DERMATOLOGY

WORKBOOK
By
DR. JAZEER

ARISE MEDICAL ACADEMY

https://instagram.com/arisemedicalacademy
www.arisemedicalacademy.com

RISE WITH ARISE

2
Introduction to Dermatology

Stratum
corneum
Stratum
lucidum

Stratum
granulosum

Stratum
spinosum

Stratum
basale

3
Stratum Basale

Stratum Spinosum

Stratum Malpighi

4
Stratum Granulosum

Stratum Lucidum

Stratum Corneum

5
Melanocytes

6
 Merkel Cells

Langerhans Cell

7
8
DERMIS

Subcutaneous
Layer

9
 Summary

Vitamin D production

The layer deficient in preterm baby

Layer in which Langerhans cells are seen

Stratum malpighi

Epidermal melanin unit

Melanocytes derived from

Inflammation of subcutaneous lobules

Type 1 Skin type Always tans , Never

Burns

Prickle cell layer

Stratum germinativum

10
Primary Skin Lesions

11
12
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Secondary Skin Lesions

15
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Investigations in Dermatology

18
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 Histopathology

Stratum Corneum

Hyperkeratosis

Parakeratosis

Stratum Granulosum

Hypergranulosis

Hypogranulosis

20
Stratum Spinosum

Acanthosis

Acantholysis

Rete Ridges

Regular elongation

Saw toothing

Microabscess

Neutrophils

Lymphocytes

Eosinophils

Other findings

Ballooning

Spongiosis

21
22
 Summary

Macule >1 cm diameter

Circumscribed elevated fluid-containing lesion <

1cm

Edematous transient lesion that lasts <24 hours

Special skin lesion seen in acne vulgaris

Filter in wood's lamp

Skin Lines important for surgical incision

First investigation in suspected superficial fungal

infection

Patch test is best interpreted at

Erythema blanches on diascopy

Basket weave HPE

Presence of nucleus in stratum corneum in oral and

vaginal mucosa is Normal (true or false)

Example of neutrophilic microabscess

Spongiosis in histopathology is characteristic of

23
 MCQ
Q. Patch test is a type of : Q. The secondary skin lesion seen
in association with the given image
A. Immediate Hypersensitivity
is :
B. Antibody Mediated Hypersensitivity
C. Immune Complex Mediated
Hypersensitivity
D. Delayed type Hypersensitivity

Q. What is the dermatological test

shown below ?
A. Papule
B. Plaque
C. Crust
D. Nodule

A. Woods lamp
B. Patch test
C. Diascopy
D. Blanch test
Appendageal Disorders - HAIR

Anagen

Telogen Catagen

24
 ALOPECIA

Androgenic Alopecia

25
Alopecia Areata

26
Trichotillomania

27
Anagen Effluvium Telogen Effluvium

28
 Summary

Duration of anagen phase

Duration of telogen phase

Miniaturization of hair is a hallmark

of

Christmas tree pattern hair loss in

female

Nail pitting in alopecia areata

Treatment of traction alopecia

Increased hair loss after

surgery/pregnancy/anaemia

Diseases of the Nail

29
 Leukonychia

Apparent Leukonychia

30
Other Nail Disorders

31
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Acne Vulgaris

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Rosacea

35
 MCQ

Q. A 24-year old unmarried woman has Q. A male patient presents with patchy
multiple nodular, cystic, pustular and hair loss of hair on scalp, eyebrows and
comedonal lesions on face, upper back beard. He has also history of rapid
graying of hair in few areas. Likely
and shoulders for 2 years. The drug of
diagnosis is:
choice for her treatment would be: A. Alopecia effluvium
A. Acitretin B. Alopecia areata
B. Isotretinoin C. Telogen effluvium
C. Doxycycline D. Androgenetic alopecia
D. Azithromycin
Q. A patient presented to the clinic with
red rashes over her face. After the lab
Q. A 17 year old girl with Acne has been tests, she was found to have anti-nuclear
taking a drug for the last two years. She antibody positive. These rashes are called
now presents with blue black as;
pigmentation of nails. The likely
medication causing the above
pigmentation is:
A. Tetracycline
B. Doxycycline
C. Minocycline
D. Azithromycin
A. Heliotrope rashes
B. Allergic rashes
C. Malar rashes
D. Rosacea rashes
Q. Alopecia universalis is ?
A. Loss of all the scalp hair
B. Loss of all body hair
C. Loss of hair at the scalp margin
D. Male pattern hair loss

