Dermatology for MRCP

Dermatology for MRCP
By
DR.SHERIF BADRAWY

Which malignancy is Associated
with Acanthosis nigricans ?
1a
Dr. Sherif
Badrawy
Digitally signed by Dr. Sherif
Badrawy
DN: cn=Dr. Sherif Badrawy,
o=KKUH, ou=Critical Care,
email=sherif_badrawy@yahoo.c
om, c=SA
Date: 2015.05.29 03:20:36
+03'00'

with Acquired ichthyosis ?
2a

Lymphoma
‫و‬‫ا‬‫ﻟ‬‫ﻠ‬‫ﻴ‬‫ﻤ‬‫ﻔ‬‫ﻮ‬‫ﻣ‬‫ﺎ‬ ‫ا‬‫ﻟ‬‫ﺴ‬‫ﻤ‬‫ﻜ‬‫ﻴ‬‫ﺔ‬
2b

with Erythroderma ?
3a

with Acquired hypertrichosis
lanuginosa ?
4a

Gastrointestinal and lung cancer
4b

with Erythema gyratum repens ?
5a

with Dermatomyositis ?
6a

with Migratory thrombo(P)hlebitis ?
7a

with Necrolytic migratory erythema
?
8a

with Pyoderma gangrenosum ?
9a

Myeloproliferative disorders
Pyo=Myo
9b

with Sweet's syndrome ?
10a

with Tylosis ?
11a

Oesophageal cancer
Tylosis is palmoplantar keratoderma
11b

General rules about skin
Malignancies ?
12a

♕ SUN, BIOPSY AND REMOVE.
❐ All dermal malignancies occur more
frequently in those with pale skin on more
SUN-EXPOSED AREAS.
❐ Diagnosis is by BIOPSY and the
treatment is with surgical REMOVAL.
❐ No form of skin has effective
chemotherapy.
12b

Clinical picture of malignant
Melanoma ?
13a

ABCDE
A: asymmetry
B: border irregularity
C: color irregularities
D: diameter > 6 mm
E: evolution (changing in appearance over time)
Worst prognosis with growing lesions.
The diameter of melanoma has not shown to be a
poor prognostic factor.
Surface ulceration is a poor prognostic factor.
13b

DD bw benign & malignant
melanoma ?
14a

ABCDE
Asymmetric
Borders uneven
Color uneven
Diameter increases
14b

best Dx test for malignant
Melanoma ?
15a

Full thickness BIOPSY is
indispensible in diagnosis. Do not
do a shave biopsy.
15b

Treatment of malignant Melanoma
?
16a

✿ Surgical removal with Good safety
margin.
✿ Interferon IV in widespread
disease.
✿ Melanoma has a strong tendency
to metastasize to the brain.
16b

Risk factors for Squamous Cell
Carcinoma of the skin ?
17a

☀ SUN-EXPOSURE 〘UV light is the most
common cause〙
☀ organ transplant dt long-term use of
immunosuppressants.
☀ chronically draining infectious sinuses (as in
osteomyelitis).
☀ Most SCCs occur in older adults (peak age is
66 years) with sun-damaged skin, arising from
actinic keratoses.
17b

When to suspect squamous cell
carcinoma ?
18a

any patient with a chronic scar that
develops into a non-healing,
painless, bleeding ulcer
18b

the most common form of skin
cancer ?
19a

Basal Cell Carcinoma least
aggressive malignant tumor of the
skin
19b

Clinical picture of Basal Cell
Carcinoma ?
20a

a WAXY lesion that is SHINY LIKE
A PEARL.
very slow to growing and is not
hyperpigmented.
Recurrence rates are less than 5%.
20b

Dx of Basal Cell Carcinoma ?
21a

BIOPSY,Unlike melanoma, wide
margins are not necessary, and
shave biopsy is a fine way to make
diagnosis.
21b

Rx of Basal Cell Carcinoma ?
22a

Mohs micrographic surgery.
〈Removal of skin cancer under a
dissecting microscope with
immediate frozen section〉This
doesn't give a chance for a big safety
margin as no need to remove a wide
margin routinely.
22b

the most common cause Kaposi
Sarcoma ?
23a

AIDS dt infection with human
herpes virus 8 (HHV8) which is
oncogenic.
in its classical form it can be a rare
tumer of elderly men
23b

Clinical picture of Kaposi Sarcoma ?
24a

reddish/purplish because it is more vascular than
other forms of skin cancer. KS is also found in the GI
tract and in the lung.
oedema of the lower limb dt lymphatic obstrucion
➜may spreasd to LNs
Only AIDS acquired through sexual contact is
associated with KS;
AIDS from injection drug use is rarely associated
with KS.
Incidence of KS is decreasing since 90s
24b

✿ Treat the AIDS with antiretrovirals and the
majority of KS will disappear as the CD4 count
improves.
✿ judicious local Radiotherapy can contain them +
Surgical resection may be used but can't contain
them
✿ Intralesional vincristine or interferon are very
successful.
✿ If these fail, use chemotherapy with liposomal
doxorubicin.
25b

A local immunostimulant used for
MOLLUSCUM CONTAGIOSUM and
CONDYLOMA ACUMINATA &
ACTINIC KERATOSES.
26b

Clinical picture of Actinic Keratoses
?
27a

★ premalignant skin lesions from high-intensity
sun exposure in fairskinned people.
★ 【Small, crusty or scaly, lesions
,Multiple】lesions may be present
★ small risk of squamous cell cancer
transformation.
★ slow to progress, but must be removed with
curettage, cryotherapy, laser, or topical 5-
fluorouracil or imiquimod
27b

Clinical picture of Seborrhoeic
Keratoses ?
28a

These lesions are extremely common in
the elderly
HYPERPIGMENTED lesions commonly
referred to as liver spots. They give a
"STUCK ON" appearance.
may look like melanoma to some
people,but seborrhoeic keratoses
have no premalignant potential
28b

Treatment of Seborrhoeic Keratoses
?
29a

REMOVAL for cosmetic reasons
with cryotherapy, surgery, or laser .
29b

Atopic Dermatitis (Eczema)
associations ?
30a

✿ overactivity of mast cells and the
immune system
✿ Asthma
✿ Allergic rhinitis
✿ Family history of atopic disorders
✿ Onset before age 5, very rare to
start after age 30
30b

Clinical picture of Atopic Dermatitis
(Eczema) ?
31a

✿ PRURITUS and scratching is the most common
presentation.
✿ LICHENIFIED SKIN :scaly rough areas of
thickened skin on the face, neck, and skin folds of
the popliteal area behind the knee.
✿ SUPERFICIAL SKIN INFECTIONS from
Staphylococcus are common because
microorganisms are driven under the epidermis by
scratching. This, in turn, leads to more itching.
31b

Dx of Atopic Dermatitis (Eczema) ?
32a

✿ Dx is mainly CLINICAL.(Diagnostic Criteria for Atopic
Eczema)
❃ AN 【ITCHY SKIN 】CONDITION IN THE LAST 12
MONTHS
❃ Plus three or more of
☀ Onset below age 2 years
☀ HISTORY OF FLEXURAL involvement
☀ VISIBLE FLEXURAL dermatitis
☀ History of generally DRY skin
☀ history of other ATOPIC disease
✿ lgE levels are elevated in atopic dermatitis.
32b

Rx of Atopic Dermatitis (Eczema) ?
33a

✿ 【Topical corticosteroids】are used in flares of disease.
Oral steroids are used only in the most severe acute flares of
disease.
✿ Tacrolimus and pimecrolimus are T cell-inhibiting agents
➜ longer-term control and help get the patient off
steroids.used topically for atopic dermatitis dt immune
system hyperactivity.
✿ Antihistamines
✿ Antibiotics when impetigo occurs
✿ Ultraviolet light (phototherapy) for severe recalcitrant
disease
33b

Clinical picture of Psoriasis ?
34a

SILVERY, SCALY PLAQUES that
are NOT ITCHY most of the
time.(may be mild itching)
Nail signs: pitting, onycholysis ±
Arthritis (10%)
34b

☀ Simple emollients
☀ TOPICAL STEROIDS (high-potency): fluocinonide, triamcinolone,
betamethasone, clobetasol
⋆ NB :Flexural psoriasis➜ emollients ,topical steroids
☀ VITAMIN A AND VITAMIN D OINTMENT help get the patient off steroids.
The vitamin D agent is CALCIPOTRIENE. Steroids cause skin atrophy.
☀ COAL TAR preparation (probably inhibit DNA synthesis)
☀ Dithranol: inhibits DNA synthesis, wash off after 30 mins, SE: burning,
staining
☢ Phototherapy Narrow band ultraviolet B light is now the treatment of choice
☢ PUVA (psoralen + ultraviolet A light)(Photochemotherapy) is also used
35b

