Dermatology

DERMATOLOGY
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GENERAL ANATOMY AND APPENDAGEAL DISORDERS 1
DERMATOLOGY
CONTENTS
GENERAL ANATOMY AND APPENDAGEAL DISORDERS ................................................................................................. 6
DEVELOPMENT OF SKIN ............................................................................................................................................ 6
GENERAL ANATOMY ................................................................................................................................................. 6
GENERAL FEATURES OF SKIN DISEASES .................................................................................................................... 7
ACNE ......................................................................................................................................................................... 8
DISEASES OF SWEAT GLAND ..................................................................................................................................... 9
DISEASES OF HAIR ..................................................................................................................................................... 9
DISORDERS OF NAIL ................................................................................................................................................ 10
PHOTOTOXICITY ...................................................................................................................................................... 11
ALLERGIC DISORDERS.................................................................................................................................................. 11
GENERAL FEATURES OF ALLERGIC DISORDERS OF SKIN ......................................................................................... 11
ATOPIC DERMATITIS ............................................................................................................................................... 12
UTRICARIA ............................................................................................................................................................... 13
HEREDITARY ANGIOEDEMA .................................................................................................................................... 13
ANAPHYLAXIS .......................................................................................................................................................... 13
DISORDERS OF SKIN PIGMENTATION ......................................................................................................................... 14
GENERAL FEATURES OF PIGMENT RELATED SKIN DISORDERS ............................................................................... 14
VITILIGO .................................................................................................................................................................. 15
PITYRIASIS ROSACEA ............................................................................................................................................... 15
PITYRIASIS RUBRA PILARIS ...................................................................................................................................... 16
TINEA VERSICOLOR ................................................................................................................................................. 16
PITYRIASIS ALBA ...................................................................................................................................................... 16
FUNGAL INFECTIONS OF SKIN ..................................................................................................................................... 17
GENERAL FEATURES OF FUNGAL SKIN INFECTIONS ................................................................................................ 17
TINEA CAPITIS ......................................................................................................................................................... 17
TINEA CORPORIS ..................................................................................................................................................... 18
TINEA CRURIS .......................................................................................................................................................... 18
TINEA BARBAE ......................................................................................................................................................... 18
TINEA PEDIS ............................................................................................................................................................ 18
TINEA UNGUIM ....................................................................................................................................................... 18
CANDIDIASIS ........................................................................................................................................................... 18
SPOROTRICHOSIS .................................................................................................................................................... 18
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DERMATOLOGY
WOOD’S LAMP AND UV LIGHT................................................................................................................................ 19

PAPULOSQUAMOUS DISORDERS ................................................................................................................................ 19
GENERAL FEATURES OF PAPULOSQUAMOUS DISORDERS ..................................................................................... 19
PSORIASIS ................................................................................................................................................................ 19
PSORIATIC ARTHRITIS .............................................................................................................................................. 21
PUVA THERAPY ....................................................................................................................................................... 21
LICHEN PLANUS ....................................................................................................................................................... 21
BULLOUS DISORDERS .................................................................................................................................................. 22
GENERAL FEATURES OF BULLOUS DISORDERS ....................................................................................................... 22
PEMPHIGUS............................................................................................................................................................. 23
EPIDERMOLYSIS BULLOSA ....................................................................................................................................... 24
PEMPHIGOID ........................................................................................................................................................... 24
DERMATITIS HERPETIFORMIS ................................................................................................................................. 24
LINEAR IGA DISEASE ................................................................................................................................................ 25
SCABIES AND PEDICULOSIS ......................................................................................................................................... 25
SCABIES ................................................................................................................................................................... 25
PEDICULOSIS ........................................................................................................................................................... 26
SYSTEMIC AND PHOTOSENESITIVE DISORDERS .......................................................................................................... 26
GENERAL FEATURES OF SYSTEMIC AND PHOTOSENSITIVE DISORDERS ................................................................. 26
DERMATOMYOSITIS ................................................................................................................................................ 27
PORPHYRIA.............................................................................................................................................................. 27
CHLOASMA.............................................................................................................................................................. 28
POLYMORPHIC LIGHT REACTION ............................................................................................................................ 28
PHOTOSENSITIVE DERMATITIS................................................................................................................................ 28
FIXED DRUG ERUPTION ........................................................................................................................................... 28
ERYTHEMA NODOSUM ........................................................................................................................................... 28
SKIN TUBERCULOSIS ................................................................................................................................................ 29
INFECTIVE DISEASES OF SKIN ...................................................................................................................................... 29
COMMON INFECTIVE DISEASES OF SKIN ................................................................................................................ 29
ERYTHEMA MULTIFORME ....................................................................................................................................... 30
STAPHYLOCOCCAL SCALDED SKIN SYNDROME ....................................................................................................... 31
STEVEN JOHNSON SYNDROME ............................................................................................................................... 31
TOXIC EPIDERMONECROLYSIS ................................................................................................................................ 31
MOLLUSCUM CONTAGIOSUM ................................................................................................................................ 31
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DERMATOLOGY
HERPES ZOSTER ....................................................................................................................................................... 31