36
Papulosquamous Disorders
Psoriasis

37
Pustular Psoriasis

38
Psoriatic Arthritis

Radiological changes in Psoriasis

P Pencil in cup deformity

O Osteolysis

I Ivory Phalanx

S Sausage Digits
O Opera Glass Deformity
N Narrowing of Joint Spaces

39
Nail Findings in Psoriasis

40
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 Histopathology
Munro’s Microabscess

Spongiform Pustule of Kogoj

Suprapapillary thinning

Management

TOPICAL PHOTOTHERAPY SYSTEMIC AGENTS

Corticosteroid
--
Clobetasol

Keratolytic agents: Methotrexate

Narrowband UVB
- Salicylic acid
Broadband UVB
- Coal tar PUVA

Vit D analogues:
-Calcitriol Cyclosporine
-Calcipotriol

Topical retinoid:
-Tazarotene Acitretin

42
 BIOLOGICAL AGENTS

Ustekinumab : anti IL – 12 / 23
Secukinumab: anti IL – 17 A
Apremilast : PDE-4 inhibitor

Adalimumab
Etanercept TNF alpha inhibitor
Infliximab

Alefacept : CD-2
Efalizumab : CD-11 T-cell inhibitors
Itolizumab : CD-6
 SUMMARY

Pathognomic nail change in psoriasis

DOC for pustular psoriasis

DOC for pustular psoriasis in pregnancy

MC joint involved in psoriatic arthritis

Lake of pus

Dermatological emergency in
psoriasis
Neutrophilic abscess seen in
psoriasis

Teratogenicity of acitretin

Pinpoint bleeding points seen on

removal of the scales in psoriasis

44
Pityriasis Rosea

45
Lichen Planus

46
 Histopathology

Hypergranulosis
Vacuolization of basal cells - most pathognomic
Colloid or civatte bodies- necrotic keratinocyte
Max Joseph space
Saw tooth appearance

47
 Lichen nitidus

Pityriasis rubra pilaris

48
 MCQ
Q. A patient with psoriasis was started on Q. A 35 year old male presents to your
systemic steroids. After stopping the clinic with deep seated pustular lesions on
treatment, patient developed generalized the palms and soles. The pustules are
pustules all over the body. Most likely sterile on examination. What is the most
cause of this condition will be: probable diagnosis :
A. Bacterial infection
B. Septicemia
C. Drug induced reaction
D. Pustular Psoriasis

Q. All of the following regarding Lichen

Planus are true except :
A. Does not involve mucous membrane
B. Associated with Hepatitis ‘C’
C. Topical Steroid are the Mainstay of A. Lichen Planus
Therapy B. HSV infection
D. Spontaneous Remissions 6 months to C. Palmoplantar Psoriasis
2 years D. Contact Dermatitis

Q. Psoralen + Ultraviolet light (PUVA) Q. A young lady presents with white lacy
therapy is useful in the treatment of : lesions in oral cavity and her proximal nail
A. Psoriasis fold has extended onto the nail bed. What
B. Vitiligo is the likely diagnosis?
C. Mycosis Fungoides
A. Psoriasis
D. All of the above
B. Lichen planus
C. Pityriasis rosea
Q. DOC for a pregnant woman in 2nd
D. Candidiasis
trimester with pustular psoriasis is
A. Prednisolone
B. Dapsone
C. Acitretin
D. Methotrexate
Q. Lichen planus associated with all
except
A. Pterygium
B. Thickened nail bed
C. Trachyonychia
D. Tented nail

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 Eczema
IRRITANT CONTACT ALLERGIC CONTACT DERMATITIS
DERMATITIS

• Rubber - PPD
• Organic solvent • Dyes
• Soap • Cosmetics
• Detergents • Metals
• Cement

50
 • Bindi dermatitis
• PTBP (para tertiary butyl phenol)

• Footwear dermatitis- PPD (paraphenylenediamine)