Etiology of Seborrhoeic Dermatitis
(Dandruff) ?
37a

hypersensitivity reaction to a dermal
infection with noninvasive
dermatophyte
organisms.(Pityrosporum ovale)
It is increased in:
• AIDS
• Parkinson disease
37b

Rx of Seborrhoeic Dermatitis
(Dandruff) ?
38a

❀ preparations containing【zinc pyrithione 】('Head
& Shoulders') and tar ('Neutrogena T/Gel') are first-
line.
❀ Antifungal agents (ketoconazole) are second-line
❀ topical steroids (hydrocortisone, alclometasone)
best used for short periods.
✈ Face and body management ketoconazole & topical
steroids Difficult to treat - recurrences are common
38b

Etiology of Pemphigus Vulgaris ?
39a

idiopathic autoimmune form and a drug induced form.
dt Autoantibodies split the epidermis (which is a very thin
layer ➜ easily rupture ➜ uncovered skin which acts like a
burn) ,(Anti-Desmoglin Abs) (> é Ashkenazi Jewish
population)
drugs associated with Pemphigus:
• ACE inhibitors
• Penicillamine
• Phenobarbital
• Penicillin
39b

Clinical picture of Pemphigus
Vulgaris ?
40a

• Bullae easily rupture because they are thin
walled
• Involvement of the MOUTH = Vulgaris ( as
nothing is more vulgar than mouth involvement)
• Fluid loss and infection if widespread; they ACT
LIKE A BURN.
The most characteristic finding is 【NIKOLSKY
SIGN】. which is the loss or "denuding, of skin
from just mild pressure.
40b

most accurate diagnostic test of
Pemphigus Vulgaris ?
41a

a biopsy showing autoantibodies on
immunofluorescent studies.
(Anti-Desmoglin Abs).
41b

Rx of Pemphigus Vulgaris ?
42a

Without treatment, pemphigus is a
fatal disease.
1. Systemic steroids (prednisone)
2. Azathioprine or mycophenolate to
wean the patient off steroids
3. Rituximab (anti-CD20 antibodies)
or IVIG in refractory cases
42b

DD bw Pemphigus Vulgaris &
Bullous Pemphigoid ?
43a

In Bullous Pemphigoid:-
❏ Abs against the Dermo-epidemal junction
❏ milder disease than pemphigus Vulgaris
❏ Bullae stay intact,they're itchy and there is less
loss of fluid and infection.
❏ NO Mouth involvement
❏ Nikolsky sign is absent
❏ more common in ELDERLY while Pemphigus
is middle-aged or older people.
43b

most accurate diagnostic test of
Bullous Pemphigoid ?
44a

❐ Biopsy with immunofluorescent
stain ➳ IgG and C3 at the
dermoepidermal junction
❐ antibodies against
hemidesmosomal proteins BP180
and BP230. 44b

best initial therapy in Bullous
Pemphigoid ?
45a

❏ corticosteroids (prednisone)
❏ Mild bullous pemphigoid
responds to erythromycin, dapsone,
and nicotinamide (not niacin).
45b

Etiology of Porphyria Cutanea Tarda
?
46a

PCT is a 【HYPERSENSITIVITY
】of the skin to abnormal
porphyrins when they are exposed
to light ➜dt deficiency of
uroporphyrin decarboxylase .
46b

Clinical picture of Porphyria
Cutanea Tarda ?
47a

❀ a BLISTERING skin disease of sun-exposed
areas ( backs of the hands and the
face).HYPERTRICHOSIS,
HYPERPIGMENTATION.
❀ associated with Liver disease (HEPATITIS C,
alcoholism) Estrogen use & Iron overload
(hemochromatosis).
❀ HEPATITIS C is the most frequently tested
association with PCT.
47b

Dx of Porphyria Cutanea Tarda ?
48a

The most accurate diagnostic test is
【↑ uroporphyrins】 in a 24-h
URINE collection.,also pink
fluorescence of urine under Wood's
lamp.
48b

Rx of Porphyria Cutanea Tarda ?
49a

Correct the underlying cause (stop
alcohol, stop
estrogens),CHLOROQUINE may be
used & remove iron with
PHLEBOTOMY.
49b

the most superficial of the bacterial
skin infections. Staphylococcus
and Streptococcus invade the
epidermis
50b

Clinical picture of Impetigo ?
51a

Golden, Honey colored , weeping,
crusting, oozing, and draining
lesions of the skin.
51b

☆ Mild disease with topical agents: •
Mupirocin • Retapamulin
• Bacitracin
☆ Severe disease with oral agents:
• flucloxacillin or cephalexin ,
erythromycin if penicillin allergic
☆ Community-acquired MRSA with:
• Doxycycline • Clindamycin • Bactrim
52b

acute infection of the upper dermis and
superficial lymphatics, usually caused by
STREPTOCOCCUS bacteria.
Erysipelas is more severe disease than
impetigo because it occurs at a deeper
level in the skin.more superficial than
cellulitis, and is typically more RAISED
AND DEMARCATED.
53b

Complications of Skin infections
with group A beta hemolytic
Streptococcus in Erysipelas ?
54a

✸ BACTEREMIA➜ septic arthritis,
GLOMERULONEPHRITIS, but NOT
RHEUMATIC FEVER.
✸ Recurrence of infection—Erysipelas can
recur in 18-30% of cases even after
antibiotic treatment.
✸ Lymphatic damage
✸ Necrotizing fasciitis
54b

Clinical picture of Erysipelas ?
55a

a bright, red, hot swollen (RAISED
& DEMARCATED) lesion on the
FACE. "St. Anthony's fire"
bacteremia, leukocytosis, fever, and
chills. Untreated disease can be
fatal.
55b

Tips on Rx of Erysipelas ?
56a

✸ Although erysipelas is more often from
streptococci, you must treat for
Staphylococcus as well unless you have a
definitive diagnostic test such as blood
cultures .
✸ The treatment of all skin infections is
similar. the same answers as for cellulitis,
folliculitis, furuncles, and carbuncles.
56b

Antibiotic Rx of Erysipelas ?
57a

☼ Mild disease: Use ORAL medications:
• Dicloxacillin, cephalexin, cefadroxyl
• Penicillin allergic: erythromycin, clarithromycin, or
clindamycin
• MRSA: doxycycline, dindamycin, Bactrim
☼ Severe disease (fever present): Use INTRAVENOUS
medications:
• Oxacillin, nafcillin, cefazolin
• Penicillin allergic: clindamycin, vancomycin
• MRSA: vancomycin, linezolid, daptomycin, tigecycline,
ceftaroline
57b

Antistaphylococcal penicillins ?
58a

Skin infection is caused by which
type of Staph ?
59a

Staphylococcus aureus, not
S.epidermidis.S. epidermidis lives
on skin as part of normal flora.
59b

severe inflammation of dermal and SUBCUTANEOUS layers
of the skin dt bacteria. Group A STREPTOCOCCUS AND
STAPHYLOCOCCUS are the most common of these bacteria
& often occurs where the SKIN HAS PREVIOUSLY BEEN
BROKEN: CRACKS in the skin, cuts, blisters, burns, insect
bites, surgical wounds,or sites of intravenous catheter
insertion. Skin on the FACE or LOWER LEGS is most
commonly affected by this infection, though cellulitis can
occur on any part of the body. Ludwig's angina is a common
example.
60b

Clinical picture of Cellulitis ?
61a

The skin is warm, red, swollen, and
tender.. Cellulitis does not have
collections of walled-off infection;
that is an abscess.
Cellulitis involves the legs more
often than the arms.
61b

No diagnostic testing is needed to
establish a diagnosis of cellulitis.
The most accurate test is to inject
sterile saline into the skin and
aspirate it for culture.
62b

Antibiotic Rx of Cellulitis ?
63a

✩ Topical antibiotics will not cover cellulitis. The infection is below
the dermal/ epidermal junction and topical antibiotics will not reach
it.
✩ Drugs are Same as Erysipelas
☼ Mild disease: Use ORAL medications:
• Dicloxacillin, cephalexin, cefadroxyl
• Penicillin allergic: erythromycin, clarithromycin, or clindamycin
• MRSA: doxycycline, dindamycin, Bactrim
☼ Severe disease (fever present): Use INTRAVENOUS medications:
• Oxacillin, nafcillin, cefazolin
• Penicillin allergic: clindamycin, vancomycin
• MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
63b

Skin disorders associated with
pregnancy ?
64a

❀ Polymorphic eruption of pregnancy
〚PRURITIC Lesions first appear in
abdominal STRIAE associated with last trimester..Rx
emollients ➜ topical steroids➜ oral corticosteroids〛
❀ Pemphigoid gestationis
〚PRURITIC BLISTERING lesions in PERI-
UMBILICAL region ➜ spread to the trunk, back,
buttocks and arms ,2nd or 3rd trimester.
Rx ORAL CORTICOSTEROIDS〛
64b

