Download MBBS Dermatology Topic Images

Psoriasis
? Well defined, deeply
erythematous plaques,
usually symmetrical on
extensors

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? Silvery (because of air
trapped between
scales), micaceous
scale

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Psoriasis

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? Grattage test (Auspitz
sign)
? Koebner's
phenomenon
? Wornoff's ring

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Guttate psoriasis
? Small raindrop like <1 cm
sized plaques,
symmetrically distributed
on trunk

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? Comes in crops
? Associated with
Streptococcal sore throats
? Mainly in children
? Antibiotic (erythromycin)

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treatment is indicated

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Pustular psoriasis
? Generalized (von Zumbusch):
? Acute, widespread, severe, life-
threatening, emergency

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? characterized by lakes of pus
? precipitated by WITHDRAWL of
SYST SEROID and others
? Rx:
? DOC: pustular psoriasis is oral

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retinoid = acitretin
? Methotrexate
? PUVA

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Nail psoriasis: (10-50%)
? Pitting (random, irregular, deep

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and large)=Thimble pitting
Other causes of nail pitting;
? Alopecia areata (patterned pits),
Nail biting and trauma, eczema
? Onycholysis and oil-drop sign

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? Subungual hyperkeratosis

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Arthropathic psoriasis: 5-10%
? HLA B-27
? Asymmetrical oligoarthritis:
MC. One or few joints of the

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hand and feet leading to
sausage digits.
? Distal IP joint disease: most
characteristic but not most
common.

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? Arthritis Mutilans:
destructive arthritis of fingers
and toes with "opera glass
deformity" or "pencil in
cup" deformity.

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Psoriasis: Histology
? HK with PK
? Munro's microabcess
? Hypogranulosis
? Acanthosis and

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papillomatosis with
rounding and elongation
of rete ridges
? Spongiform pustules of
Kogoj

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? Suprapapillary thinning
? Upper dermal vessel
dilatation and tortusity
with mononuclear
infiltrate

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Lichen Planus
? Idiopathic
inflammatory disease
of skin with
significant MUCOSAL

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and NAIL
involvement
? CMI mediated
autoimmune disease
with possible

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association with HCV
? KOEBENERIZATION
is characteristic

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Lichen Planus
? 5 P's: pruritic, purple or

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violaceous, polygonal,
plane topped, papules &
plaques
? White reticualte lines:
Wickham striae: Tyndall

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effect due to focal
hypergranulosis
? Flexor aspect of wrist, lumbar
area, scalp, penis, oral
mucosae and shins

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? Possible nail involvement

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Lichen Planus
Mucosal LP:
? 50% of pt
? Net-like white,

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non-removable,
reticular
pattern is
most
characteristic

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? More chronic

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Lichen Planus
Nail LP:
? 10-25% of pt
? Longitudinal

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ridging and
grooving and
scarring leading to
dorsal pterygium
formation,

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? Difficult to treat

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Lichen Planus
Scalp LP: Lichen
planopilaris or
follicular LP

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? follicular LP
papules with
atrophic scarring
alopecia.
? Difficult to treat

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Lichen Planus
Histology
? Hyperkeratosis without
PK
? focal wedge shaped

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hypergranulosis
? irregular acanthosis (saw
toothing)
? Civatte or colloid
bodies (Apoptotic),

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? basal cell degeneration
(BCD),
? MAX-JOSEPH space
? band-like infiltrate of
lymphocytes at the DEJ.

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MOST CH.

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PITYRIASIS ROSEA:
? Etiology: ? (HHV7).
? C/F:
? herald patch is followed

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in a few days to weeks
by eruption of multiple
smaller lesions
following skin lines in a
"fir tree" pattern with

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typical peripheral
collarette scale
? Course: Spontaneous
resolution after 4-8
weeks.

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? Differential Diagnosis:
Secondary syphilis is
an important differential

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Pemphigus vulgaris ? Clinical appearance
Nikolsiky sign

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Pemphigus vulgaris
? Tzanck smear:
characteristic
acantholytic cells.
? Skin biopsy: Fresh

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blister (<48hr)
shows Suprabasal
cleavage,
acantholysis with
row of tombstone

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appearance.

