Cutis,King's Evil
? MC Cut. TB in India.
? Secondary reactivation tuberculosis spread by contiguity.
? A pre existing TB focus (Lymph Node MC, bone ,
--- Content provided by FirstRanker.com ---
joint, tendon, lacrimal apparatus etc) breaks through theoverlying skin to form a characterstic painless TB ulcer
(sinus) with bluish margins and undermined edges.
? The ulcer (sinus) is fixed to underlying structure (eg.
LN).
--- Content provided by FirstRanker.com ---
? Heals with puckered or cord-like scars.Secondary TB
TBCO
(Tuberculosis cutis
orificialis)
--- Content provided by FirstRanker.com ---
? Rare TB of mucosal orifices and adjacent skin inpatients with advanced visceral (Genitourinary,
gastrointestinal and pulmonary) TB due to
autoinoculation.
? Clinically presents as PAINFUL shallow ulcers at
--- Content provided by FirstRanker.com ---
the skin near mouth, anus, and urethral meatus.TUBERCULIDS
Lichen
scrofulosorum:
? Grouped lichenoid papules with perifollicular
--- Content provided by FirstRanker.com ---
pattern over the trunk.? found in children or young adults
? Sweat gland and perifollicular epitheloid cell
granuloma without caseation
Bacterial Infections
--- Content provided by FirstRanker.com ---
? ERYSEPLOID: rare infection caused by Erysiplothrix infisherman, butchers presenting as painful, tender, erythematous
lesion with a purplish hue.
ERYTHRASMA:
? Corynebacterium
--- Content provided by FirstRanker.com ---
minutissimum.? reddish-brown, scaly and
finely wrinkled macules
in Axillary and
genitocrural areas.
--- Content provided by FirstRanker.com ---
? characteristic "coral-red" fluorescence under
Wood's light.
? Rx: 1) Oral erythromycin
2) Topical : clindamycin,
--- Content provided by FirstRanker.com ---
whitfield's ointment ormiconazole
Pityriasis versicolor:
Clinical Picture
KOH: Sphagetti & Meatball
--- Content provided by FirstRanker.com ---
Tinea nigra
? Exophiala
(Phaeoannellomyces)
werneckii
? Brown or black
--- Content provided by FirstRanker.com ---
asymptomatic annularlesions
? Palms/ soles
? Western Hemisphere
? Rx: topical keratolytics
--- Content provided by FirstRanker.com ---
(sulfur/ salicylic acid),scraping, antifungal
Piedra
? superficial infection of hair shaft
? Nodules along the hair-shaft: nodule is the ascomycete fruiting
--- Content provided by FirstRanker.com ---
body of the fungus, know as an ascostroma? In tropics
? does not fluoresce under Wood's light
?
Trichosporon beigelii
--- Content provided by FirstRanker.com ---
white Piedraeasily detached
? Piedra hoartae
black Piedra
very adherent
--- Content provided by FirstRanker.com ---
? Rx: SHAVING, salicylic acid, Azoles, Formalin shampoosTinea capitis
? ECTOTHRIX
? ENDOTHRIX
Tinea capitis: NON-Inflammatory
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CATEGO CLINICAL APPEARANCERIES
Grey
?Ectothrix
patch
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?Microsporum sp.?Greenish fluroscence
?one or several patches of scaly
scalp with hairs broken just
above the level of the scalp
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?hair is lusterless and gray( covered with arthrospores)
"Black
?Endothrix
dot"
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?T.tonsurans, violaceum?hairs are notably fragile and
break easily at the level of the
scalp looks like "black dots".
Tinea Capitis: Inflammatory
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? KERION:? Severe tender, inflammatory,
boggy, cystic swelling with easily
plucked hair
? Caused by zoophilic organisms (M.
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canis, M. nanum, T. equinum, Tmentagrophytes var.
mentagrophytes)
? Scarring alopecia
? Agminate folliculitis:
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? Less severe inflammation thankerion with sharply defined, dull
red plaques studded with follicular
pustules.