Skin disorders associated with TB ?
65a
Lupus Vulgaris
Scrofuloderma: breakdown of skin
overlying a TB focus

❅【 LUPUS VULGARIS】 ( 50% of cases) 『in
the FACE erythematous flat plaque ➜ elevated
➜ulcerate』
❅ ERYTHEMA NODOSUM
❅ Scarring alopecia
❅ Scrofuloderma: breakdown of skin overlying a
TB focus
❅ Verrucosa cutis
❅ Gumma
65b

Hypothyroidism ?
66a

ϟ DRY (anhydrosis), cold, yellowish SKIN
ϟ DRY, coarse scalp HAIR, loss of lateral
aspect of eyebrows
ϟ NON-PITTING OEDEMA (e.g. hands,
face)
ϟ ECZEMA
ϟ Xanthoma
ϟ Pruritus
66b

Hyperthyroidism ?
67a
pretibial myxoedema
Thyroid acropachy

❐ Pretibial myxoedema: lateral
malleoli
❐ Thyroid acropachy: clubbing
❐ Scalp hair thinning
❐ ↑ sweating
❐ Pruritus
67b

Definition of Erythema multiforme ?
68a

skin condition dt deposition of
immune complex (mostly IgM) in the
superficial microvasculature of the
skin and oral mucous membrane that
usually follows an infection or drug
exposure.usually in second and third
decades of life.
68b

Etiology of Erythema multiforme ( &
SJS,TEN) ?
69a

♕ The commonest association is with Mycoplasma
pneumoniae & HSV.
❐ Idiopathic
❐ Bacteria: MYCOPLASMA, Streptococcus
❐ Viruses: HSV, Orf
❐ Drugs: penicillin, sulpha Drugs,
allopurinol,Rifampicin, NSAIDs,
oral contraceptive pill, nevirapine, carbamazepine
❐ Connective tissue disease e.g.SLE ,Sarcoidosis
❐ Malignancy
69b

Clinical picture of Erythema
multiforme ?
70a

PINK-RED BLOTCHES, with the
classical "TARGET LESION"
appearance,with a pink-red ring
around a pale center ,mild itching,
symmetrically arranged and starting
on the extremities. . Resolution
within 7-10 days.
70b

DD of Erythema multiforme ?
71a
Steven-Johnson syndrome
toxic epidermal necrolysis

❂ Erythema multiforme minor - Typical 【TARGET
LESION】 distributed acrally
❂ Erythema multiforme major - Typical【TARGET
LESION】 distributed acrally with MUCOUS MEMBRANE
involvement + epidermal detachment < 10% of TBSA
❂ SJS/TEN - Widespread 【BLISTERS】 predominant on
the trunk and face, ERYTHEMATOUS OR PRURITIC
MACULES and MUCOUS MEMBRANE erosions; epidermal
detachment is less than 10% TBSA for Steven-Johnson
syndrome and 30% or more for TEN.
71b

scarring Alopecia (destruction of
hair follicle)
non-scarring Alopecia (preservation
of hair follicle)
72b

Causes of Scarring alopecia ?
73a

Trauma
BURNS
Radiotherapy
Lichen planus
Discoid lupus
Tinea capitis (untreated if a kerion
develops)
73b

Causes of Non-scarring alopecia ?
74a
TRICHOTILLOMANIA
alopecia areata
Telogen efluvium

♂-pattern baldness
Drugs: Cytotoxic drugs, Carbimazole,Colchicine,
Contraceptive pill,
heparin
Nutritional: IRON AND ZINC DEFICIENCY
Autoimmune: ALOPECIA AREATA
Telogen efluvium (hair loss following stressful period
e.g. Surgery)
TRICHOTILLOMANIA "hair loss from a patient's
repetitive self-pulling of hair"
74b

Etiology of Alopecia areata ?
75a

autoimmune condition ➜ the body
attacks its own hair follicles ➜
suppresses or stops hair growth.
75b

Clinical picture of Alopecia areata ?
76a

localised, well demarcated patches
of hair loss. At the edge of the hair
loss, there may be small, broken
'exclamation mark' hairs
76b

◥ Topical or intralesional
corticosteroids
◥ Topical minoxidil
◥ Phototherapy
◥ Dithranol
◥ Contact immunotherapy
◥ Wigs
77b

DD of Shin lesions ?
78a
Necrobiosis lipoidica
diabeticorum
Pretibial myxedema

❐ Erythema nodosum
❐ Pretibial myxedema(Graves'
dis,shiny,orange peel skin )
❐ Pyoderma gangrenosum
❐ Necrobiosis lipoidica diabeticorum 《shiny, painless
areas of yellow/red skin typically on the shin of
diabetics often associated with telangiectasia 》《dt
small-vessel damage➜ partial necrosis of dermal
collagen and CT.》➜ Rx low dose Aspirin + bandage.
78b
erythema nodosum
Pyoderma
gangrenosum

Definition of Erythema nodosum ?
79a

Inflammation of the fat cells under
the skin, resulting in tender red
nodules or lumps that are usually
seen on both SHINS (Forearms,
thighs) Usually resolves
spontaneously within 6 weeks
Lesions heal without scarring
79b

Etiology of Erythema nodosum ?
80a

❐ streptococci, TB, brucellosis
❐ sarcoidosis,IBD, Behcet's
❐ Malignancy/lymphoma
❐ penicillins, sulphonamides,
combined oral contraceptive pill
❐ PREGNANCY (✔)
80b

Definition of Pyoderma
Gangrenosum ?
81a

a condition that causes tissue to become necrotic➜ deep ulcers
usually on the legs.➜ chronic wounds. Ulcers initially look like small
bug bites or papules,➜ later deep, red, necrotic ulcers with a
violaceous border. Though the wounds rarely lead to death, they can
cause pain and scarring.
81b

Etiology of Pyoderma Gangrenosum
?
82a

✿ not well understood➜ thought to be due to immune
system dysfunction, and particularly improper functioning
of neutrophils.
❐ Idiopathic in 50%
❐ IBD: ulcerative colitis > crohn's
❐ Rheumatoid arthritis, SLE
❐ MULTIPLE MYELOMA
❐ Lymphoma, myeloid leukemias
❐ Monoclonal gammopathy (IgA)
❐ Primary biliary cirrhosis
❐ can occur in diabetes mellitus but it is rare
82b

Rx of Pyoderma Gangrenosum ?
83a

❍ First-line therapy is systemic
CORTICOSTEROIDS AND CYCLOSPORINE.
❍ topical and intralesional steroids, Mupirocin,
and Gentamicin alternated with Tacrolimus can
be effective.
❍ If ineffective ➜ combinations of
CORTICOSTEROIDS ,cyclosporine
,mycophenolate mofetil ,infliximab; or
plasmapheresis.
83b

Clinical picture of Seborrhoeic
dermatitis ?
84a
Cradle Crap

Eczematous lesions on the sebum-
rich areas: scalp (Cradle
Crap) (may cause dandruff),
periorbital, auricular and nasolabial
folds. Otitis externa and blepharitis
may develop.
84b

Most common site of Venous
Ulceration ?
85a

above the medial malleolus
85b

Investigations of Venous Ulceration
?
86a

Ankle-brachial pressure index (ABPI) is
important in non-healing ulcers to assess for
poor arterial flow which could impair healing
..'normal' ABPI may be regarded as between 0.9
- 1.2. Values below 0.9 indicate arterial disease.
values above 1.3 may also indicate arterial
disease, in the form of false negative results
secondary to arterial calcification (e.g. In
diabetics).
86b

☸ COMPRESSION BANDAGING, usually four
layers (only treatment shown to be of real
benefit)
☸ Oral pentoxifylline (Trental®), a peripheral
vasodilator, improves healing rate
☸ Little evidence base for ( flavinoids
,hydrocolloid dressings, topical growth factors,
ultrasound therapy and intermittent pneumatic
compression)
87b

factors determining prognosis of
patients with malignant melanoma ?
88a

the invasion depth of a tumour
(Breslow depth) is the single most
important factor.
< 1 mm 5 year survival 95-100%
1 - 2 mm 5 year survival 80-95%
2.1 - 4 mm 5 year survival 60-75%
> 4 mm 5 year survival 50%
88b

Definition of Erythema ab igne ?
89a
reticular pigmented rashon shins + slow relaxing
reflexes → Hypothyroidism (sitting near the fire)

❂ a skin disorder caused by over exposure
to HEAT (HEAT = IGNE) ➜
RETICULATED ERYTHEMA,
HYPERPIGMENTATION, scaling and
telangiectasias in the affected area.
❂ A typical history would be an elderly
women who always sits next to an open
fire (ovens)
89b