51
 Summary

MC cause of Irritant
Contact Dermatitis

MC cause of Allergic
Contact Dermatitis

MC metal causing ACD

MC topical drug causing

ACD

52
 Chemical Leukoderma

MONOBENZYLETHER OF
HYDROQUINONE

PARA TERTIARY BUTYLPHENOL –

PTBP

PARA TERTIARY BUTYL CATECHOL –

PTBC
PARA PHENYLENEDIAMINE - PPD

Atopic Dermatitis

53
INFANTILE AD CHILDHOOD AD ADULT AD

54
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Endogenous Eczema

56
 Summary

Chronic erythematous itchy condition with

sharply marginated lesions covered by
yellowish greasy scales

Single coin like clearly demarcated eczematous

plaque

Scalp Seborrheic dermatitis in infant

Lack of skin surface lipids, dry skin with crazy

paving reticulate pattern with minimal
inflammation

Crops of clear vesicles with severe itching

over the palms and soles with sago-grain
appearance

Eczema associated with venous insufficiency

and chronic edema involving lower limb

57
 MCQ
Q. White dermographism is seen in Q. A 15 year old girl comes with itchy
lesions on elbow . Her family history is
positive for Asthma , what could bw the
probable diagnosis
A. Seborrhoeic dermatitis
B. Atopic dermatitis
C. Allergic contact dermatitis
D. Erysepalas
A.Chronic Urticaria Q. Most common cause of skin infection
B. Atopic dermatitis in atopic dermatitis
C Angioedema A. Staphylococcus aureus
D. Pressure dermatitis B. HSV
C. Fungal infections
D. Streptococcus
Q. Spongiosis is seen in :
A. Acute eczema
B. Chronic eczema
C. Psoriasis
D. Pemphigus

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 Urticaria

Lesions disappear <24hrs Lesions disappear >24hrs

Chronic Spontaneous Physical

Stimuli Type of urticaria

Touch/stroke Dermographism
Heat Heat urticaria
Cold Cold urticaria
Sun Solar urticaria
Exercise Cholinergic urticaria
Pressure Pressure urticaria
Water Aquagenic urticaria

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 Red dermographism

White dermographism

Black dermographism

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Urticaria Pigmentosa

61
Reactive Erythemas

62
 Summary

Urticarial lesion persisting for more

than 24 hours

Urticaria developing after sun

exposure

Urticaria developing after sweating

Darier’s sign is seen in

Treatment choice for Anaphylaxis

63
Bacterial Skin Infections

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 Impetigo

NON-BULLOUS IMPETIGO BULLOUS IMPETIGOGO

STREP. > STAPH AUREUS STAPH. AUREUS

ERYTHROMYCIN DICLOXACILLIN

66
Ecthyma Pyogenicum

Ecthyma Gangrenosum

Ecthyma contagiosum

ERYSIPELAS CELLULITIS

CAUSATIVE
ORGANISM

BORDERS

67
 Summary

Crops of pustules

Causative of Ecthyma
Gangrenosum

Golden yellow, honey

coloured crusts

Varnish crust

Chocolate crust

Necrotising fasciitis localized

to scrotum
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 Summary
Tissue paper like wrinkling of skin,
Potato chips desquamation.

Life threatening multisystem disease due

to bacterial toxin. Acute onset of fever,
erythema, desquamation and circulatory
shock.

Boiled lobster appearance,

Sunburn with goose pimples.
Sandpaper rash, strawberry tongue.

PARONYCHIA

Pseudomonas infection of the nail.

Green nail syndrome.

70
Viral Skin Infections

HPV infections (warts)

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 Summary

Characteristic HPE finding in Molluscum

contagiosum

Treatment of Choice of Genital warts

Treatment of Choice of Genital warts

In pregnancy

Characteristic HPE finding in HPV

Low grade, Locally invasive, rarely

metastasize... Histologically benign
tumour.

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HSV Infections

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Varicella infection

75
 Post-herpetic Neuralgia Herpes Zoster Herpes Zoster Oticus
Ophthalmicus

Persistence or recurrence of
pain for more than 120 days.

Rx: Hutchinson’s sign: Ramsay Hunt Syndrome:

● Ipsilateral facial
• Gabapentin
paralysis
● Ear ache
● Vesicles in the
ear

76
Summary

Grouped vesicles on an
erythematous base

Grouped vesicles on an
erythematous base on a dermatomal
distribution

Painful vesicles over the fingertips

Itchy vesicles over the palms and
fingertips
Pustules over the palms and fingers
without itching
( sterile pustules )