? Caused by zoophilic species
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Tinea Capitis: Inflammatory
? FAVUS: honeycomb
? T. Schoenleinii
? Jammu & Kashmir
? cup shaped yellow scutula coverd
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with crusts & foul smell? endothrix-style growth, but
without the arthrocondia
? channels are formed within the
hair shaft
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as air bubbles movealong these channels in KOH
mount
? Woods lamp: bluish fluroscence
? Scarring alopecia
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T facei/ barbae
? Facei: children, females:
? Sharply marginated,
erythematous, scaling, and
crusted plaques Note
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asymmetry.? May be associated with T.
capitis
? Barbae:
? adult males
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shaving withinfected material
? closely resembling tinea capitis,
with invasion of the hair shaft.
? Pustular folliculitis
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? Easily removable hair? Rarely KERION
? Tinea Incognito: Picture
modified by steroid application.
T. corporis/ cruris
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? Annular lesions withperipheral enlargement and
central clearing & scaling,
sharply marginated plaques
with or without pustules or
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vesicles, usually at margins.? fusion of lesions produces
gyrate patterns.
? T. rubrum
CRURIS: Synonym: "Jock
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itch" , Dhobi itch"? similar lesions in groin area
T. mannum
? unilateral (dominant) scaling
particularly in the skin creases
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and the nails are usuallyinvolved
? "one hand, two feet"
distribution is typical of
epidermal dermatophytosis of
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the hands and feet.? After treatment, recurs unless
onychomycosis of fingernails,
feet, and toenails is eradicated
? Fissures and erosions provide
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portal of entry for bacterialinfections
T. pedis (Athlete's foot):
? infection of the toe web-spaces
and the soles.
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?There are 3 main clinical
patterns.
? Chronic Plantar Scaling = Dry or
"Moccasin" type.
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? Bullous TineaPedis: Sudden
eruption of pruritic or painful
vesicles on the soles. The eruption
is usually unilateral. It is usually
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caused by T. Mentagrophytes.?
Interdigital Tinea Pedis: Peeling,
maceration and fissuring occurs
frequently in the lateral toe clefts
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(4th and 5th).Onychomycosis (T. Unguium)
? Etio: T. rubrum (MC).
? Types:
?
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(1)DSO (MC):? Initial Infection of Nail bed and
hyponychium.
? distal nail edge onycholysis with
subungual debris, subungual
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hyperkeratosis anddiscolouration
? (2) PSO (LC):
? Nail fold
nail plate
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? IMP: Seen Mostly inIMMUNOCOMPROMISED AND
HIV.
? Rx: DOC: TERBINAFINE X 6-
12 weeks [Griso: 6 (fingernail)-
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12(toenail) months].Candidiasis
? moist, flexural sites.
? Pustules (Sattelite) at the edges are
characterstic. Shows Psedohyphae in
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KOH prep.? more common at the extremes of age and
during pregnancy.
? Predisposing factors:
? diabetes mellitus, pregnancy,
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? broad-spectrum antibiotics,? obesity, dentures,
? Cushing disease, uremia,
? malignancy and immunodeficiency.
Topical treatment
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Nystatin, imidazole cream, amphotericinlozenges (in oral candidiasis =swish and spit)
Systemic treatment: AMP- B DOC in
disseminated Candidiasis. Oral fluconazole,
itraconazole, ketoconazole
--- Content provided by FirstRanker.com ---
?SPOROTRCHOSIS
? ETIO: Sporothrix schenckii (Dimorphic)
? C/F:
? patients working with plants and farmers
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? follows penetrating injury by plant product(thorn)
? months after the injury there is
subcutaneous nodule which breaks down to
form chronic ulcer ( Fixed Cutaneous
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Sporotrichosis =15%)? Lymphangitic form (85/%) is characterized
by appearance of a chain of similar dermal
nodules along the drainig lymphatics in a
linear configuration (Sporotrichoid pattern)
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? Other sporotrichoid infections: M. marinum,kansasii
? LAB: Biopsy shows foreign body granuloma
with cigar shaped bodies and asteroid
bodies surrounded by eosinophilic material.