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Pemphigus vulgaris
? Skin biopsy for Direct
Immunofluroscence
(DIF): Perilesional

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skin shows the
presence of
intercellular IgG and
C3 deposition within
the epidermis in a

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Fish Net Pattern.

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HAILEY-HAILEY DISEASE: (FAMILIAL
BENIGN PEMPHIGUS)
? AD disease
? minute vesicles, erosions,

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crusting, fissures and foul
smell in the intertriginous
areas
? caused by a defect in calcium
pump of cadherin junctions

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(desmosomes) of epidermal
cells leading to acantholysis
(ATPase2C1).
? It can be confused with
intertrigo, candidiasis & tinea

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cruris.
? (IMP: Histologically
appearance is likened to a
"dilapidated or crumbling
Brick-wall")

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Bullous pemphigoid
? Prototype of subepidermal
blistering dis
? commoner than pemphigus
vulgaris & occurs in old age (i.e.

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>60)
? autoantibody reacting with
basement membrane zone: major
& minor bullous pemphigoid
antigens (BP AG 1&2 with 230

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&180 KD respectively)
? autoantibodies localize to the
epidermal side (ROOF) of
NaCl split skin

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Bullous pemphigoid

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? Tzanck smear:
No acantholytic
cells, many
eosinophils, few
neutrophils

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? Histology:
subepidermal
blisters i.e. intact
epidermis forms
the roof, with

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mixed dermal
infiltrates,
especially
eosinophils.

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Bullous pemphigoid

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? DIF: linear
deposition of C3 +/-
IgG at DEJ
? Salt split IF:
antibodies in the roof

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of salt split

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LINEAR IGA DISEASE
? Clinical Picture

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LINEAR IGA DISEASE
? Histology:

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the picture
resembles DH
or BP.
? DIF:
Characterized

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by linear IgA
deposition in
basement
membrane
zone (BMZ).

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DERMATITIS HERPETIFORMIS
? Intense itching
? Grouped paulovesicles
which are usually excoriated
and scabbed and needs to be

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differentiated from Scabies
and acute atopic dermatitis.
? The sites of predilection are
elbows and knees,
buttocks, upper back and

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face.
? Intact vesicles seldom seen
since they are ruptured by
self scratching. Lesions heal
with no scarring.

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DERMATITIS HERPETIFORMIS
? Histology: Neutrophilic
Microabscess in dermal
papillary tip is
characteristic.

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? DIF: It shows granular
IgA deposition in BMZ.
? Screening for the
presence of celiac
disease.

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? Provocation test: iodides
in diet or patch.

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EPIDERMOLYSIS BULLOSA ACQUISITA (EBA)
? An acquired
IMMUNOBULLOUS disease

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mimicking BP
? Bullae tend to occur at sites
of trauma.
? The IgG in these patients
binds to the anchoring fibrils

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(COL 7A1) attached to the
Lamina densa.
? EBA can be differentiated
from BP on a salt-split DIF
only (here in BASE of split)

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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,

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6 4 integrins: split thru lamina
lucida with significant scarring
? EB dystrophicans: split thru
lamina densa/ sublamina densa
(defective Collagen 7)

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severe scarring mainly in AR
form

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Irritant CD
Commonest
irritants:

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Water (MC), soaps,
solvents, alkalis,
acids, feces and
urine
Napkin

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dermatitis,
detergents, solvents
and vegetables etc
Housewives'
eczema.

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ACD
? Individual susceptibility
? Requires sensitization or
priming
? Latency

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? Memory T cells are
involved
? delayed hypersensitivity
reaction (Type IV)
? Patch test

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? MC: Nickel

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ACD
? Airborne allergic
contact dermatitis
(ABCD):

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? Airboene allergens
? Exposed sites
? May spread to all over body
? Parthenium
hysterophorus

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(congress grass) is
commonest cause of
ABCD in India.
? Sesquiterpene lactone

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ATOPIC DERMATITIS

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Phases of AD:
? Infantile: Face &
flexures, trunk f/b
extensors when
crawling

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? Children: Flexures
? Adults: Flexural

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ATOPIC DERMATITIS
ATOPIC STIGMATA:
? The lateral thinning of

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the eyebrows is
termed "Hertoghe's
sign".
? A deep fold (Dennie-
Morgan-fold) can be

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found under the lower
lid

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ATOPIC DERMATITIS
ATOPIC STIGMATA:
? Hyperlinear palms

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? P. Alba:
? white area (alba) with
scaling (pityriasis.),
? common in children, atopics,
dry skin and malnutrition.