MALIGNANT SKIN DISEASES ........................................................................................................................................ 32
GENERAL FEATURES OF MALIGNANT SKIN DISEASE ............................................................................................... 32
ACANTHOSIS NIGRICANS ........................................................................................................................................ 33
MYCOSIS FUNGOIDES ............................................................................................................................................. 34
HISTIOCYTOSIS ........................................................................................................................................................ 34
BASAL CELL CARCINOMA ........................................................................................................................................ 35
FEATURES OF MALIGNANT MELANOMA ................................................................................................................ 35
MANAGEMENT OF MALIGNANT MELANOMA ........................................................................................................ 36
GENODERMATOSES .................................................................................................................................................... 37
XERODERMA PIGMENTOSA .................................................................................................................................... 37
INCONTINENTIA PIGMENTI ..................................................................................................................................... 37
NEUROFIBROMATOSIS ............................................................................................................................................ 37
TUBEROUS SCLEROSIS ............................................................................................................................................. 38
ICHTHYOSIS ............................................................................................................................................................. 38
LEPROSY ...................................................................................................................................................................... 39
MYCOBACTERIUM LEPRAE ...................................................................................................................................... 39
EPIDEMIOLOGY OF LEPROSY ................................................................................................................................... 39
CLASSIFICATION OF LEPROSY .................................................................................................................................. 40
FEATURES OF LEPROSY ........................................................................................................................................... 40
LEPROMIN TEST ...................................................................................................................................................... 42
DIAGNOSIS OF LEPROSY .......................................................................................................................................... 42
TREATMENT OF LEPROSY ........................................................................................................................................ 42
LEPRA REACTIONS ................................................................................................................................................... 43
SEXUALLY TRANSMITTED DISEASES ............................................................................................................................ 44
GENERAL FEATURES OF SEXUALLY TRANSMITTED DISEASES ................................................................................. 44
WARTS..................................................................................................................................................................... 45
GONORRHOEA ........................................................................................................................................................ 46
LYMPHOGRANULOMA VENERUM .......................................................................................................................... 46
DONOVANOSIS ........................................................................................................................................................ 47
CHANCROID ............................................................................................................................................................ 47
HERPES .................................................................................................................................................................... 48
SYPHILIS ...................................................................................................................................................................... 48
TREPONEMA PALLIDUM ......................................................................................................................................... 48
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DERMATOLOGY
GENERAL FEATURES OF SYPHILIS ............................................................................................................................ 49

CONGENITAL SYPHILIS ............................................................................................................................................ 50
PRIMARY SYPHILIS ................................................................................................................................................... 50
SECONDARY SYPHILIS .............................................................................................................................................. 50
TERTIARY SYPHILIS .................................................................................................................................................. 51
DIAGNOSIS OF SYPHILIS .......................................................................................................................................... 51
TREATMENT OF SYPHILIS ........................................................................................................................................ 52
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DERMATOLOGY
KEY TO THIS DOCUMENT
Text in normal font – Must read point.