--- Content provided by FirstRanker.com ---
? TREATMENT: Saturated Sol. of KI.PEDICULOSIS CORPORIS
? affects the poor and neglected and
flourishes in overcrowded, dirty situations
Transmission is mainly by direct close
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body contact or by sharing infestedclothing
? seen on the clothing only (NOT on
body) esp. the inner lining of clothing
including the seams of underpants..
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? Intense pruritus? Excoriation with secondary bacterial
infection and hyperpigmented changes
are common.
? predilection for the upper back.
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? Treatment: It is the clothing ratherthan the patients which require
treatment
Laundering or boiling the
clothing and bedding is essential. The
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patient should bath thoroughly with soapand water.
PEDICULOSIS PUBIS:
? crab louse (Phthirus pubis)
? confined to the pubic and
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anal hair, but in hirsute orheavily infested patients, the
chest hair, arm and leg hair,
as well as the axilla, beard and
eyelashes can be infested.
--- Content provided by FirstRanker.com ---
? attach themselves to hairswith their strong back legs
? The nits attach themselves
to the hair and probably are
nourished by apocrine
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secretion.PEDICULOSIS PUBIS:
? all classes of society, as opposed
to other varieties of lice
? sexually transmitted disease
--- Content provided by FirstRanker.com ---
although this is not always the case.? Blue black colored pigmented macule
on the sides of trunk and inner aspect
of thighs (Maculae ceruleus=
taches Bleues= Tache Bleu?tres)
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may be present.? Rx:
? pt + sexual partners
? Screen for other STDs
? SHAVING THE HAIR
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? Permethrin, lindane? Eyelids: permethrin or physostigmine
or petroleum jelly
PAPULAR URTICARIA:
? PAPULAR URTICARIA
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(lichen urticatus) is ahypersensitivity reaction
pattern to insect/arthropod
bites like mosquitoes, bed
bugs, other insects seen in
--- Content provided by FirstRanker.com ---
rainy season etc.? multiple, itchy, reddish and
excoriated papules
? on exposed parts of body
? recurrent
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? mainly in children.Cutaneous leishmaniasis
? OLD WORLD: (L. major, L. tropica):
? Vector: sandfly Phlebotomus.
? Purely cutaneous form also known as
--- Content provided by FirstRanker.com ---
Baghdad Boil, Oriental Sore, DelhiBoil, Kandahar sore and Lahore Sore.
(pt. from Rajasthan)
? Exposed skin of face and extremeties
? It is of two types viz. moist or rural type
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characterized by ulcer formation and dryor urban type with non ulcerating
chronic erythematous, succulent and
infiltrated nodules
? Lesions may become annular with central
--- Content provided by FirstRanker.com ---
clearing, scarring and crustingVOLCANO sign
Post Kala-azar Dermal Leishmaniasis
(PKDL)
? L. donovani
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? many years afterincompletely treated
visceral Leishmaniasis
patients develop either
? (a) macular hypo or
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depigmented macules onface, arms and upper trunk
simulating LL Hansen's or,
? (b) Warty, infiltrated
papular lesions in the
--- Content provided by FirstRanker.com ---
central area of face nearnose and mouth (Muzzle
sign).
Dermatological diagnostics
? Acetowhitening: subclinical
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condylomata acuminata.? Diascopy (VITROPRESSION):
? distinguish erythema from purpura
?
Apple Jelly Nodules: Lupus vulgaris
--- Content provided by FirstRanker.com ---
? Darier's sign: urticaria pigmentosa(cutaneous mastocytosis)
? Grattage test & Auspitz's sign:
slight scratching of a scaly lesion
reveals
--- Content provided by FirstRanker.com ---
? initially fine scales? candle wax scales
? red Berkley's membrane;
? punctate bleeding points (Auspitz
sign)
--- Content provided by FirstRanker.com ---
? suggests of psoriasis. (others: Darier'sdisease and actinic keratosis)
Dermatological diagnostics
? Nikolskiy sign : an
indicator of active
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acantholysis distinguishbetween intraepidermal
and subepidermal
blistering diseases
? Pemphigus (vulgaris/
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foliaceous)? S.S.S.S.