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? Usually multiple ill-defined
patches on face, neck upper
trunk
? Keratosis pilaris:
Antenna sign

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ATOPIC DERMATITIS
ATOPIC STIGMATA:
? Increased incidence of
infections: Eczema
herpeticum or

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Kaposi's varicelliform
eruption: severe
widespread HSV infection

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Seborrheic dermatitis
?

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distinctive morphology: Red
lesions covered with
yellowish, greasy scales
?
distinctive distribution:

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(scalp, face and upper trunk)
which are areas rich in
sebaceous glands.
?
infants: Scalp (Cradle

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Cap)
?
Severe course with HIV and
Parkinsonism. Also
associated with

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Cerebrovascular accidents.
?
Rx: topical antifungals,
selenium sulfide and steroids

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ASTEATOTIC ECZEMA (XEROTIC ECZEMA,

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ECZEMA CRAQUELE)
? elderly and people
with dry skin
? winter
? reduction of in skin

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surface lipid
? Extensor
extremities dry,
slightly scaly and
criss-crossed on the

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surface (crazy-
paving) to produce
a reticulate pattern
with minimal
inflammation

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LICHEN SIMPLEX (CIRCUMSCRIBED
NEURODERMATITIS)
? circumscribed
area of
lichenification

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? Chronic itching
and rubbing
? Idiopathic
? Easily acessed
sites: wrists,

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elbows, ankles,
back of neck,
genetilia

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Nummular dermatitis (Discoid Eczema)
? circular or oval

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plaques of eczema
with a clearly
demarcated margin.
? coin-shaped, 1 to 5
cm in diameter itchy

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plaques.
? There are
commonly
distributed on the
extremities

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? Usually symmetrical

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Popmpholyx or Dishydriotic eczema
? vesicular palmo-plantar
dermatitis
? deep-seated Tapioca or

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sago-grain like vesicles on
palms and soles and sides of
fingers,
? Etiology: Idiopathic, allergic
contact reactions (nickel),

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atopy,
? Dyshidriosis is NOT a must.
? Management:
? self resolving in 2-4 weeks
? topical corticosteroids, on

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occasion short course of
systemic corticosteroids

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CHANCRE
? Clinical
picture

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CHANCROID
? Chancroid
? Giant Chancroid

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Herpes genitalis
? Primary HG

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Recurrent HG

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LGV ? Sign of
Groove

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Granuloma Inguinale (Donovanosis)
? Clinical picture

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Syphilis
SECONDARY SYPHILIS:
? Systemic: fever,
malaise, anorexia
? Skin: (in 75%):. The

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lesions are symmetrical,
polymorphic (never
Vesico-bullous);,
asymptomatic affecting
palms and soles.

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? Buschke Olendroff
sign (BO sign)+:
rebound tenderness

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Syphilis: S2
? Generalized

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lymphadenopathy
? Mucosal
involvement ( in
1/3rd): over genitalia
and mouth:

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? Mucous patches:
? Snail-track ulcer:
? Condylomata lata
Infectivity: Mucous patches> C lata > Chancre > S2 skin lesions

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URETHRAL DISCHARGE: Gonorrhea

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? Neisseria gonorrhoeae
(gonococcus) GNDC
? Incubation period: 1-10
days
? MALES:

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? acute gonococcal urethritis
burning micturition, frequency,
purulent discharge per-urethra
? NOT ALWAYS frankly purulent
and patient may be

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asymptomatic.
? complicated by Tysonitis,
periuretheral abscess, littritis,
cowperitis, prostatitis, seminal
vesiculitis and epididymitis.