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 MCQ
Q. Where does the latent varicella zoster Q. A 45 year old male has multiple
virus resides in the body: grouped vesicles on T 10 dermatome
A. Lymph nodes associated with pain. What is the most
B. T-cells probable diagnosis ?
C. Nerve ganglion A. Scabies
D. Skin B. Herpes simplex
C. Herpes zoster
Q. A 3 year old girl develops umbilicated D. Dermatitis herpetiformis
papule over the face following a trivial
infection as shown in the image. The Q. Forchheimer spots are seen in:
characteristic histopathological feature A. RUBELLA
would be ? B. ROSEOLA
A. Russel Bodies C. ERYTHEMA INFECTIOSUM
B. Molluscum Body D. MEASLES
C. Henderson Patterson Body
D. Sclerotic Body Q. Bushke - Lowenstein Tumor is:
A. HIGH GRADE
Q. Identify the sign marked on the given B. HISTOLOGICALLY MALIGNANT
image : C. HPV 16, 18
A. Darrier sign D. LOCALLY INVASIVE
B. Auspitz sign
C. Hutchinson sign
D. Nikolsky sign

Fungal Skin Infections

DERMATOPHYTOSIS

SKIN HAIR NAIL

TRICHOPHYTON

EPIDERMOPHYTON

MICROSPORUM

78
TINEA CAPITIS

79
CENTRAL CLEARING

CENTRAL SCARRING

CENTRAL CRUSTING

80
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 Summary

Tender boggy swelling in scalp , with lymphadenopathy

Shield like scutulum,

Endemic in kashmir
Steroid Modified Tinea

Most common type:

TINEA
UNGUIUM Most common in HIV patients:

Drug of choice Tinea Capitis

Drug of choice Tinea Rubrum, Tinea Corporis, Tinea

Cruris, Tinea Pedis, etc.

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Candidiasis

83
 Pityriasis Versicolor

Deep Fungal Infections

84
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 Spaghetti and meatballs KOH

Pre-malignant type of Candidiasis

Nail Scratch sign +

Characteristic HPE finding in Sporotrichosis

Medlar bodies, muriform cells, sclerotic

bodies, copper penny bodies

Rose gardener’s disease

MCQ
Q. An 8 year old boy presents with tender Q. A 6yr old child presents complaining
boggy swelling and easily pluckable hair, of patchy hair loss on the back of the
what is the most probable diagnosis ? scalp. Examination reveals well
A. Alopecia Areata demarcated areas of scaling. Which of
B. Favus the following is the most likely diagnosis?
C. Kerion A. Androgenic hair loss
D. Trichotillomania B. Psoriasis of the scalp
C. Seborrheic dermatitis
Q. Which of the following will not commonly D. Tinea capitis
present as shown in the image below :
Q. A 10 year old boy presented with
painful boggy swelling of scalp, multiple
sinuses, with purulent discharge, easily
pluckable hair and lymph nodes enlarged
in occipital region. Which will be most
helpful for diagnostic evaluation?

A. Biopsy and Giemsa evaluation

B. Bacterial culture
C. KOH mount
D. Patch test, gram staining, Tzanck
A. Trichophyton rubrum smear
B. Microsporum canis
C. Epidermophyton
D. Trichophyton schoenleinii

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Mycobacterial Skin Infections

87
88
 TREATMENT OF CUTANEOUS TB

HRZE HRE

2 months 4 months

H- Isoniazid R- Rifampicin Z-
Pyrazinamide E- Ethambutol

Summary

Warty type of cutaneous TB

Ulcerative type of cutaneous TB

Plaque type of cutaneous TB

MC Cutaneous TB in Children

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 Leprosy

LEPROMATOUS
TUBERCULOID TYPE
LEPROSY

SKIN
LESIONS

SIZE

SENSATION

SSS
SKIN
SMEAR

LEPROMIN
TEST

90
91
 MDT

Paucibacillary Multibacillary

6 months 12 months

Type-1 Type-2
Lepra reaction Lepra reaction
Immunological
reaction :

Type of patient
affected :

Skin lesions :

Treatment:

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 NERVE DISABILITY

Ulnar nerve

Median nerve

Radial nerve

Lateral popliteal
nerve

Posterior tibial
nerve

Trigeminal nerve

Facial nerve

94
 Summary
MC type of leprosy

Rarest type of leprosy

Saucer right way up appearance

Satellite lesions
Pseudopodia( finger like projections)