Complications of Erythema ab igne ?
90a

If the cause is not treated patients
may develop squamous cell
carcinoma
90b

Skin affection in DM ?
91a
NEUROPATHIC
ULCER

✿ NECROBIOSIS LIPOIDICA DIABETICORUM ➜ Shiny,
painless areas of yellow/red/brown skin typically on the
shin with surrounding telangiectasia ✿ INFECTION ➜
Candidiasis, Staphylococcal
✿ NEUROPATHIC ULCERS
✿ VITILIGO
✿ LIPODYSTROPHY
✿ GRANULOMA ANNULARE➜
Papular lesions that are often slightly
hyperpigmented with central depression
91b
GRANULOMA ANNULARE

Definition of Lichen Planus ?
92a

❀ Itchy, papular RASH of the skin
and/or mucous membranes of unknown
etiology; mostly immune mediated
❀ Lichenoid drug eruptions dt:
Gold
Quinine
Thiazides
92b

Clinical picture of Lichen Planus ?
93a

❀ Itchy, papular RASH most common on the PALMS,
SOLES, genitalia and flexor surfaces of arms.
❀ Red scaly/violaceous
❀ MUCOUS MEMBRANE involvement
❀ Rash often polygonal in shape, 'white-lace' pattern on the
surface (wickham's striae)
❀ Koebner phenomenon seen
❀ Nails: thinning of nail plate, longitudinal ridging.
❀ Age mostly bw of 30 and 60, but it can occur at any age.
❀ may be associated with other autoimmune diseases
93b

Definition of Lichen Sclerosus?
94a

a disease of UNKNOWN CAUSE that
results in ITCHY white patches on
the skin, which may cause scarring on
and around GENITAL
SKIN➜atrophy of the epidermis with
white plaques forming. common in
elderly ♀s
94b

✯ A biopsy is often performed to
exclude other diagnoses ( ↑ risk of
vulval Squamous cell carcinoma)
✯ Rx by Topical steroids and
emollients
95b

is a contagious skin infection caused by the mite
Sarcoptes scabiei.
Severe itching is dt in the parasite which burrows
under the host's skin, causing intense allergic
itching dt a delayed type IV hypersensitivity
reaction to mites/eggs which occurs about 30
days after the initial infection.
typically affects children and young adults. 〘
THE SCABIE BABY 〙
96b

Clinical picture of Scabies ?
97a

⋆ Widespread ITCHING
⋆ Linear BURROWS on the side of fingers,
INTERDIGITAL WEBS and flexor aspects
of the wrist
⋆ In infants the face and scalp may also be
affected
⋆ Secondary features are seen due to
scratching: excoriation, infection
97b

✸ Permethrin 5% is first-line
✸ Malathion 0.5% is second-line
✸ Pruritus persists for up to 4-6
weeks post eradication
98b

Instructions on using anti-scabies
Rx ?
99a

⋆Avoid close physical contact with others until treatment is complete
⋆All household and close physical contacts should be treated at the
same time, even if asymptomatic
⋆Launder, iron or tumble dry clothing, bedding, towels, etc., on the
first day of treatment to kill off mites
⋆Apply the insecticide cream to cool, dry skin➜ between fingers and
toes, under nails, armpit area, creases of the skin such as at the wrist
and elbow➜Allow to dry and leave on the skin for 8-12 hours for
permethrin, or for 24 hours for malathion, before washing off
➜Reapply if insecticide is removed during the treatment period, e.g.
If wash hands,➜Repeat treatment 7 days later
99b

☠ Type 1
⋆ Presents < 40 years old
⋆ Positive family history
⋆ Associated with HLA-CW6
☠ Type 2
⋆ Presents > 50 years old
⋆ No family history
100b

❑ Abnormal T cell activity
stimulates keratinocyte proliferation
(rather than an actual primary
keratinocyte disorder)
❑ Mediated by type 1 helper T cells
❑ associated with HLA-CW6.
101b

Factors may exacerbate psoriasis ?
102a

❏ Trauma
❏ Alcohol
❏ B-blockers, lithium ,NSAIDs,ACE
I, antimalarials (chloroquine &
hydroxychloroquine)
❏ Systemic steroids withdrawal
102b

SEs of phototherapy in Psoriasis ?
103a

skin ageing, squamous cell cancer
(not melanoma)
103b

Systemic Rx of Psoriasis ?
104a

☢ Methotrexate: USEFUL IF
ASSOCIATED JOINT DISEASE
☢ Anti TNF α: infliximab,
etanercept and adalimumab
☢ Cyclosporin
☢ Systemic retinoids
104b

Definition of Guttate psoriasis ?
105a

unstable form, sudden appearance of
innumerable monomorphic psoriasiform
papules (Scaly) on trunk and proximal
extremities (Tear drop papules) usually in
young adults.Preceded by streptococcal
infection 2-4 weeks, usually an upper
respiratory tract infection
105b

Rx of Guttate psoriasis ?
106a

❂ Most cases resolve spontaneously
within 2-3 months
❂ no antibiotics
❂ Topical agents as per psoriasis
❂ UVB phototherapy
❂ Tonsillectomy may be necessary
with recurrent episodes
106b

Definition of Toxic Epidermal
Necrolysis (TEN) ?
107a

❏ end of a spectrum of skin disorders which includes
erythema multiforme and Stevens- Johnson
syndrome.
❏ SJS/TEN - Widespread 【BLISTERS】
predominant on the trunk and face,
ERYTHEMATOUS OR PRURITIC MACULES and
MUCOUS MEMBRANE erosions; epidermal
detachment is less than 10% TBSA for Steven-
Johnson syndrome and 30% or more for TEN.
❏ Positive Nikolsky's sign.
107b

Drugs known to induce TEN ?
108a

same as erythema multiforme
penicillin, sulpha Drugs, allopurinol,
rifampicin, NSAIDs, oral
contraceptive pill,nevirapine,
carbamazepine
108b

❂ Stop precipitating factor
❂ intensive care unit
❂ IV IG effective and is now
commonly used first-line
❂ immunosuppressive agents
(Cyclosporin and cyclophosphamide),
plasmapheresis
109b

Definition of Keloid scars ?
110a

tumour-like lesions that arise from
the connective tissue of a scar and
extend beyond the dimensions of
the original wound
110b

Etiology of Keloid scars ?
111a

overgrowth of granulation tissue
(collagen type 3) at the site of a
healed skin injury which is then
slowly replaced by collagen type 1.
111b

Predisposing factors for Keloid scars
?
112a

❂ More common in young, black, male
adults, rare in the elderly
❂ Common sites (in order of decreasing
frequency): sternum, shoulder, neck, face,
extensor surface of limbs, trunk
❂ Keloid scars are less likely if incisions
are made along relaxed skin tension lines
112b

❂ Early keloids may be treated with
intra-lesional steroids e.g.
Triamcinolone
❂ Excision is sometimes required
113b

Definition of Acanthosis nigricans ?
114a

❂ symmetrical, hyperpigmentation
(brown), velvety plaques often
found on the neck, axilla and groin.
❂ Pts < 40 y, may be genetically
inherited, and is associated with
obesity or endocrinopathies
114b

Etiology of Acanthosis nigricans ?
115a

【Endocrine】
★ insulin resistant diabetes mellitus
★ excess circulating androgens, particularly Cushing's disease, acromegaly,
polycystic ovarian disease
★ Addison's disease and hypothyroidism
★ Prader-Willi syndrome
【Obesity-related】
The majority of cases of acanthosis nigricans are associated with obesity "Type
3 Acanthosis Nigricans"
【Drugs】
oral contraceptive pill, Nicotinic acid
【Familial】
autosomal dominant "Acanthosis nigricans type 1"
【Malignancy】
may be associated with Gastric cancer
115b

Definition of Pompholyx ?
116a

a type of eczema which affects both
the hands and the feet . It is also
known as dyshidrotic eczema. dt
unknown cause (may be an Allergic
reaction).
116b

Clinical picture of Pompholyx ?
117a

★ Small blisters on the palms and
soles
★ Pruritic, sometimes burning
sensation
★ Once blisters burst skin may
become dry and crack
117b

★ Cool compresses
★ Emollients
★ Topical steroids
118b

Definition of Pityriasis rosea ?
119a

a skin rash begins with a single "HERALD
PATCH" lesion (usually on trunk), and
then disseminates ➜1 or 2 weeks by a
generalized body rash. It can look like
secondary syphilis but it SPARES THE
PALMS AND SOLES. (common in spring
season). SPRING = ROSEA
119b

Etiology of Pityriasis rosea ?
120a

unknown Cause, herpes hominis
virus 7 (HHV-7) is a possibility
usually in young adults.
120b