Asked in any previous medical entrance
examinations
Text in bold font – Point from Harrison’s

text book of internal medicine 18th
edition
Text in italic font – Can be read if

you are thorough with above two
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DERMATOLOGY
GENERAL ANATOMY AND APPENDAGEAL DISORDERS
DEVELOPMENT OF SKIN
rd
Melanoblast cells appear in basal layer of epidermis 3 month of intrauterine life
Dermal and Epidermal melanoblasts are formed from Neural Crest
GENERAL ANATOMY
Normal Skin Cycle (Turn over time of epidermis) 28 days

Epithelium of Skin Stratified squamous epithelium
Nutrition to epidermis is derived from Diffusion from capillary plexus in dermis
Odland bodies is seen in Stratum granulosum
Odland body is Keratinosome
Keratin is produced from Stratum granulosum
Keratohyaline granules are seen in Stratum granulosum
Important layer in regulating permeability Stratum granulosum
NOT true about granular layer of skin It is the terminal layer of differentiation
Under Developed Layer in VLBW babies Stratum corneum
Stratum lucidum Sandwiched between S.corneum and S.granulosum,
contains degenerated cells
Melanocytes are present in Stratum basale
Highest concentration of melanocyte Face
Epidermal melanin unit 1 melanocyte with 36 keratinocytes
Melanin in melanocyte is stained with Mason Fontana stain
Immigrant cells Melanocytes and merkel cells
Merkel cells are derived from Neural crest
Stem cells of skin are seen in Hair follicle bulge, Interfollicular region, Sebaceous
gland
Immunocompetent cells of skin Langerhan cells
Hallmark of epidermal cells Keratin filaments
Seen in basal epidermis Keratinocyte, melanocytes, langerhan cells, merkel cells
Blaschko Lines Developmental lines, NOT dermatome, DIFFERENT from
nervous, vascular, lymphatics
Blaschko line pattern is visible in Lichen striatum, incontinenta pigmenti,
scarlet fever, sarcoidosis
Neither raised Nor depressed Macule
Flat discolouration on skin as 1 cm is called Macule
NOT a primary skin lesion Abscess, crust
Parakeratosis Nuclei retained in stratum corneum
Henle’s and Huxley’s layer are histologically seen in Bulb of hair follicle
Holocrine secretion seen in Sebaceous gland
Normal microbial flora in skin and mucous membrane It establishes in body only after the neonatal period
Normal commensals of skin Staphylococcus aureus, Candida albicans,
Propioibacterium, Corynebacterium, Streptococcus,
Diphtheroids
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DERMATOLOGY
Normal commensals of skin Candida, Propionibacterium acne
GENERAL FEATURES OF SKIN DISEASES
Intrinsic causes of skin disease Atopic dermatitis, Pityriasia alba, Seborrhoic dermatitis
Dermatitis that occur due to plant Phytophotodermatitis
derived phytophotoxic substance
Chemical agents causing dermatitis by local irritation Rubber, X rays, lime
Dermatitis may be clinical manifestation of deficiency of Biotin, niacin, pyridoxine
Greasy yellowish scale is associated with Seborrhoeic dermatitis
Red dermatographism is seen in Seborrheic dermatitis
MC form of seborrheic dermatitis affecting Petaloid
trunk
Cradle cap Infantile seborrhoeic dermatitis
MC occupational disease Dermatosis
Primary skin lesion Plaque - > 1 cm flat topped seen in psoriasis and exfoliative
dermatitis, tumor - > 5 cm solid
Secondary skin lesion Scale – excessive accumulation of stratum corneum
Annular means ring
Herpetiform means Grouped
Milia Small, firm papules with keratin
Nummular Coin
Spongiosis seen in Acute eczema
Spongiosis means Intercellular edema of epidermis
Characteristic Finding of Eczema Lichenification
Winter itch is also known as Asteatotic eczema, Xerotic eczema
Dermatosis Papulosis Nigra Seborrheic keratosis
Sign of Leser Trelat Seborrhoeic keratosis
Cayenne pepper spots Dermatosis
Pentasomida Tongue worm
Fordycee’s spots in oral cavity arise from Sebaceous gland
Fordycee spot Ectopic sebaceous gland found in healthy people
Fordycee spot mainly involve Lip > buccal mucosa
Acrochordon Skin tag, fleshy papules
Exposure to sunlight can precipitate Discoid lupus erythematosus
Discoid lupus erythematosus Also known as chronic cutaneous lupus erythematosus,
hyperkeratosis, follicular plugging, atrophy
Cyanne pepper appearance on diascopy Discoid lupus erythematous
Chloroquine is indicated in treatment of DLE
Predominant acral eruptions are seen in RMSF, secondary syphilis, erythema
multiforme
Severe in rainy season and improved completely in Insect bite allergy
winter
Erythematous papule with central punctum Insect bite
Morbilliform eruption is seen in Rubella, measles
Hives and wheels caused by Cold, hepatitis C, serum sickness
Pruritis is NOT seen in Pemphigus
A young boy with rashes on web spaces and penis Lichen nitidus
Lichen sclerosis Atrophy of epidermis with dermal fibrosis
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DERMATOLOGY
Calcifying epithelioma Dermatofibroma