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URETHRAL DISCHARGE
DIAGNOSIS:
? Gram's staining. Presence of GNDC
inside the PMN's is diagnostic of
Gonorrhoea. (95% sensitive and specific

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in males while sensitivity is less in
cervical, rectal, oropharyngeal cases
Do a culture.)
? Culture: on Thayer-Martin medium.
Transport on Stuart's medium]

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? There is no useful serological test for
gonorrhoea.
TREATMENT:
? Cefixime or ceftriaxone
? V.V. IMP: Syndromic approach

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advocates ADDING drug for Chlamydia
For all cases of uretheral discharge:
Cefixime 400 mg stat + Azithromycin 1 g
stat.

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GENITAL WARTS: CONDYLOMA

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ACUMINATA
? HPV: 6, 11 most commonly; Types
16, 18, 31, 33, and 35 are strongly
associated with genital dysplasia and
carcinoma.

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? C/F: Multiple, soft, filiform papules,
discrete with some coalescing to
raspberry-like lesions, on the glans
penis and prepuce or perianally.
? Diagnosis:

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? primarily clinical;
? Acetowhitening:
? Pap smear All women should have an
annual Pap smear.

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TT

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Skin lesions
? Number: 1-3
? Symmetry: Localized
? Size: Large
? Borders: Regular: Well-

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defined raised border
and depressed center
(saucer right side up)
? Sensation: Total
anesthesia

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? Hair: Total loss
? Surface: Dry and scaly

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BT
Skin lesions
? Number: Single or few (3-10)

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? Symmetry: Localized
? Size: Large
small
? Borders: Well-defined but with
areas of poor definition

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(Serrated); Satellite
lesions near margins
? Sensation: Significant
hypesthesia
? Hair: Significant loss

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? Surface: Significantly Dry +/-
scaly

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Skin lesions
? Number: Several (10-30):
BB

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? Symmetry: Asymmetrical
? Size: small> large
? Borders:
?
Both well defined and ill

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defined lesions coexist
(polymorphic) in equal
number
?
Bizarre geographical

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lesion
?
Annular lesions
?
Swiss cheese

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or
punched out lesions are
characteristic
? Sensation: Mild-moderate
hypesthesia

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? Hair: mild loss
? Surface: dry/ shiny

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Skin lesions
LL
? Number: Numerous,

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uncountable
? Symmetry: B/L
symmetrical
? Size: small
? Borders: Ill-defined

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? Sensation:
Normoaesthetic
? Hair: normal
? Surface: shiny

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LL: Other Imp Details

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? oil-smeared appearance
? shiny and succulent
nodules.
? infiltration of the facial
skin especially over the

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forehead, the zygoma, the
chin, and the earlobes
? lateral madarosis
? depressed nasal bridge
? leonine facies.

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? Nasal symptoms
(stuffiness, crusts &
epistaxis)
earliest
symptoms.

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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.

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? Usually in Mexico, central America
? HISTOID LEPROSY:
? firm, succulent papules or
nodules ON rather than within
the skin.

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? relapse, primary dapsone
resistance and rarely de novo
also in LL.
? They have a characteristic
histology of bundles of

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spindle cells a la
dermatofibroma
? highly bacillated
but
WITHOUT globi.

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Leprosy: Some Imp
Details
? Deformities are
major cause of
morbidity with

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leprosy. Hand
deformities include
mainly claw hand
(Ulnar nerve
paralysis). Foot drop

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is commonest
complication in foot.
? trophic ulcerations.

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Type-1 Lepra Reaction
? erythema, edema, and

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tenderness of the existing
skin lesions without new
lesions
? In downgrading type some
new lesions may appear

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? Resolving lesions
desquamate
? Neuritis is the major
complaint and can lead to
significant deformities.

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? Sometimes there is SILENT
neuritis

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Type-2 lepra reaction
? Systemic features are
SEVERE: fever, malise,

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arthralgias, Myalgias
? Cutaneous lesions: ENL:
multiple, symmetrical,
tender, erythematous,
S/C nodules in CROPS on

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face, extremities and
trunk.
? They heal in 3-7 days
with bruise like changes
? Existing skin lesions

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remain unchanged

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ATYPICAL MYCOBACTERIAL CUTANEOUS
INFECTION:
? M. marinum: Swimming
pool granuloma or Fish

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Tank Granuloma
? C/F: Red-brown asymptomatic
papules which enlarge into
plaques with verrucous surface
at the site of inoculation

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(extremities) in individuals
working with aquarium etc,
usually without LN
enlargement but sometimes
spread along lymphatics gives a

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sporotrichoid pattern.
? Rx: ATT poorly effective.
Minocycline is most effective
drug.