Definition of Pityriasis Versicolor ?
121a

rash on the trunk and proximal
extremities dt superficial cutaneous
fungal infection caused by
Malassezia furfur
121b

Clinical picture of Pityriasis
Versicolor ?
122a

★ 【Scaly Patches】 on the trunk
and proximal extremitiesmay be
hypopigmented, pink or brown
(hence versicolor)
★ Mild pruritus
122b

Predisposing factors for Pityriasis
Versicolor ?
123a

◢ Occurs in healthy individuals
◢ Immunosuppression
◢ Malnutrition
◢ Cushing's
123b

Rx of Pityriasis Versicolor ?
124a

★ Topical antifungal
e.g.Clotrimazole or Terbinafine or
selenium sulphide
★ If extensive disease or failure to
respond to topical treatment then
consider oral itraconazole
124b

Definition of Acne Rosacea ?
125a

chronic condition of unknown
aetiology characterized by facial
erythema (redness) and sometimes
pimples
125b

Clinical picture of Acne Rosacea ?
126a

☯ Typically affects nose, cheeks and
forehead
☯ Flushing is often first symptom
☯ Telangiectasia are common
☯ Later develops into persistent erythema
with papules and pustules
☯ Rhinophyma
☯ Ocular involvement: blepharitis
126b

❃ Topical metronidazole may be used for mild
symptoms
❃ More severe disease is treated with systemic
antibiotics e.g. Oxytetracycline.
❃ Oral isotretinoin: severe acne only under specialist
supervision.
❃ Recommend daily application of a high-factor
sunscreen
❃ Camouflage creams may help conceal redness
❃ Laser therapy esp. in prominent telangiectasia
127b

Definition of Acne vulgaris ?
128a

a common skin disorder which usually
occurs in adolescence. It typically affects
the face, neck and upper trunk and is
characterized by the obstruction of the
pilosebaceous follicle with keratin plugs ➜
comedones, inflammation and pustules.
128b

Etiology of Acne vulgaris ?
129a

⋆ Follicular epidermal hyperproliferation
➜ keratin plug➜ obstruction of the
pilosebaceous follicle. Activity of
sebaceous glands may be controlled by
androgen, although levels are often
normal in patients with acne
⋆ Colonisation by the anaerobic bacterium
propionibacterium acnes➜ Inflammation
129b

❅ Single topical therapy (topical retinoids, benzyl peroxide)
❅ Topical combination therapy (topical antibiotic, benzoyl peroxide,
topical retinoid)
❅ Oral antibiotics: e.g. Oxytetracycline, doxycycline. need 3-4
months to work. Minocycline considered second line treatment due
to the possibility of irreversible pigmentation.
❅ Gram negative folliculitis may occur as a complication of long-
term antibiotic use - high-dose oral trimethoprim is effective if this
occurs
❅ Oral isotretinoin: severe acne only under specialist supervision dt
SEs.a very effective Rx of severe acne (2/3 of patients have a
long term remission or cure following a course of oral isotretinoin
❅ no role for dietary modification in patients with acne
130b

❃ Teratogenicity: ♀s MUST be using two forms of
contraception (e.g. Combined oral contraceptive pill and
condoms)
❃ DRY skin, eyes and lips: THE MOST COMMON SE of
isotretinoin
❃ Depression
❃ Nose bleeds (caused by dryness of the nasal mucosa)
❃ Raised triglycerides
❃ Hair thinning
❃ BENIGN INTRACRANIAL HYPERTENSION: isotretinoin
treatment should not be combined with tetracyclines for this
reason
131b

☀ Dermatitis ➳ Perioral & Acrodermatitis
(red, crusted lesions)
☀ Alopecia
☀ Short stature
☀ Hypogonadism
☀ Hepatosplenomegaly
☀ Geophagia (ingesting clay/soil)
☀ Cognitive impairment
132b

Definition of Koebner phenomenon
?
133a

skin lesions which appear at the site
of injury.
133b

Etiology of Koebner phenomenon ?
134a

❍ Psoriasis
❍ Vitiligo
❍ Warts
❍ Lichen planus
❍ Lichen sclerosus
❍ Molluscum contagiosum
134b

Etiology of Café-au-lait spots ?
135a

✿ Neurofibromatosis type I & II
✿ Tuberous sclerosis
✿ Fanconi anemia
✿ Mccune-Albright syndrome
135b

Etiology of skin bullae:(Bullous
disorders) ?
136a

▲ Congenital: epidermolysis bullosa
▲ Autoimmune: bullous
pemphigoid, pemphigus
▲ Insect bite, Trauma, friction
▲ Drugs: barbiturates, furosemide
136b

Definition of Molluscum
contagiosum ?
137a

a viral infection of the skin or
occasionally of the mucous
membranes. It is caused by a DNA
poxvirus.common in
immunocompermised patients,
137b

Clinical picture of Molluscum
contagiosum ?
138a

Flesh-white or colored, dome-shaped,
and pearly in appearance .sometimes
called water warts 1-5 millimeters in
diameter, with a DIMPLED
(UMBILICATED) CENTER. They are
generally not painful, but they may
itch or become irritated.
138b

Definition of Dermatitis
herpetiformis ?
139a

an autoimmune blistering skin
disorder associated with COELIAC
DISEASE. It is caused by
DEPOSITION OF IgA IN THE
DERMIS.
139b

Clinical picture of Dermatitis
herpetiformis ?
140a

ITCHY, vesicular skin lesions on the extensor
surfaces〚spares the flexor surfaces〛 (e.g.
Elbows, knees ,buttocks & may be the shoulders)
➜ Skin biopsy: direct immunofluorescence shows
deposition of IgA in a granular pattern in the
upper dermis
Colonoscopy➜ 90 % show abnormalities
Small intestinal biopy➜ villous atrophy
140b

Rx of Dermatitis herpetiformis ?
141a

◥ Gluten-free diet
◥ Dapsone
141b

Types of Contact dermatitis ?
142a
Allergic contact dermatitis
Irritant contact dermatitis

▲ Irritant contact dermatitis:non-allergic due to weak acids
or alkalis (e.g. Detergents).common on the hands. Erythema
is typical, crusting and vesicles are rare
▲ Allergic contact dermatitis: type IV hypersensitivity
reaction. 〈ex. Nickel Dermatitis〉➜jewellery such as
watches,also dt hair dyes➜acute weeping eczema at the
margins of the hairline rather than scalp itself. Dx by (skin
patch test). Topical treatment with steroids
▲ Cement Common cause of contact dermatitis. The
alkaline nature of cement ➜ irritant contact dermatitis & the
dichromates in cement ➜ allergic contact dermatitis
142b

Definition of Keratoacanthoma ?
143a

a common low-grade (unlikely to
metastasize or invade) skin tumour
that is believed to originate from the
neck of the hair follicle.
143b

Clinical picture of Keratoacanthoma
?
144a

☀ look like a VOLCANO OR
CRATER
☀ Initially a smooth dome-shaped
papule
☀ Rapidly grows to become a crater
centrally-filled with keratin
144b

Spontaneous regression of
keratoacanthoma within 3 months is
common, often resulting in a SCAR. Such
lesions should however be urgently
excised as it is difficult clinically to exclude
squamous cell carcinoma. Removal also
may prevent scarring.
145b

Clinical picture of Granuloma
annulare ?
146a

chronic dermatological autoimmune
condition Papular lesions that are
often slightly hyperpigmented and
depressed centrally
Typically occur on the dorsal surfaces
of the hands and feet, and on the
extensor aspects of the arms and legs
146b

Definition of Erythroderma ?
147a

is a term used when more than 95%
of the skin is involved in a rash of
any kind
147b

Etiology of Erythroderma ?
148a

◤ Eczema (Most common cause)
◤ Psoriasis
◤ Lymphoma
◤ Drugs e.g. Gold
◤ Idiopathic
Complications are hypothermia, fluid loss,
hypoalbuminemia and
infections.
148b

Definition of Erythrasma ?
149a

PINK OR BROWN RASH asymptomatic,
flat, slightly scaly, usually found in the
groin or axillae. It is caused by an
overgrowth of the Gram +ve bacterium
DIPHTHEROID CORYNEBACTERIUM
MINUTISSIMUM Common in diabetics
and the obese, and in warm climates; it is
worsened by wearing occlusive clothing.
149b

by Wood's light
The ultraviolet light of a Wood's lamp
➜ organism fluoresce a coral red
color, DDfrom other bacterial
infections and other skin conditions.
(fungal infections will also be
fluorescent)
150b