Firm red to brown nodule that shows dimpling of overlying Dermatofibroma
skin with lateral compression
Recurrent oral ulcers with pain and erythematous halo Aphthous ulcer
around them
Cayenne pepper strippling due to hemosiderin is found Plasma cell balanitis of zoon
in
Keratoderma seen in Pityriasis rubra pilaris, Reiter syndrome
Veldt sore is common in Deserts
Change seen in Poikiloderma Atrophy, Telangiectasia, Pigmentary changes
MC site of felon Thumb
Boil can NOT occur at Palm
Diascopy Skin blanch with pressure or not
Diascopy is useful in Lupus vulgaris, cutaneous vasculitis,
nevus anemicus
Treatment of erythematous skin rash with multiple pus Corticosteroids
lakes in a pregnant woman
Itchy exudative lesions on face, palms and soles, siblings Systemic ampicillin
also have similar complaints. treatment of choice in
such patient
Drug of choice of Chronic folliculitis Cloxacillin
NOT a keratolytic agent Zinc oxide
PUVA therapy is indicated in Psoriasis, Vitiligo, Atopic dermatitis
Dermabrasion is contraindicated on Eyelids, Pyoderma skin infection, Skin with severe
radiation dermatitis, Basal cell carcinoma
Crystal used in microdermal abrasion Aluminium oxide
Commonly used depilating agent Thioglycolate
ACNE
Iodine toxicity causes Acne like eruption

Causes of acneiform eruption Cryptococcus, acne rosacea, Behcet’s
disease
NOT a cause of acneiform eruption Sarcoidosis
NOT a causative factor for acne Only food
Not involved in etiopathogenesis of acne Colonization of staphylococcus aureus
Acne Vulgaris is due to Obstruction of Pilosebaceous gland
Comedones are characteristic of Acne vulgaris
19 years female, multiple papulopustular erythematous Acne vulgaris
lesion on face and neck
Acne acuminata is found in Tuberculosis
Steroid acne Absence of comedones, occasional pruritis,
absence of nodulocystic lesion
Middle aged male with recurrent abscess Acne inversa
and discharging sinus and fibrosis over
axilla
Drug used for Acne Retinoids
Oral retinoids used in treatment of Acne vulgaris
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DERMATOLOGY
Treatment of acne 13 cis retinol, minocycline, erythromycin

Treatment of choice in acne Topical Isotreitoin and Doxycycline
Recalcitrant pustular acne treated by Retinoid
Acne with Inflammatory Lesions Oral Doxycycline
Treatment of inflammatory acne Minocycline
Treatment of comedonal acne Retinoids
Drug of choice for 24 year old unmarried woman having Isotretinoin
multiple nodular cystic, pustular comedonic lesions on
face, upper back and shoulder for 2 years
Treatment of nodulocytic acne Isotretinoin
Treatment of choice in Nodulocystic acne Retinoic acid
MC complication of synthetic retinoid Dry mouth and skin rash
Isotretinoin Can cause rosacea, can cause permanent
skin thinning, should not be used with
tetracycline
Drug of choice in a teenager girl with moderate acne Cyproterone acetate
also complaining irregular menses
NOT a treatment of acne vulgaris Androgen
NOT an useful form of Vitamin A Retinoic acid
DISEASES OF SWEAT GLAND
Key role in sweating Hypothalamic preoptic nucleus