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ATYPICAL MYCOBACTERIAL CUTANEOUS

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INFECTION:
? M. ulcerans: Buruli ulcer:
? Develops as a painless SC swelling
which ulcerates to form a painless,
deeply undermined grossly

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necrotic ulcer with exposure of
underlying fat usually present on
extremities and persisting for
years without LN enlargement
? Malnourished/ immunosuppressed

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? Rx: ATT ineffective. Excision and
grafting may be required though
Rifampicin and TMP-SMX may be
effective.

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Primary TB

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TB Chancre :
? 5% of Cutaneous TB (rare)
? Cut. analog of pulmonary
Ghon's complex (skin lesion
and draining lymph node)

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? Well defined painless nodule
breaking down to a non-
tender ulcer with undermined
edges occurring on extremities
and face in mainly children

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following a penetrating injury
associated with regional LN
enlargement (3-8 weeks).

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Secondary TB
Lupus

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vulgaris
? Usually solitary, asymptomatic, well defined, red-
brown annular plaque
? extends peripherally with central atrophy and
scarring and an advancing and a receding edge.

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? Sentinel lesions
? The lesion is soft on probing (gelatinous consistency)
and diascopy reveals apple-jelly nodules)

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Secondary TB
TBVC

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(Tuberculosis
verrucosa cutis)
Syn: prosecutor's
wart, anatomist's
wart

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? Secondary re-infection TB in a patient with
good immunity
? seen on exposed sites (feet > hand).
? Irregular, verrucous red-brown plaque with
rough horny surface and deep clefts and

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fissures with crusting and purulent discharge.
? LN spared unless secondarily infected.

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Secondary TB
Scrofuloderma :
Syn: TB

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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 ,

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joint, tendon, lacrimal apparatus etc) breaks through the
overlying 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).

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? Heals with puckered or cord-like scars.

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Secondary TB
TBCO
(Tuberculosis cutis
orificialis)

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? Rare TB of mucosal orifices and adjacent skin in
patients with advanced visceral (Genitourinary,
gastrointestinal and pulmonary) TB due to
autoinoculation.
? Clinically presents as PAINFUL shallow ulcers at

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the skin near mouth, anus, and urethral meatus.

---

TUBERCULIDS
Lichen
scrofulosorum:
? Grouped lichenoid papules with perifollicular

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pattern over the trunk.
? found in children or young adults
? Sweat gland and perifollicular epitheloid cell
granuloma without caseation

---

Bacterial Infections

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? ERYSEPLOID: rare infection caused by Erysiplothrix in
fisherman, butchers presenting as painful, tender, erythematous
lesion with a purplish hue.
ERYTHRASMA:
? Corynebacterium

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minutissimum.
? reddish-brown, scaly and
finely wrinkled macules
in Axillary and
genitocrural areas.

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? characteristic "coral-
red" fluorescence under
Wood's light.
? Rx: 1) Oral erythromycin
2) Topical : clindamycin,

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whitfield's ointment or
miconazole

---

Pityriasis versicolor:
Clinical Picture
KOH: Sphagetti & Meatball

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---

Tinea nigra
? Exophiala
(Phaeoannellomyces)
werneckii
? Brown or black

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asymptomatic annular
lesions
? Palms/ soles
? Western Hemisphere
? Rx: topical keratolytics

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(sulfur/ salicylic acid),
scraping, antifungal

---

Piedra
? superficial infection of hair shaft
? Nodules along the hair-shaft: nodule is the ascomycete fruiting

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body of the fungus, know as an ascostroma
? In tropics
? does not fluoresce under Wood's light
?
Trichosporon beigelii

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white Piedra
easily detached
? Piedra hoartae
black Piedra
very adherent

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? Rx: SHAVING, salicylic acid, Azoles, Formalin shampoos