Photosensitive skin disorders ?
151a

diseases aggravated by exposure to sunlight
❐ SLE, discoid lupus
❐ Porphyria (not acute intermittent)
❐ Herpes labialis
❐ Pellagra
❐ Xeroderma pigmentosum
❐ Solar urticaria
❐ Polymorphic light eruption
151b

dermatophyte fungal infections ..Dermatophytes live only in
tissues with keratin (i.e., the skin, nails, and hair) and are a
common cause of infection. Causative organisms include
Microsporum,
Trichophyton, and Epidermophyton. The immune response
to the
dermatophyte, rather than the organism itself.
nomeculature according to part of the body is infected.
☆ Tinea capitis - scalp
☆ Tinea corporis - trunk, legs or arms
☆ Tinea pedis - feet
152b

Most common cause of Tinea capitis
(scalp ringworm) ?
153a

✯ Trichophyton tonsurans.
✯ May also be caused by
microsporum canis acquired from
cats or dogs
153b

Dx of microsporum canis causing
Tinea capitis (scalp ringworm) ?
154a

Wood's lamp ➜ green fluorescence
154b

Etiology of Tinea corporis ?
155a

✫ Trichophyton rubrum (also causes
fungal nail infection)
✫ Trichophyton verrucosum (e.g.
From contact with cattle)
155b

Clinical picture of Tinea corporis ?
156a

Well-defined, erythematous Ring
shaped scaly patches with central
cleaning.
156b

Patients can be treated with topical
or systemic antifungals.Tinea
CAPITIS & Onychomycosis MUST
be treated with systemic drugs.
157b

Clinical picture of Tinea pedis
(athlete's foot) ?
158a

itchy, peeling skin between the toes
Common in adolescence
158b

★ Chroni Liver disease
★ Chronic kidney disease
★ Iron deficiency anemia
★ Polycythemia
★ Lymphoma
★ Hyper- and hypothyroidism
★ Diabetes
★ Pregnancy
★ 'Senile' pruritus
★ Urticaria ,eczema, scabies, psoriasis, pityriasis rosea
159b

DD bw Hirsuitism & Hypertrichosis
?
160a

hirsuitism ➜ androgen-dependent
hair growth in women,
hypertrichosis ➜ androgen-
independent hair growth.
160b
suit = androgen

Etiology of hirsuitism (androgen-
dependent hair growth in women) ?
161a

★ Polycystic ovarian syndrome
★ Congenital adrenal hyperplasia
★ Cushing's syndrome
★ Androgen therapy
★ Androgen secreting ovarian tumour
★ Adrenal tumour
★ phenytoin
161b

Etiology of hypertrichosis
(androgen-independent hair
growth) ?
162a

★ minoxidil, CYCLOSPORIN, diazoxide
★ Congenital hypertrichosis lanuginosa,
★ congenital hypertrichosis terminalis
★ Porphyria cutanea tarda
★ ANOREXIA NERVOSA
★ GI and Lung malignancies.
162b

Assessment of hirsuitism
(androgen-dependent) ?
163a

Ferriman-Gallwey scoring system
163b

Rx of hirsuitism (androgen-
dependent) ?
164a

★ weight loss if overweight
★ Cosmetic techniques such as
waxing/bleaching
★ combined oral contraceptive pills
★ Facial hirsuitism: topical
EFLORNITHINE - contraindicated in
pregnancy and breast-feeding
164b

Definition of Yellow nail syndrome ?
165a

a very rare medical syndrome that includes
PLEURAL EFFUSIONS, LYMPHEDEMA (due to
lymphatic hypoplasia) and YELLOW
DYSTROPHIC NAILS ( characteristic thickened
and discolored nails). 40% will also have
BRONCHIECTASIS. It is also associated with
CHRONIC SINUSITIS and persistent coughing.
It usually affects adults.
165b

Etiology of Fungal nail infections
(Onychomycosis) ?
166a

★ Dermatophytes - mainly
Trichophyton rubrum, 90% of cases
★ Yeasts - such as Candida
★ Non-dermatophyte moulds
166b

Clinical picture of Onychomycosis ?
167a

☢ Unsightly' nails are a common
reason for presentation
☢ Thickened, rough, opaque nails
are the most common finding
167b

☢ oral TERBINAFINE is currently
recommended first-line with oral
itraconazole as an alternative. Six
weeks therapy is needed for
fingernail infections whilst toenails
should be treated for 12 weeks
168b

Definition of Myxoid cysts ?
169a

are benign ganglion cystson the
distal, dorsal aspect of the finger.
There is usually osteoarthritis in the
surrounding joint.
more common in middle-aged
women
169b

Etiology of Onycholysis (separation
of the nail plate from the nail bed) ?
170a

✎ Idiopathic
✎ Trauma e.g. Excessive manicuring
✎ fungal Infection
✎ psoriasis, dermatitis
✎ Raynaud's
✎ hyper- and hypothyroidism
‫و‬‫ا‬‫ﻟ‬‫ﻔ‬‫ﻄ‬‫ﺮ‬ ‫ﺑ‬‫ﺎ‬‫ﻟ‬‫ﻤ‬‫ﺎ‬‫ﻧ‬‫ﻴ‬‫ﻜ‬‫ﻴ‬‫ﺮ‬ ‫ا‬‫ﻟ‬‫ﻠ‬‫ﺤ‬‫ﻢ‬ ‫ﻣ‬‫ﻦ‬ ‫ﻳ‬‫ﻄ‬‫ﻠ‬‫ﻊ‬ ‫ﻣ‬‫ﻤ‬‫ﻜ‬‫ﻦ‬ ‫ا‬‫ﻟ‬‫ﻀ‬‫ﻔ‬‫ﺮ‬
‫و‬‫ا‬‫ﻟ‬‫ﺪ‬‫ر‬‫ﻗ‬‫ﻴ‬‫ﺔ‬ ‫و‬‫ا‬‫ﻟ‬‫ﺼ‬‫ﺪ‬‫ﻓ‬‫ﻴ‬‫ﺔ‬ ‫و‬‫ا‬‫ﻟ‬‫ﺮ‬‫ﻳ‬‫ﻨ‬‫ﻮ‬‫د‬
170b

Protection against/ Prevention
against skin cancer ?
171a

❍ Melanoma (By protective clothing
such as hats, tightly woven clothes).
No role of SPF 15-30.
❍ Squamous cell carcinoma (By SPF
15-30)
171b

Throbbing pain over pulp with non-
purulent vesicles. Tzanck smear
shows multinucleated giant cells ?
172a

Herpetic whitlow (HSV 1 of 2).
Common in health care workers/
dentist comes in contact with
orotracheal secretions . Spread
through direct inoculation into
broken skin.
172b

Etiology of Xanthelasmas ?
173a

idiopathic but also seen in primary
biliary Cirrhosis .
Present at the medial aspects of
eyelids B/L.
173b

Liability of Squamous cell
carcinoma for metastasis ?
174a

Squamous cell carcinoma that arise
from actinic keratoses rarely
metastasize, but those that arise on
the lips and on ulcers are more
likely to metastasize by
LYMPHATIC channels.
174b

The most common skin tumor of the
Lips ?
175a
Basal cell carcinoma of the eyelidSquamous cell carcinoma of
the lip

Squamous cell carcinoma occurs on
the lip far more commonly than
does Basal cell carcinoma.
175b

Liability of Basal Cell Carcinoma for
metastasis ?
176a

Basal Cell Carcinoma is slow
growing and locally destructive but
has virtually no metastatic potential.
176b

Multiple Basal Cell Carcinoma on
non-sun-exposed areas are
suggestive of ?
177a

arsenic exposure or inherited basal
cell nevus syndrome
177b

Risk factors for Malignant
Melanoma ?
178a

★ short, intense bursts of sun exposure
★ congenital melanocytic nevi, an ↑
number of nevi, or dysplastic nevi.
★ familial atypical mole and melanoma
(FAM-M) syndrome.
178b

Definition of Mycosis Fungoides
(Cutaneous T-Cell Lymphoma) ?
179a

★ Not a fungus, but a slow,
progressive tumor of T cells.
★ related to chronic
immunostimulation ➜ helper T cells
gather in the epidermis.
★ Industrial exposure to irritating
chemicals appears to ↑ risk.
179b

Erythematous scaly rash that is
pruritic with central clearing ?
180a

Tinea corporis diagnosed by skin
scraping and KOH examination.
Treated by Terbinafine applied
topically.
180b

best method of protection against
sun related skin diseases ?
181a

Child presented with flaccid bulla,
erythema diffuse, skin tenderness
and fever, facial edema and perioral
crusting ?
182a

staphylococcal scalded skin
syndrome
182b

Most common malignant tumor of
eyelid ?
183a

Retained vaginal tampons cause ?
184a

Staphylococcal Toxic shock
syndrome ( Fever, hypotension,
multi organ involvement of 3 or
more organs required for diagnosis.
184b

Normal skin at birth but then
progressing to dry, rough skin with
horny plates over extensor surfaces
(Lizard Skin) ?
185a