Inverted saucer appearance

Swiss cheese appearance

Almost symmetrical lesions in leprosy

Glove & stocking pattern sensory loss

Saddle Nose deformity, Leonine Facies

MC cranial nerve involved

MC peripheral nerve involved

First sensation lost in leprosy

Globi in SSS

Lepra reaction is the adverse drug

reaction
95
Parasitic Skin Infections

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 Summary
Circle of Hebra

Pathognomic skin lesion in scabies

Scabies seen in immunosuppressed individuals like

HIV, malignancy or neurological diseases

Creeping eruptions / Lesions that moves few mm

every day

98
 MCQ
Q. A 12 year old boy had a gradually
progressive plaque on the buttocks for Q. Identify the type of leprosy shown in
the last 3 years. The plaque was 15 cm in the image :
diameter, annular in shape with crusting A. Tuberculoid Leprosy
and induration at the periphery and B. Lepromatous Leprosy
scarring at the centre. What is the most C. Borderline Tuberculoid Leprosy
likely diagnosis ? D. Indeterminate Leprosy
A. Tinea Corporis
B. Granuloma Annulare Q. The image given below demonstrates
C. Lupus Vulgaris involvement of which nerve in leprosy
D. Borderline Leprosy A. Facial Nerve
B. Optic Nerve
Q. Scrofuloderma most commonly arises C. Oculomotor Nerve
from the following underlying structure: D. Trigeminal Nerve
A. Subcutaneous tissue
B. Lymph nodes Q. What is the indication of Thalidomide
C. Joint use in leprosy :
D. Bone A. Tuberculoid leprosy
B. Type-1 reaction
Q. Which form of leprosy shows the C. Erythema nodosum leprosum
pattern of lesion shown in image? D. All of the above

Q. The average incubation period of

Leprosy is :
A. 5-7 days
B. 5-7 weeks
C. 5-7 months
D. 5-7 years

A. Indeterminate leprosy
B. Borderline borderline
C. Borderline tuberculoid
D. Borderline lepromatous

99
 STI

GENITAL ULCERS

PAINLESS PAINFUL

SYPHILIS CHANCROID
CAUSATIVE

Treponema pallidum Haemophilus ducreyi

INCUBATION PERIOD:

9 – 90 days 3-5 days

Primary Syphilis Chancroid

100
Primary Syphilis Chancroid
CHARACTERISTICS OF ULCER

LYMPHADENOPATHY

101
Primary Syphilis Chancroid

102
 LGV Donovanosis
CAUSATIVE

Chlamydia trachomatis Klebsiella granulomatis

L1, 2 ,3

INCUBATION PERIOD:

3 – 30 days 8 – 80 days

CHARACTERISTICS OF ULCER

LYMPHADENOPATHY

103
 LGV Donovanosis

INVESTIGATIONS

Smear:
Nucleic Acid Amplification Test-
Donovan bodies, closed safety
NAAT
pin appearance

TREATMENT:

Doxycycline Azithromycin

Azithromycin Doxycycline

COMPLICATIONS

104
Herpes Genitalis

105
 SUMMARY

A genital ulcer on smear shows

closed safety pin appearance

Ulcer not concomitant with

lymphadenopathy
Genital ulcer showing gram-ve
coccobacilli in a
School of fish pattern or railroad track
appearance

An STI with multiple pearly white dome

shaped umbilicated papules in the groin

Painless ulcer + painless

lymphadenopathy

Painless transient ulcer followed by

painful lymphadenopathy

Multiple painful ulcer with undermined

edge + unilateral painful
lymphadenopathy

Polycyclic erosions, Multiple painful ulcer

+ bilateral painful lymphadenopathy

Ulcer that bleeds to touch with

subcutaneous inguinal swelling

106
Syndromic Management of STI

107
Secondary Syphilis

108
Early Congenital Syphilis

Late Congenital Syphilis

109
 MCQ
Q. A young man presents with
asymptomatic macules and erythematous Q. Which among the following STI`s
painless lesion over glans with exhibit the type of alopecia as shown in
generalized lymphadenopathy. Treatment the image:
of Choice in this condition:
A. Ceftriaxone
B. Benzathine penicillin C. Acyclovir
D. Fluconazole

Q. The most frequent cause of recurrent

genital ulceration in a sexually active
male is :
A. Syphilis A. Primary Syphilis
B. Herpes Genitalis B. Chancroid
C. Aphthous Ulcer C. LGV
D. Chancroid D. Secondary Syphilis
Q. A man presents with maculopapular
rash 2 weeks after having a genital ulcer Q. Diagnose the STD shown on the
as shown below. Causative organism of Image?
the condition is:

A. Chancroid
B. HIV
A. H. ducreyi C. Donovanosis
B. Treponema pallidum D. LGV
C. Granulomatis
D. Chlamydia

Q. School of fish appearance is shown by

A. Haemophilus Ducreyi
B. Gonococcus
C. Chlamydia
D. Donovania Granulomatis

110
Pigmentary Disorders
Vitiligo

111
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113
 INDETERMINATE
PITYRIASIS ALBA LEPROSY