---

Tinea capitis
? ECTOTHRIX
? ENDOTHRIX

---

Tinea capitis: NON-Inflammatory

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CATEGO CLINICAL APPEARANCE
RIES
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, T
mentagrophytes var.
mentagrophytes)
? Scarring alopecia
? Agminate folliculitis:

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? Less severe inflammation than
kerion 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 move
along 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 with
infected 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 with
peripheral 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 usually
involved
? "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 bacterial
infections

---

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 Tinea
Pedis: 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 and
discolouration
? (2) PSO (LC):
? Nail fold
nail plate

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? IMP: Seen Mostly in
IMMUNOCOMPROMISED 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, amphotericin
lozenges (in oral candidiasis =swish and spit)
Systemic treatment: AMP- B DOC in
disseminated Candidiasis. Oral fluconazole,
itraconazole, ketoconazole

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?

---

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.

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? 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 infested
clothing
? 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 rather
than the patients which require
treatment
Laundering or boiling the
clothing and bedding is essential. The

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patient should bath thoroughly with soap
and water.

---

PEDICULOSIS PUBIS:
? crab louse (Phthirus pubis)
? confined to the pubic and

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anal hair, but in hirsute or
heavily infested patients, the
chest hair, arm and leg hair,
as well as the axilla, beard and
eyelashes can be infested.

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? attach themselves to hairs
with 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

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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 a
hypersensitivity reaction
pattern to insect/arthropod
bites like mosquitoes, bed
bugs, other insects seen in

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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

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Baghdad Boil, Oriental Sore, Delhi
Boil, 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 dry
or urban type with non ulcerating
chronic erythematous, succulent and
infiltrated nodules
? Lesions may become annular with central

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clearing, scarring and crusting
VOLCANO sign

---

Post Kala-azar Dermal Leishmaniasis
(PKDL)
? L. donovani

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? many years after
incompletely treated
visceral Leishmaniasis
patients develop either
? (a) macular hypo or

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depigmented macules on
face, arms and upper trunk
simulating LL Hansen's or,
? (b) Warty, infiltrated
papular lesions in the

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central area of face near
nose 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

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? Darier's sign: urticaria pigmentosa
(cutaneous mastocytosis)
? Grattage test & Auspitz's sign:
slight scratching of a scaly lesion
reveals

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? initially fine scales
? candle wax scales
? red Berkley's membrane;
? punctate bleeding points (Auspitz
sign)

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? suggests of psoriasis. (others: Darier's
disease and actinic keratosis)

---

Dermatological diagnostics
? Nikolskiy sign : an
indicator of active

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acantholysis distinguish
between intraepidermal
and subepidermal
blistering diseases
? Pemphigus (vulgaris/

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foliaceous)
? S.S.S.S.
? epidermolysis bullosa
? toxic epidermal necrolysis/
SJS (Pseudo Nikolskiy)

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---

Dermatological diagnostics
? Antenna sign:
grossly plugged
follicular prominances
showing a long strand

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of keratin protruding
when examined in
light seen in Keratosis
Pilaris.
? Buttonholing sign:

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NF 1 (with central
vertical pressure the
lesion disappears
under the skin)

---

Dermatological diagnostics

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Carpet Tack Sign: or carpet en tack sign: removal of
adherent 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. Characteristically
seen in Lichen planus,
psoriasis, vitiligo and by
Auto-inoculation in Verruca,
Molluscum contagiosusm

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? Dermographism: Physical
urticaria, 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.

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Lesions spread centrifugally
while clearing in center at a
rate of around 5 mm/day with
a characteristic trailing
scale.

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---

Arrangement of lesions
? Erythema multiforme:
Target lesions, drugs and
herpes/mycoplasma
infections.

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? Erythema chronicum
migrans: In Lyme's
disease small papules
develop into gradually
enlarging annular lesions

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and clearing from center
and 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 of
erythematous annular
rings. Most common :
plaques develop on
LUNG Ca

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mainly trunk and
extensor extremities
Most characterstic:
which are transient
and keep on coming

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Breast Ca
and 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

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? Papules: perifollicular
hyperkeratotic over dorsum
of hands and trunk

---

Reiter's disease
? KDB

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? Circinate
balanitis

---

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 the
CMVE SPARES the
joints)

---

DERMATOMYOSITIS (DM)/ (PM)
? Characteristic skin findings:

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? HELIOTROPE Rash: violaceous
or purplish periorbital erythema
and edema
? Nail fold telangiectasia and
cuticle-dystrophy

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? V sign: CMVE in the V area of
neck; 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.