Acetylcholine acts as a postganglionic Sweat glands
sympathicomimetic of
Sweat gland of palm can be differentiated from others Secretion stimulated by emotional stimuli
by
Apocrine gland Modified sweat gland, present in groin and axilla,
infection is known as hidradenitis suppurativa
Hidrandenitis suppurativa is infection of Apocrine glands
Hidradenitis suppurative commonly Axilla
affects
Hidradenitis suppurativa NOT found in Scalp
Miliaria is a disease of Eccrine gland
Crystalline miliaria is due to obstruction of Sweat glands
Miliaria crystalline affects Stratum corneum
Bromhidrosis produced by intake of Onion, garlic, asafoetida
Fox fordycee spot Common in adult woman, common in axilla and areola
Apocrine miliaria Fox fordycee disease
DISEASES OF HAIR
Hair bulb is situated in Upper part of subcutaneous fat

Commonly noticed feature in preterm infants Lanugo hair
Lanugo Hair appears at 4 months
Factor promoting hair growth in female Testosterone
Hair Growth in girls is NOT Estrogen dependent
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DERMATOLOGY
After death, hair become loose by 72 hours

Hair Cycle 30 days
Anagen phase of hair Phase of activity and growth
Time period between physical emotional stress and hair 3 months
loss
22 year woman, diffuse hair loss one month, past Telogen effluvium
history of enteric fever, before 4 months
Scarring alopecia/Cicatrical alopecia Lichen planus, DLE, SLE
Pseudopelade is a synonym for Cicatrical alopecia
Cicatrical alopecia with blue grey patches Whitish lesion in buccal mucosa
hyperpigmentation is commonly associated with
NON cicatrical alopecia Psoriasis. alopecia areata, androgenic alopecia, SLE
MC type of non scarring alopecia Androgenic alopecia
NON scaring alopecia Alopecia areata
Alopecia neoplastica Metastatic tumor hair loss
Alopecia areata presumed to be Autoimmune etiology
Patchy loss of hair on scalp, eyebrows, beard, history of Alopecia areata
rapid graying of hair in a few areas
Exclamation hair mark, Going grey overnight Alopecia areata
Sand paper appearance of nail Alopecia areata
Not associated with alopecia areata Geographic tongue
Treatment of Alopecia areata Whitfield ointment
Alopecia areata treated by Minoxidil
Greying of hair in a village is mainly due to Nutritional cause
7 year old boggy swelling of scalp with multiple KOH mount
discharging sinus with cervical lymphadenopathy with
easily pluckable hair
KOH mount 2 drops of 10 – 20 % KOH
Drug useful in treating hair loss Minoxidil
Excessive hair growth is NOT associated with Reserpine
Man with diffuse hair loss involving crown and frontal Female pattern baldness
scalp with maintenance of frontal hair line
Drug of choice in androgenic alopecia Finasteride
Contraindicated in androgenic alopecia Testosterone
Feature of hypertrichosis that differentiates it from Hypertrichosis occurs in forehead and temporal region of
hirsutism face
Hypertrichosis is informally called as Warewolf syndrome
White piedra is caused by Trichosporum beigelli
Black piedra is caused by Piedra hortae
DISORDERS OF NAIL
Maturity of fetus is most reliably decided by Nail growth

Nail involvement in Psoriasis, lichen planus, fungal infection, alopecia, viral
infection
Muehrcke lines are seen in Hypoalbuminemia
Terry nails are seen in Cirrhosis
Tinea unguim affects Nail plate
Oncholysis associated with Allergic dermatitis, Psoriasis, Antineoplastic therapy
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ALLERGIC DISORDERS 11
DERMATOLOGY
MC Site of Onychomycosis Toe Nails