? epidermolysis bullosa
? toxic epidermal necrolysis/
SJS (Pseudo Nikolskiy)
--- Content provided by FirstRanker.com ---
Dermatological diagnostics
? Antenna sign:
grossly plugged
follicular prominances
showing a long strand
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of keratin protrudingwhen examined in
light seen in Keratosis
Pilaris.
? Buttonholing sign:
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NF 1 (with centralvertical pressure the
lesion disappears
under the skin)
Dermatological diagnostics
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Carpet Tack Sign: or carpet en tack sign: removal ofadherent scales in DLE reveals downward projection of scales
which are follicular plugs
? Dimpling sign:
dermatofibroma.
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Dermatological diagnostics
? Koebeners' Phenomenon:
Spread of lesions of same
morphology (isomorphic
phenomenon) at the site
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of trauma. Characteristicallyseen in Lichen planus,
psoriasis, vitiligo and by
Auto-inoculation in Verruca,
Molluscum contagiosusm
--- Content provided by FirstRanker.com ---
? Dermographism: Physicalurticaria, Normal
? White Dermographism:
AD
Annular/ Figurate lesions:
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? Granuloma annulare:annularly arranged papules
over dorsum of hands in
diabetes.
? Erythema annulare
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centrifugum: variable causes,supposed to be a
hypersensitivity reaction to
many causes including drugs,
infections and malignancies.
--- Content provided by FirstRanker.com ---
Lesions spread centrifugallywhile clearing in center at a
rate of around 5 mm/day with
a characteristic trailing
scale.
--- Content provided by FirstRanker.com ---
Arrangement of lesions
? Erythema multiforme:
Target lesions, drugs and
herpes/mycoplasma
infections.
--- Content provided by FirstRanker.com ---
? Erythema chronicummigrans: In Lyme's
disease small papules
develop into gradually
enlarging annular lesions
--- Content provided by FirstRanker.com ---
and clearing from centerand is long lasting (1-3
months).
Arrangement of lesions
? Erythema gyratum
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repens: Associated?Erythema
with malignancies with
marginatum: In
rheumatic carditis
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wood grain pattern oferythematous annular
rings. Most common :
plaques develop on
LUNG Ca
--- Content provided by FirstRanker.com ---
mainly trunk andextensor extremities
Most characterstic:
which are transient
and keep on coming
--- Content provided by FirstRanker.com ---
Breast Caand going
? Necrolytic Migratory
Erythema: Seen in
Glucagonoma.
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PITYRIASIS RUBRA PILARIS:
An uncommon cause of
erythroderma, where the
underlying defect is
abnormal keratinisation:
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? Palmoplantar keratoderma(PRP Sandal)
? Red (salmon colored)
patches with islands of
sparing
--- Content provided by FirstRanker.com ---
? Papules: perifollicularhyperkeratotic over dorsum
of hands and trunk
Reiter's disease
? KDB
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? Circinatebalanitis
SJS/ TEN
SJS
TEN
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DERMATOMYOSITIS (DM)/ (PM)
SKIN: photosensitive rash
? Pathognomic skin
findings:
? GOTTRON'S PAPULES:
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Small violaceous to red,flat topped papules with
central depression over
dorsal IP and MCP
joints.
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? GOTTRON'S SIGN:Confluent macular
violaceous erythema
(CMVE) over the same
sites, Elbows, malleoli
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etc. (IMP: in SLE theCMVE SPARES the
joints)
DERMATOMYOSITIS (DM)/ (PM)
? Characteristic skin findings:
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? HELIOTROPE Rash: violaceousor purplish periorbital erythema
and edema
? Nail fold telangiectasia and
cuticle-dystrophy
--- Content provided by FirstRanker.com ---
? V sign: CMVE in the V area ofneck; SHAWL sign: CMVE over
shoulder girdle
? Linear CMVE on dorsum of
hands tracking along the
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tendons (Dowling's lines)? MECHANICS' hand: non
pruritic, hyperkeratotic,
symmetrical, fissured, scaly
and hyperpigmented hands.