Summary

Vitiligo that doesn’t cross midline

and runs along dermatome

Disease showing Koebner's

phenomenon

Vitiligo like patches with white

forelock

Inheritance of albinism

Hypopigmented scaly patches over

face of child without any sensory
deficit

114
115
Cafe au lait macules

Ceruloderma

116
 Summary

Vitiligo that doesn’t cross midline and

runs along dermatome

Disease showing Koebner's phenomenon

Vitiligo like patches with white forelock

Inheritance of albinism

Hypopigmented scaly patches over face

of child without any sensory deficit

117
 MCQ

Q. 7 year old boy chandu presents with Q. All are true about this condition except
recurrent, scaly, hypopigmented patch on
face, diagnosis is :

A. Genetic predisposition is known

A. Vitiligo B. Leukotrichia is associated with good
B. Indeterminate Leprosy prognosis
C. Pityriasis Alba C. PUVA is used for treatment
D. Pityriasis Rosea D. Topical steroids are useful

Q. Diagnose the underlying pigment

disorder shown in the pregnant lady;

A. Lentigines
B. Freckles
C. Phototoxic reaction
D. Chloasma

Q. Identify the image given below?

A. Nevus of Ito
B. Melasma
C. Mongolian spot
D. Nevus of Ota

118
Vesiculobullous Disorders

119
 Pemphigus Vulgaris

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

120
Pemphigus Vegetans

121
 Pemphigus Foliaceous

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

122
 Bullous Pemphigoid

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

123
Pemphigoid Gestationis

Linear IgA Disease

124
Dermatitis Herpetiformis

125
 Summary
Cerebriform tongue

Desmoglein-3 and desmoglein-1 defect

Site of lesion in pemphigus foliaceus

Positive nikolsky sign is seen in

Tense bulla in a urticarial base seen in elderly
patients
String of pearl appearance
Bullous lesion beginning from periumbilical area
in 2/3rd trimester
Blistering disease where dapsone is used in the
treatment
DIF in Dermatitis herpetiformis
DIF in Linear IgA disease

Congenital Epidermolysis Bullosa

EB Junctional Dystrophic
Simplex EB EB

• Mutations in genes
• Mutation in genes • Mutation in
for keratin K5 14
for Laminin Collagen - 7

126
Inherited Bullous diseases
Darier’s Disease

127
 Hailey-Hailey Disease

Summary

Child with blisters localized to palms and soles

developing on trauma

Defect in dystrophic EB

Epidermolysis bullosa with Intra-epidermal defect

Nail finding in Darier’s disease

HPE findings in Hailey-Hailey disease

HPE findings in Darier’s disease

128
INTERPRETATION DIRECT IMMUNOFLUORESCENCE :

Disorder Pattern seen

IgG and C3 deposition in

Pemphigus vulgaris
epidermis showing a fishnet
Pemphigus foliaceus
pattern

Linear deposits IgG and C3 at

Bullous pemphigoid
dermo-epidermal junction

Linear deposits IgA at dermo-

Linear IgA disease
epidermal junction

Granular IgA deposits at papillary

Dermatitis herpetiformis
tips

MCQ

Q. Dyskeratosis is seen in: Q. A 30 year old man had severely itchy

papulo-vesicular lesions on extremities,
A. Darier’s disease knees, elbows and buttocks for one year.
B. Pemphigus vulgaris Direct Immunofluorescence staining of
C. Eczema the lesions showed IgA deposition at
D. Epidermolysis bullosa dermoepidermal junction. The most
probable diagnosis is :
A. Pemphigus Vulagris
Q. Identify the skin disorder in a 70 year
B. Bullous Pemphigoid
old male?
C. Dermatitis Herpetiforms
D. Nummular Eczema

Q. Eruptions of herpes gestationalis

begins from
A. Infraorbital
B. Vulva
A. Staphylococcal scalded skin syndrome C. Periumbilical region
B. Pemphigus vulgaris D. Flanks of abdomen
C. Pemphigus Foliaceous
D. Bullous pemphigoid

129
 Genodermatoses
Neurofibromatosis I
Diagnostic Criteria NF1

Café-au-lait spots (6 or more, with size >1.5cm in adults and >0.5cm

C in children )

R Relative with NF1

A Axillary or inguinal freckles

B Bony dysplasia such as Bowing of long bone or sphenoid wing dysplasia

B

I Iris hamartomas (Lisch nodules) (2 or more)