Proximal subungual onychomycosis is a marker for HIV/Immunocompromised
Drug effective as pulse therapy in Itraconazole
onychomycosis
Relative contraindications for the use of Hepatitis
oral agents for treatment of
onychomycosis of toenails
Duration of terbinafine therapy Finger nail for 6 weeks, toe nail for 12 weeks
Periungual telangiectasia Lupus erythematosus, scleroderma,
diabetes mellitus
Thimble pitting nail Psoriasis
Pterygium & Thinning of Nails Lichen planus
Blue black pigmentation of nail Minocycline
Koilonychia Iron deficiency anemia
Oil drop nail is seen in Psoriasis of nail
Yellow nail syndrome Bronchiectasis, pleural effusion,
lymphedema, discolored nails
Griseofulvin for nail dermatophytosis for 3 months
Treatment of Paronychia Partial nail removal, incision and drainage
Best treatment for Paronychia Nail fold removal
Zadik procedure Resection of part of nail with nail bed
PHOTOTOXICITY
Skin type and sunburn sensitivity classification by Type I – always burn, never tan. Type VI – never burn, always
Fitzpatrick tan
Phototoxicity is associated with Tetracycline, Griseofulvin, Amiodarone
Photosensitivity is seen in Amiodarone, Ciprofloxacin
Maximum photosensitivity Pefloxacin
High degree of photosensitivity Doxycycline > minocycline
Drug with higher incidence of Photosensitivity Doxycycline
Least associated with photosensitivity Acute intermittent porphyria
Recently approved sunscreen ingredient Ecamsule
ALLERGIC DISORDERS
GENERAL FEATURES OF ALLERGIC DISORDERS OF SKIN
Principal cause of Hay fever Pollen

Coin shaped eczema Nummular eczema
Features of nummular eczema Exacerbations are associated with dry
skin, exacerbated by emotional factors,
occurs in all age group, pruritic
Eczema herpeticum is seen with HSV
After hepatitis B vaccination, allergic family history and Eczema herpeticum
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DERMATOLOGY
pruritis involving face and convexities, numerous

umbilicated vesicles, fever and lymphadenopathy after
2 days
Kaposi’s varicelliform eruption is seen in Atopic dermatitis> Darrier’s disease
Contact dermatitis is a type of Spongiotic dermatitis
MC cause of Allergic Contact Dermatitis in Forehead of Para tetra butyl phenol formaldehyde glue
Indian Females
MC cause of Air Borne Contact Dermatitis in India Parthenium Hysterophorus
Features of air borne contact dermatitis Involves depth of creases, lid and
retroauricular areas, patch test is positive,
photosensitivity is absent
MC drug causing Allergic Contact Dermatitis Neomycin
MC Problem associated with use of Condoms Contact Dermatitis
Berloque dermatitis is associated with contact of Cosmetics
MC metal causing Allergic Contact Dermatitis Nickel
MC site of irritant contact dermatitis Hand
Investigation Of Choice For Contact Dermatitis Patch test
Patch test is read after 2 days
Patch test reading is delayed in Neomycin
Most effective treatment for contact dermatitis Moist compression
55 year male, uncontrolled diabetes mellitus, Azathioprine
hypertension, severe air borne contact dermatitis
ATOPIC DERMATITIS
MC site of atopic dermatitis Antecubital fossa

MC site of atopic dermatitis Elbow
Itch is disease Atopic dermatitis
Characteristic of atopic dermatitis Pruritis
Minor clinical feature of atopic dermatitis Dry skin, morgagnian fold, pityriasis alba,
dermographism
Dennie morgan fold Atopic dermatitis
Perioral pallor and dennie’s line Atopic dermatitis
Infant presented with erythematous lesion on cheek, Atopic dermatitis
extensor aspect of limbs, mother has history of
bronchial asthma
Recurrent episodes of flexural eczema, contact Atopic dermatitis
utricaria, recurrent skin infections, severe abdominal
cramps, diarrhea upon taking sea foods
3 year old child, eczematous dermatitis on extensor Atopic dermatitis
surfaces. mother had history of bronchial asthma
Severe in rainy season, improved completely in winter Atopic dermatitis
(sundry)
Lesions of atopic dermatitis may be infected by Staphylococcus aureus
Patch test Atopic dermatitis
45 year old farmer has itchy erythematous popular Patch test
lesion on face, neck, V area of chest, dorsum of hands
and forearm for 3 years, lesions are severe in summer
and improve by 75% in winter. Most appropriate test to
diagnose
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DERMATOLOGY
Investigation of choice for Atopic Dermatitis Clinical Examination

Topical drug of choice for atopic Tacrolimus
dermatitis
UTRICARIA
Utricarial lesions Utricaria pigmentosa (mastocytosis),