--- Content provided by FirstRanker.com ---
DLE: CHRONIC CUTANEOUS LE (CCLE)
Scleroderma: MORPHEA
? Cutaneous sclerosis
alone without systemic
involvement.
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? Ivory colored plaqueswith a peripheral rim of
violaceous color and the
surface is shiny, smooth
and bound down with
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loss of hair (ScarringAlopecia) and sweat
glands and in late
stages even nerves
Scleroderma: MORPHEA
--- Content provided by FirstRanker.com ---
Types:? Circumscribed or localized:
usually on trunk.
? Linear scleroderma: upper or
lower extremity especially in
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children.? Frontoparietal (en coup de
sabre): linear scleroderma
occurring on the head with or
without hemiatrophy of face. PARRY
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ROMBERG SYNDROME: [SAFE]Seizures, Alopecia, Facial
hemiatrophy Exophthalmos
Scleroderma: MORPHEA
? Generalized morphea:
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widespread morphaeic plaquesover trunk and limbs.
? Pansclerotic (Morphea
profunda): involvement
(trunk, extremities, face, and
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scalp, with sparing offingertips and toes) of
dermis, fat, fascia, muscle,
bone. Mostly seen with linear
morphea. Can lead to severe
--- Content provided by FirstRanker.com ---
contractures and disability.LICHEN SCLEROSUS ET ATROPHICUS (LSA):
? atrophic, porcelain-
white, angular, well-
defined, indurated
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papules or plaques,and characteristic follicular
dilatation & keratotic
plugs, known as dells
occurring most commonly
--- Content provided by FirstRanker.com ---
on the ANOGENITALSKIN of both sexes. It is
more common in females
than males (10:1).
? The epidermal changes
--- Content provided by FirstRanker.com ---
differentiate it frommorphea.
Fixed drug eruption
? Drugs commonly
implicated:
--- Content provided by FirstRanker.com ---
? Persistent purplish? Barbiturates
? OCP
erythema that lasts 4-8
? NSAIDs
--- Content provided by FirstRanker.com ---
BONDweeks, can be bullous
? Foscarnet (penile
ulcers)
Fixed
--- Content provided by FirstRanker.com ---
and recurs at the same? Sulfonamides
Shiny
? Phenolphthalein
spot on taking the
--- Content provided by FirstRanker.com ---
PAD? Allopurinol
drug again
? Dapsone
? Heals with
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hyperpigmentation? Genitals and acral
extremities
Xeroderma pigmentosum: (AR)
Melanopenic diseases
--- Content provided by FirstRanker.com ---
? Nevus depigmentosus(Achromicus): stable,
congenital, off-white
macules, unilateral, may
have rounded borders or
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irregular along lines ofBlaschko but usually without
underlying skeletal or other
abnormality.
? Hypomelanosis of Ito:
--- Content provided by FirstRanker.com ---
bilateral, along embronal skinfusion lines (Blaschko's
lines), marble cake
pattern or fountain-spray
pattern; 60 to 75% have
--- Content provided by FirstRanker.com ---
systemic involvement--CNS,eyes, musculo-skeletal
system.
Dermal Melanocytosis: Hamartomas
? Nevus of Ota: periorbital speckled slate gray
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pigmentationPERSIST
? Nevus of Ito: similar pigmentation of the
acromioclavicular areas: PERSIST
Dermal Melanocytosis: Hamartomas
--- Content provided by FirstRanker.com ---
? Mongolian Spots: congenital gray-bluemacular lesions, which are characteristically
located on the lumbosacral area in ~80%
of Asians and disappear in early childhood
Nutritional dermatoses:
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? Kwashiorkor:? Flaky or enamel paint
dermatosis and flag sign
? Vit A defeciency and
EFA def:
--- Content provided by FirstRanker.com ---
? PHRYNODERMA? Riboflavin def:
? Deficiency causes
Keratoconjunctivitis,
Angular stomatitis,
--- Content provided by FirstRanker.com ---
Chelitis, Perleche andsmooth tongue. It can
also cause genital scaly
and patchy rashes.