Velvety pink or whitish
hypopigmented macules that do not
tan and don't appear scaly,scale on
scraping ?
186a

Erythematous morbilliform rash
rapidly evolves into
skin Exfoliation ?
187a

Toxic Epidermal Necrolysis
187b

Red cutaneous papules in aging
adults. Don't regress. Increase in
number with age . Light microscopy
shows proliferation of capillaries
and venules ?
188a

✿ Cherry Angiomas
NB:Other types of Blood vessel tumer
✿ Strawberry Hemangiomas➜ 1st week of life,
regresses by 5-8 years of life.
✿ Spider angiomas ➜outward radiating vessels
(Estrogen dependent )
✿ Cavernous Hygromas ➜lymphatic cysts at
birth (lateral neck). Associated with Turner
Syndrome and Down's Syndrome.
188b

Maculopapular rash+ post cervical
lymphadenopathy+ post. Auricular
lymphadenopathy ?
189a

Recurrent chalazion you should
think of ?
190a

may be underlying Mebomian gland
carcinoma.
190b

Definition of Lentigo maligna ?
191a

increased number of malanocytes at
EPIDERMODERMAL JUNCTION It's
premalignant lesion and the factor most
important in determining prognosis is
thickness of the lesion.
it takes the same risk factors of malignant
melanoma (ABCDE) with D > 6 cm more
likely to be malignant.
191b

Wood's lamp results in Dermatology
?
192a

Tinea capitis ➜ green fluorescence.
Erythrasma ➜ coral red fluorescence
192b

Definition of Sweet's syndrome ?
193a

a skin disease ➜ the sudden onset of fever,
leukocytosis, and tender, erythematous,Characteristic
plum colored papules and plaques that show dense
infiltrates by neutrophil granulocytes on histologic
examination.
Classified as: Idiopathic SS, malignancy-associated
SS, and drug-induced SS.
193b

Definition of Erythema chronicum
migrans ?
194a

RASH often seen in the early stage of Lyme
disease. Present anywhere from 1 day to1 month
after a tick bite. This rashisn't dt an allergic
reaction to the bite, but rather an actual skin
infection with the Lyme bacteria, BORRELIA
BURGDORFERI
"Erythema migrans is the only manifestation of
Lyme disease allow clinical diagnosis in the
absence of laboratory confirmation."
194b

Dog breeder has a bald patch on
scalp with inflammation and
scaling. Wood's lamp shows bright
green fluorescence ?
195a

Tenia capitis (M.canis) Treated by
miconazole/ketoconazole
195b

Old woman presents with mildly
itchy white atrophic plaque on vulva
and abdomen ?
196a

Lichen sclerosus (Diagnosed by
biopsy showing thinning of
epidermis, acanthosis with
elongation of ridges. Increased risk
of vulvar squamous cell CA).
196b

Dome shaped lesion on nose with
pearly white look and raised edge ?
197a

nodular basal cell carcinoma. Major
risk factor is sun exposure. Most
common cutaneous neoplasm.
197b

Patient with complaints of difficulty
to get up from chair has purplish
non itchy rash of the eyelids ?
198a

Dermatomyositis (muscle biopsy
and raised CPK levels).
198b

Epilepsy, ash leaf(hypopigmented)
patches, adenoma sebaceum(acne
like eruption), periungal ?
199a
ash leaf
adenoma sebaceoum

tuberous sclerosis(bourn ville's
disease). Fundoscopy may show
white streaks along fundal vessels .
199b

Female (pregnant/OCPs) presents
with increased pigmentation over
face that increases with sunlight
along with weight gain ?
200a

Small brown macules after sun
exposure, fade in winter months ?
201a

Freckles
Macule of pigmentation which tends
to persist in winter➜ lentigo
(common in old people).
201bFRECKLES
LENTIGO

University student in a spring
season complains of red patch over
chest with scaly skin followed by
oval macules on rest of trunk, arms
and legs after 3 days ?
202a

Pityriasis rosea (remember spring
season).
SPRING = ROSEA
202b

Well circumscribed erythematous
lesion on dorsum of hand in DM-1 ?
203a

Granuloma annulare(occur in
association with D.M-1).
203b

D.M-1 man on returning from
summer holiday noticed some patch
on her body that didn't tanned ?
204a

vitiligo due to melanocyte function
loss (loss of melanocytes from basal
layer of epidermis ).
204b

A disease of depigmentation whose
pathogenesis is unknown. The
mechanism may be autoimmune,
neurologic, or both.
205b

Clinical picture of vitiligo ?
206a

small, sharply demarcated, depigmented
MACULES or patches on otherwise normal skin,
often on the hands, face, or genitalia ➜
expand, sometimes in dermatomal patterns ➜
include large segments of skin.
The disease is usually chronic and progressive,
with some patients becoming completely
depigmented.
206b

Topical or systemic PSORALENS and exposure
to sunlight or PUVA may be helpful.
Patients must wear sunscreen because
depigmented skin lacks inherent sun protection.
Dyes and makeup may be used to color the skin,
or the skin
may be chemically bleached to produce a
uniformly white color.
207b

with Icthyosis vulgaris ?
208a

6 month baby with itchy eruptions
on trunk and soles ?
209a

Scabies.〘 THE SCABIE BABY 〙
209b

Rash appearing few days after
starting drug therapy. Varying in
size and purpuric center ?
210a

Pruritic purple papule with white
lacy appearance in buccal mucosa in
2 year old boy ?
211a

Patient with history of IBD deep
violet border ulcer on leg ?
212a

Pyoderma granulosum (biopsy and
culture from ulcerated tissue is done
that shows neutrophilic infiltration
and hemorrhage).
212b

Obese man with erythematous
plaque with a SCALING BORDER
AND HEALING FROM CENTER
over thigh ?
213a

tenia cruris (common in summer
months).
213b

Ulcerated painful boil like regions in
a patient with diarrhea and anemia (
IBD)?
214a

Goosebumps over skin of neck in a
patient of mitral valve prolapse ?
215a

Pseudoxanthoma elasticum.
215b

Definition of Pseudoxanthoma
elasticum ?
216a

a genetic disease ( autosomal recessive)
that causes fragmentation and
mineralization of elastic fibers in some
tissues. The most common problems arise
in the skin and eyes, and later in blood
vessels in the form of premature
atherosclerosis & mitral valve prolapse.
216b

Painful penile ulcer with
suppurative lymph adenopathy ?
217a

chancroid (hemophilus ducreyi).
217b

Medditerranean woman with pale
pink nodules on face ?
218a

Burning stingy rash over shoulders,
elbows and buttocks(biopsy shows
papillary neutrophilic inflammation
and abscess). Past history of
thyroiditis is present ?
219a

Pale pink non itchy symmetrical
rash on palms/soles and limbs in a
patient with generalized
lymphadenopathy and joint pains.
White erosions in mouth are also
seen ?
220a

Secondary syphilis.
220b
mouth erosions

Purplish polygonal itchy rash in a
patient of primary biliary cirrhosis ?
221a

Etiology of white nails ?
222a

Latin American woman presents
with nasal congestion. O/E shows
red ulcerated papule in nostril ?
223a

mucocutaneous leishmaniasis
223b

Primigravida in 3rd trimester
complains of pruritus and blisters
around umbilicus and upper thigh ?
224a

Necrotic ulcers with purplish rim on
legs in a patient of rheumatoid
arthritis ?
225a

pyoderma gangrenosum (Give
prednisolone).
225b

Patches of depigmentation with well
demarcated scaly white skin on
upper chest
226a

pityriasis versicolor caused by
malassezia furfur (give clotrimazole
ointment).
226b

Definition of Darier's disease ?
227a

an autosomal dominant disease characterized by Itchy
crusty patches (greasy brown papules) on the skin of chest,
neck, back, ears, forehead, and groin, but may involve other
body areas. The rash associated with Darier's disease often
has a distinct odor. Finger nails become fragile and this
helps in diagnosis of the disease.
227b

A person noticed unsightly skin over
chest and scapula (greasy brown
papules) while sun bathing
228a

Young man presented with well-
defined patch of hair loss on scalp,
nail pitting, hypopigmented skin but
no scarring ?
229a

Alopecia areata (club hairs/
exclamation mark)
229b

Intensely painful, rapidly spreading
facial rash with demarcated border
and fever/flu like symptoms ?
230a

Erysipelas (group A streptococcus).
230b

Definition of Hidradenitis
Suppurativa ?
231a

◢ bilateral (abcesses, cyst, pustules,
papules) affects areas bearing
apocrine sweat glands or sebaceous
glands, such as the underarms, under
the breasts, inner thighs, groin and
buttocks.
◢ adolescent/adults
231b