N Neurofibromas (2 or more) or 1 plexiform neurofibroma

G Glioma of optic nerve

2 out of 7 required for confirmation

130
 Diagnostic Criteria NF2

Multiple Inherited
MI
Schwannoma
S
Meningioma
M
Ependymoma
E• Most classical feature :

• Presence of Bilateral acoustic neuroma – certainly indicate NF2

• C/F common to NF1 & NF2 :

132
Tuberous Sclerosis

133
 Xeroderma Pigmentosa

P Photosensitivity

P Premature ageing

P Pigmentary changes

P Pre-malignant & malignant changes

1000x increased risk of malignancy, 2/3 cases die by age 20
P
Photophobia

Incontinentia Pigmenti

V
Vesicular (at birth)
V Verrucous (at childhood)
H Hyperpigmentation
H Hypopigmentation

134
 Ichthyosis

Ichthyosis Vulgaris X Linked Ichthyosis Lamellar Ichthyosis

AD XLR AR

Defect of
Defect of steroid
Defect of filaggrin transglutaminase-1
sulfatase enzyme
enzyme

135
 Summary

Pathognomonic sign of NF1

Clinical feature common in NF1 &

NF2

Bag of worms

Vogt’s triad

Dryness of skin + photosensitivity +

photophobia

VVHH

Defect of filaggrin

Ash leaf macules

136
 MCQ

Q. Regarding X-linked Ichthyosis all are Q. . A boy presents with history of severe
true except : sunburn after only a few minutes
A. Steroid sulfatase deficiency exposure to sunlight. There is freckling
over the sun exposed areas, dry skin and
B. Extensor distribution sparing flexures
C. Large dark brown scales some pigmentary changes in the skin as
D. More common in males given in image. What is the most possible
diagnosis :
Q. 30 year old female presents with
seizures, Her past history reveals that
she is on antiarrhythmic drugs, On
General Examination she has skin
lesions as shown in the figure below.
What other findings is associated in this
patient?

A. Port wine stain

B. Lisch Nodules in Iris
C. Button hole sign
D. Shagreen patch A. Icthyosis
B. Xeroderma pigmentosum
C. Melanocytic nevus
D. Incontinentia pigmenti

Q. What is the inheritance pattern of

incontinentia pigmenti:
A. Autosomal dominant

B. Autosomal recessive
C. X-linked dominant
D. X-linked recessive

137
Nutritional Dermatosis

138
Pellagra

139
 Scurvy

Acrodermatitis Enteropathica

140
 Summary
Casal’s necklace
Phrynoderma and Bitot’s spot
Flag sign

Monkey facies, alopecia and severe muscle wasting

Gauntlet sign
Corkscrew hair , Swan neck deformity of hair,
perifollicular hemorrhage

Periorificial dermatitis presenting during weaning periods

MCQ
Q. Which mineral deficiency can lead to Q. A 45 year old man with a history of
the following condition? excessive alcohol intake complaints of a
12 month history of intermittent scaling
over his hands and feet associated with a
scaly hyperpigmented lesion on neck as
given in the image. In addition, he had
marked erythema over tongue and has
been complaining of loose stools for
several months. He scores low on mini
A. Zinc mental state examination. The most likely
B. Calcium diagnosis is:
C. Selenium
D. Magnesium

Q. Which of the following feature are true

regarding the marasmus child in the
given image?

A. Beriberi
B. Pellagra
C. Porphyria Cutanea Tarda
D. Scurvy
Crazy pavement /Flaky dermatoses
Flag sign
Monkey facies
Diffuse edema
141
Nevi, Hamartoma and Benign Skin Lesions

Congenital Melanocytic Nevus

142
Acquired Melanocytic Nevus

143
 NEVUS DEPIGMENTOSUS NEVUS ANEMICUS
Aka: Nevus achromicus

Bald patch on scalp since birth evolving into

glossy yellow shiny papules linearly along
Blaschko’s lines
Androgen sensitive nevus,
hyperpigmentation with overlying dark coarse
hair and some acneiform papules

Well defined hyperpigmented black lesion

with hypertrichosis since birth
Nevus surrounded by a hypopigmented
zone

Hypopigmented pale circumscribed area of

pallor present since birth, blanches on
diascopy
Whorled hypopigmentation along
Blaschko's lines, Chinese character pattern