(Oro-Oculo-Genital
--- Content provided by FirstRanker.com ---
syndrome).Nutritional dermatoses:
? Niacin def: pellagra:
? Diarrhoea, Dermatitis and
Dementia
--- Content provided by FirstRanker.com ---
? symmetric, photosensitive andphoto-exacerbated rash
? initially diffuse erythema with
itching
vesicles which lead
--- Content provided by FirstRanker.com ---
to heavy, Dry-Brown crusting,Hyperkeratosis and
lichenification on being
ruptured.
? The rash on neck is called
--- Content provided by FirstRanker.com ---
"Casal's Necklace" while thaton the dorsum of hands are
called the "Glove" or
"Gauntlet" of Pellagra.
(Similarly Boot of Pellagra
--- Content provided by FirstRanker.com ---
over feet.)Nutritional dermatoses:
? Vit C def: SCURVY
? Hemorrhagic signs: includes
hemorrhagic gingivitis,
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perifollicular petechiae andsubperiosteal hemorrhages
leading to pseudoparalysis in
childhood.
? Hyperkeratosis of hair follicles:
--- Content provided by FirstRanker.com ---
Presents as rough, pointed,follicular papules the hair of
which has a "swan-neck" or
"Cork-Screw" appearance
mainly over upper arms,
--- Content provided by FirstRanker.com ---
buttocks, thighs, calves, shinsetc.
? Hematologic abnormalities:
Anemia, capillary fragility test
etc.
--- Content provided by FirstRanker.com ---
Nutritional dermatoses:
? Zn def: Acrodermatitis
enteropathica (AR)
? Diarrhea, Alopecia and Dermatitis
? periorificial & acral moist, crusted with
--- Content provided by FirstRanker.com ---
large erosions and peripheral scales.? Low serum zinc levels but inc on oral
dosing
? ZEBRA STRIPED Hair
Necrobiosis lipoidica diabeticorum
--- Content provided by FirstRanker.com ---
? More common in young femalediabetic patients.
? symmetrical, well defined,
irregular, brown-red plaques
on both shins and feet.
--- Content provided by FirstRanker.com ---
Sometimes, it may appear on theface, arms and trunk. The
epidermis is atrophic and
delicate vessels occur over the
surface. Chronic stage may
--- Content provided by FirstRanker.com ---
present as Ulcers.? Treatment : unsatisfactory; I/L
steroids
? Does not correlate with
normalization of hyperglycemia.
--- Content provided by FirstRanker.com ---
Pseudo Xanthoma Elasticum
? Defective elastin
? distinctive peau d'orange
surface pattern resulting
from closely grouped
--- Content provided by FirstRanker.com ---
clusters of yellow(chamois-colored) papules
in a reticular pattern on the
neck, axillae, and other
body folds
--- Content provided by FirstRanker.com ---
? Angioid streaks andhemorrhages in retina
Neutrophilic dermatosis
? Pyoderma
gangrenosum
--- Content provided by FirstRanker.com ---
presents with chronicpainful ulcers with
irregular geographical
borders
? MC on legs
--- Content provided by FirstRanker.com ---
? Associated with Ulc.Colitis and Crohn's
Neutrophilic dermatosis
Sweets Syndrome:
? Associated with
--- Content provided by FirstRanker.com ---
? Idiopathic? Infections
? Drugs
? Malignancies (leukemias)
? IBDs & other autoimmune diseases
--- Content provided by FirstRanker.com ---
? Pregnancy? Acute, Febrile neutrophilic dermatosis
? Skin lesions are tender, erythematous
asymmetrical papulo-nodules which at times
may look pseudovesicular
--- Content provided by FirstRanker.com ---
? Wonderful response with STEROIDS & Potass.Iodide
Neurofibromatosis-1
STURGE- WEBER syndrome
Tuberous Sclerosis Complex
--- Content provided by FirstRanker.com ---
Ichthyosis
? Lamellar Ichthyosis
? AR
? Defective
TRANSGLUTAMINASE
--- Content provided by FirstRanker.com ---
? ABSENT GRANULAR layer? Onset within 1 yr/birth
? Plate like thick brown
scales
? Scarring with ectropion
--- Content provided by FirstRanker.com ---
etc possible