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---

DLE: CHRONIC CUTANEOUS LE (CCLE)

---

Scleroderma: MORPHEA
? Cutaneous sclerosis
alone without systemic
involvement.

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? Ivory colored plaques
with a peripheral rim of
violaceous color and the
surface is shiny, smooth
and bound down with

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loss of hair (Scarring
Alopecia) and sweat
glands and in late
stages even nerves

---

Scleroderma: MORPHEA

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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 plaques
over trunk and limbs.
? Pansclerotic (Morphea
profunda): involvement
(trunk, extremities, face, and

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scalp, with sparing of
fingertips and toes) of
dermis, fat, fascia, muscle,
bone. Mostly seen with linear
morphea. Can lead to severe

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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

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on the ANOGENITAL
SKIN of both sexes. It is
more common in females
than males (10:1).
? The epidermal changes

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differentiate it from
morphea.

---

Fixed drug eruption
? Drugs commonly
implicated:

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? Persistent purplish
? Barbiturates
? OCP
erythema that lasts 4-8
? NSAIDs

--- Content provided by‌ FirstRanker.com ---

BOND
weeks, can be bullous
? Foscarnet (penile
ulcers)
Fixed

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and recurs at the same
? Sulfonamides
Shiny
? Phenolphthalein
spot on taking the

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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 of
Blaschko but usually without
underlying skeletal or other
abnormality.
? Hypomelanosis of Ito:

--- Content provided by​ FirstRanker.com ---

bilateral, along embronal skin
fusion lines (Blaschko's
lines), marble cake
pattern or fountain-spray
pattern; 60 to 75% have

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systemic involvement--CNS,
eyes, musculo-skeletal
system.

---

Dermal Melanocytosis: Hamartomas
? Nevus of Ota: periorbital speckled slate gray

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pigmentation
PERSIST
? Nevus of Ito: similar pigmentation of the
acromioclavicular areas: PERSIST

---

Dermal Melanocytosis: Hamartomas

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? Mongolian Spots: congenital gray-blue
macular 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:

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? PHRYNODERMA
? Riboflavin def:
? Deficiency causes
Keratoconjunctivitis,
Angular stomatitis,

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Chelitis, Perleche and
smooth 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 and
photo-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 that
on 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,

--- Content provided by FirstRanker.com ---

perifollicular petechiae and
subperiosteal hemorrhages
leading to pseudoparalysis in
childhood.
? Hyperkeratosis of hair follicles:

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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, shins
etc.
? 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 female
diabetic patients.
? symmetrical, well defined,
irregular, brown-red plaques
on both shins and feet.

--- Content provided by‌ FirstRanker.com ---

Sometimes, it may appear on the
face, 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 and
hemorrhages in retina

---

Neutrophilic dermatosis
? Pyoderma
gangrenosum

--- Content provided by‍ FirstRanker.com ---

presents with chronic
painful ulcers with
irregular geographical
borders
? MC on legs

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? Associated with Ulc.
Colitis and Crohn's

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Neutrophilic dermatosis
Sweets Syndrome:
? Associated with

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? Idiopathic
? Infections
? Drugs
? Malignancies (leukemias)
? IBDs & other autoimmune diseases

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? Pregnancy
? Acute, Febrile neutrophilic dermatosis
? Skin lesions are tender, erythematous
asymmetrical papulo-nodules which at times
may look pseudovesicular

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? Wonderful response with STEROIDS & Potass.
Iodide

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Neurofibromatosis-1

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STURGE- WEBER syndrome

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Tuberous Sclerosis Complex

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Ichthyosis
? Lamellar Ichthyosis
? AR
? Defective
TRANSGLUTAMINASE

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? ABSENT GRANULAR layer
? Onset within 1 yr/birth
? Plate like thick brown
scales
? Scarring with ectropion

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etc possible

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