Rx of Hidradenitis Suppurativa ?
232a

Systemic antibiotics (tetracycline or
minocycline)
232b

Definition of Tinea Nigra ?
233a

Superficial fungal infection that
causes dark brown to black painless
patches on palms and soles. Caused
by Exophiala Werneckii.
233b

Etiology of clubbing of the nails ?
235a

Pulmonary - Carcinoma of bronchus,
Bronchiectesis, Tuberculosis, Fibrosing
alveolitis, Asbestosis.
Cardiovascular - Bacterial endocarditis,
Cyanotic, congenital heart disease
Miscellaneous - Cirrhosis, Crohn's disease,
Ulcerative colitis, Thyrotoxicosis.
235b

Human Papilloma Virus
double stranded DNA virus
236b

kids with severe atopic dermatitis
can get ________ with HSV
237a

What can be given to immune
compromised as prophylaxis after
exposure to varicella?
238a

VZIG- varicella zoster immune
globulin, within 96hrs
238b

Oral steroids may speed recovery
Oral antivirals decrease duration of
PHN (post herpetic neuralgia)
PHN- tx with TCA, gabapentin
(Neurontin), topical capsaicin (after
complete healing)
239b

Stool does what to the pH of skin?
240a

elevates the pH, and candida love
alkaline conditions
240b

Candida _________ is a fungal
infection of the skin folds
241a

Intertrigo
most common in obese and DM
satellite lesions common
241b

Etiology of Roseola infantum ?
242a

Etiology of "fifth disease" or
"slapped cheek syndrome" ?
243a

ERYTHEMA INFECTIOSUM
it is caused by parvovirus B19
mild prodromal symptoms, sore throat,
malaise, low grade fever
facial erythema followed by lacy "fish net"
pattern rash
adult women may develop itching and
arthritis
243b

the most common of all cutaneous
drug reactions ?
244a

MORBILLIFORM ERUPTIONS-
indistinguishable from viral exanthems
generalized erythematous pruritic
eruption, symmetrical, usually spares face
but may involve palms and sole and
mucous membranes
usually starts 7-10 days after starting drug
TX is to remove drug and treat itching
244b

Fixed drug eruptions are commonly
cause by ?
245a

tetracyclines and sulfonamides- cause
eruption of glans penis
=single or multiple red plaques appear
after exposure and reappear in same place
with subsequent exposure
lesions itch and burn, may form bulla and
erode, the desquamation and crust
245b

Diagnosis and treatment of lice ?
246a

Nits easier to see than lice,
fluorescent under woods lamp
TX- permethrin 1% OTC, rinse out
in 10 minutes or single dose oral
ivermectin 200 micrograms/kg
Nit removal essential but diffictult
246b

Etiology of Swimmer's itch ?
247a

schistosome parasite, in fresh water
TX- antihistamines, col wet
dressings
247b

True or false, nerve endings go all
the way to the epidermis ?
248a

False, they terminate in the dermis
248b

Which sweat glands are found in the
armpit and groin area, they open
into hair follicles and produce milky
sweat ?
249a

apocrine.. if
inflammed➜Hidradenitis
Suppurativa
249b

Which sweat glands cover most of
the body,and open directly to the
skin via skin pores ?
250a

What is the most common
presentation of eczema?
251a

subacute eczema
itchy, red, scailing patches, papules
and plaques
borders may be indistinct, variable
patterns and degree of itch
scratching and repeated exposure
converts to a chronic process
251b

Definition of angioedema?
252a

acute or chronic hive-like swelling of the
hypodermis (subcutaneous tissue) and
mucosa, caused by increased vascular
permeability
color is usually uniform and it often
involves the lips, palms and soles, limbs
and genitalia
often occurs with urticaria
252b

How would I differentiate acne from
rosacea?
253a

there are no comedones in rosacea
253b

What are the skin findings in
folliculitis?
254a

dome shaped pustules with small
erythematous halos arising in the
follicle
254b

What is the most common causative
organism in folliculitis?
255a

staphylococcus aureus
cultures not routinely done
KOH to RO dermatophyte
255b

What is the treatment of bacterial
folliculitis?
256a

minimize heat, friction, and occlusion
antibacterial soap
mupirocin (bactroban) TID x 5 days for
limited superficial involvement- treat
nasal passages and finger tips also
oral antistaphylococcal drugs-oxacillin,
dicloxacillin, cefuroxime
256b

bleeding at edges of psoriatic plack
when picked off
257b

Clinical picture of Acral lentiginous
melanoma ?
258a

✫ normally seen on the sole of the foot, and
occasionally on the palm of the hand
✫ It is characterised by a raised darker area
surrounded by a paler macular (lentiginous) area
that may extend for several centimetres around
the raised area
✫ Lentigo maligna melanoma occurs on the sun-
exposed skin areas (usually the face) of elderly
patients
258b

Clinical picture of Morphoea ?
259a

✿ a very ﬁrm, white or violaceous patch of skin on any body
site, but more commonly on the thighs, trunk and upper
arms
✿ commonly in children or young adults.
✿ infection with Borrelia burgdorferi may be the cause ➜
supported by some patients with early morphoea lesions
appear to respond to tetracycline antibiotics
259b

Clinical picture of Factitious
dermatitis ?
260a

a form of factitious disorder➜ patients will
intentionally feign symptoms and signs of disease
to assume the patient role. It is also self-inflicted
skin damage, most commonly from prolonged
scratching, but sometimes by means of sharp
instruments or another agency.history of suicide
or psychiatric disoredr may a clue.
260b

Effects of ultraviolet radiation ?
261a

phototoxic reaction.The damage
caused is due to the formation of
PYRIMIDINE DIMERS ➜prevent
the enzyme DNA polymerase from
replicating the DNA strand beyond
the site of dimer formation
261b

Clinical picture of Pityriasis
lichenoides acuta ?
262a

purely cutaneous disorder➜
lymphocytic inﬁltration,➜ multiple
crops of PRURITIC papules
occurring on the trunk and limbs
Rx ➜ichthyol UV light therapy may
beneﬁt
262b

Clinical picture of Tinea incognito ?
263a

Is tinea when the clinical appearance has been
altered by inappropriate treatment, usually a
TOPICAL STEROID CREAM ➜the original
infection slowly extends➜The steroid cream ↓
inﬂammation ➜ the condition feels > irritable
when the cream is stopped for a few
days➜steroid cream is promptly used again➜ ≫
steroid applied➜ ≫ extensive the fungal
infection becomes
263b

Henna tattoing induced allergic
reaction is caused by ?
264a

P-Phenylaminediamine
lsothiazolinones are present in a
number of cosmetics, and are
another common cause of allergic
contact dermatitis
264b

Palms and Soles Rash ?
265a
Keratoderma blenorrhagica

✬ Secondary and Congenital Syphilis.
✬ Lichen Planus
✬ Rocky Mountain Spotted Fever& Typhus.
✬ Hand, Foot, and Mouth Disease➜Coxsackie A virus.
✬ Kawasaki, Measles, or Toxic Shock Syndrome .
✬ Meningococcemia ➜ petichiae on the palms and soles.
✬ Bacterial endocarditis➜ Janeway lesions and Osler's nodes.
✬ Tylosis (risk of esophageal carcinoma)
✬ Acral lentiginous melanoma
✬ Keratoderma blenorrhagica ➜(Reiter's syndrome)
✬ Graft Versus Host Disease rash.
265b

Definition of Telogen effluvium ?
266a

a scalp disorder characterized by the
thinning or shedding of hair resulting from
the early entry of hair in the telogen phase
(the resting phase of the hair follicle).
Emotional or physiological stress may
result in an alteration of the normal hair
cycle and cause the disorder
266b

Dx of Telogen effluvium ?
267a

Effluvium can present with similar appearance to
alopecia totalis, with further distinction by
clinical course, microscopic examination of
plucked follicles, or biopsy of the scalp.Histology
➜ telogen hair follicles in the dermis with
minimal inflammation in effluvium, and dense
peribulbar lymphocytic infiltrate in alopecia
totalis.
267b

heavy smoker, multiple, small punched-out ulcers
situated on the lower third of both legs. Both dorsalis
paedis and posterior tibial pulses appear absent.
Which diagnosis ﬁts best with this clinical picture?
Flea infestation
Multiple venous ulcers
Vasculitis
Multiple arterial ulcers
Traumatic skin damage
268a

A 12-year-old boy has had a gradually progressive plaque on
his buttock for the past 3 years. The plaque is 15 cm in
diameter, annular in shape with crusting and induration at
the periphery and scarring at the centre. Which one of the
following options is the most likely diagnosis?
Tinea corporis
Granuloma annulare
Lupus vulgaris
Borderline leprosy
Cutaneous leishmaniasis
269a

Lupus vulgaris
The most common manifestation of
cutaneous TB.
269b

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