144
Vascular Anomalies

145
146
147
 Summary
Emptying sign is demonstrated in

Port Wine stain regresses by 1 year of age

Sudden multiple eruption of seborrheic keratosis

MC cyst in the skin

Universal tumor

Skin lesion seen in Peutz jeghers syndrome

Dimple sign

Small raised nodular lesion that bleeds on touch on

trivial trauma

MCQ
Q. Malignant transformation to melanoma
Q. A child presents with a solitary white is common in:
well defined patch on his right thigh. What A) Dermal nevus
is the diagnosis? B) Junctional nevus
A. Piebaldism C) Large Congenital Melanocytic nevus
D) Becker’s nevus
B. Acral vitiligo

C. Nevus achromicus
D. Albinism

Q. Identify the given skin lesion ?

A. Basal cell carcinoma

B. Nevus of ota
C. Halo nevus
D. Becker`s nevus
148
 Basal Cell Carcinoma

Squamous Cell Carcinoma

149
 Malignant Melanoma

TYPES OF MM (SANAL)

SUPERFICIAL ACRAL AMELANOTIC LENTIGO

SPREADING LENTIGINOUS NODULAR MM MELANOMA MALIGNA
MM MELANOMA

150
 MYCOSIS FUNGOIDES

HPE :

Localized collection of T-
lymphocytes in the epidermis

Atypical lymphocytes in the

epidermis & dermis
 Summary

ABCDE

Most common type of malignant melanoma in

India

Least malignant, best prognosis in malignant

melanoma

Most malignant, worst prognosis in malignant

melanoma

Critical depth in malignant melanoma

Most common type of skin cancer

Type of BCC that destroys the tissue

underneath it
Typical HPE finding in BCC
Most common skin cancer in dark pigmented
races

SCC developing over burns or scars

MC primary lymphoma of skin

Lymphocyte abscess seen in mycosis fungoides

Atypical lymphocyte in the epidermis and

dermis

152
 Drug Reactions
Fixed Drug Eruptions

SJS & TEN

153
154
 MCQ

Q. A 55 year old woman has well-

Q. A 3-month old male infant developed
demarcated reddish brown macular rash
on her arm. The lesion occurs a furuncle. A few days later, he
periodically and resolves slowly, with developed blisters, peeling of the skin;
some persisting hyperpigmentation. She there were no mucosal lesions. The
is otherwise healthy and takes no
medications except an occasional most likely diagnosis is ?
laxative.
A. Infantile pemphigus

B. Stevens Johnson syndrome

C. Staphylococcal scalded skin

syndrome

D. Toxic epidermal necrolysis

A. Urticaria

B. Lichen Planus

C. Pemphigus

D. Fixed drug eruption

Q. What is not true about Erythema

multiforme ?

A. Associated with Herpes simplex

B. Involves distal parts of extremities

C. Target lesions

D. No vesicle

155
Miscellaneous

156
Dermatomyositis

157
158
 Woods Lamp Findings
Disorder Fluorescent colour

Brilliant green
Tinea capitis
Green

Pityriasis versicolor Pale yellow to Apple green

Erythrasma Brilliant coral red

Tuberous sclerosis Pale white (bluish)

(ash leaf spot)
Vitiligo Bright white (ivory white)

Porphyria cutanea tarda Red/pink

KOH Findings
Disorder Finding

Dermatophytosis Fungal hyphae

Candidiasis Pseudo-hyphal filaments

Banana & grapes appearance

Pityriasis versicolor Spaghetti & meatballs appearance

Tzanck Smear Findings

Conditions Type of cells

Pemphigus vulgaris Tzanck cell / Acantholytic cells

Multinucleated giant cells (MNG) and

Herpes simplex, varicella & herpes zoster
Tzanck cells

159
 Diascopy Findings
Disorder Sign

Pure erythema due to vasodilation Blanching

RBC extravasation petechiae/purpura Non–blanching

Lupus vulgaris Apple jelly nodules / Golden brown nodules

Sarcoidosis Sago grain appearance

Nevus Depigmentosus Non Blanching

Nevus anemicus Blanching

160
 INTERPRETATION DIRECT IMMUNOFLUORESCENCE :

Disorder Pattern seen

Pemphigus vulgaris IgG and C3 deposition in epidermis

Pemphigus foliaceus showing a fishnet pattern

Linear deposits IgG and C3 at

Bullous pemphigoid
dermo-epidermal junction

Linear deposits IgA at dermo-

Linear IgA disease
epidermal junction

Granular IgA deposits at papillary

Dermatitis herpetiformis
tips

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