Hypo/Hyperthyroidism, Systemic onset juvenile rheumatoid
arthritis (Still’s disease)
Utricaria vasculitis Immune complex disease
Utricaria pigmentosa is related to Mast cells
Darrier sign Utricaria pigmentosa
Pseudodarrier sign Congenital smooth muscle hamartoma
Rubbing the lesion, utricarial wheal confined to border Utricaria pigmentosa
of the lesion
NOT associated with Peripheral neuropathy Utricaria pigmentosa
Stain for Mastocytosis Toluidine blue
Treatment of erythematous wheal all over the body, no Antihistaminic
respiratory difficulty
22 year woman, small itchy wheal after physical Cholinergic utricaria
exertion, walking in sun, eating hot and spicy food
Scratching of skin is associated with Dermatographic urticaria
HEREDITARY ANGIOEDEMA
Quincke’s disease is popularly known as Angioneurotic edema

C1 Inhibitor deficiency causes Hereditary Angioneurotic Edema
Hereditary angioneurotic edema is due to deficiency of C1 esterase Inhibitor
Recurrent laryngeal edema in patient, low serum C4, C1 esterase inhibitor deficiency
normal C3, normal factor B.
Episodic painful edema on face and larynx, deficiency of C1 esterase inhibitor
Hereditary angioedema Enzyme involved is C1 INH,C1 inhibitor targets Hageman
factor, complement C4,C2 decrease,
Peanut, neck swelling, tongue swelling, hoarseness of Angioneurotic edema
voice
Patient taking peanuts develops swelling in neck, Angioneurotic edema
hoarseness of voice and stridor, edema of base of
tongue
NOT true about angioneurotic edema Pitting edema on lips and mucous membrane
Treatment of angioedema Antihistaminics, cyproheptadine, doxepin
ANAPHYLAXIS
Pruritic erythema on eating sea food Localized anaphylaxis

After contrast media injection in radiology department, Adrenaline
severe hypotension, bronchospasm, cyanosis
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DISORDERS OF SKIN PIGMENTATION 14
DERMATOLOGY
DISORDERS OF SKIN PIGMENTATION
GENERAL FEATURES OF PIGMENT RELATED SKIN DISORDERS
Hyperpigmented lesions Melanoma, dyskeratosis congenital, lentigenes lichen

planus
A 5 year girl has scattered 1 – 3 mm light Freckle
brown macules on her face, trunk and
extremities. These macules become more
numerous in summer months but fade
over winter.
Lentigene is associated with LAMB, LEOPARD, Peutz Jegher syndrome
LAMB (Carney complex – Autosomal dominant) Lentigene, Atrial myxoma, Mucocutaneous myxoma, blue
nevi
LEOPARD Lentigene, ECG abnormality, Primarily conductive
defect,Ocular hypertelorism, Pulmonary stenosis, Subaortic
valvular stenosis, Abnormal genitals, Retardation of Growth,
Deafness (SNHL)
Ephelis is also called as Freckle
Pigmentation in freckle is due to Large melanosome
Melanotic hyperpigmentation (normal Freckle, photosensitive dermatitis
number of melanocytes)
Idiopathic guttate hypomelanosis Anterior aspects of leg and forearm
commonly occurs over
Hyperpigmentation seen in Melasma, nevus anaemicus, nevus depigmentosa
Hyperpigmentation is NOT seen in Hypothyroidism
Child, solitary white well defined hypopigmented lesion Nevus achromicus
in his right thigh
Nevus predisposing to malignancy Junctional nevus
Maximum malignant potential Junctional nevus
Malignant change in benign nevus takes place in Superficial spreading nevus
Best treatment of capillary nevus Argon laser treatment
Riehl’s melanosis mainly involves Face and neck
Fine reticular pigmentation with palmar pits Dowling Dego’s disease
Skin pigmentation Clofazimine, Minocycline, Gold
Skin pigmentation caused by Busulfan
Rain drop pigmentation Arsenic
Slate like discoloration of skin Chlorpromazine, minocycline, amiodarone
Slate like pigmentation Hemochromatosis
Photosensitive lichenoid like eruptions Gold therapy
Manifestations of Albinism Nystagmus, Photophobia, Refractory error
Defect in tyrosinase gene causes Lack of pigmentation
Oculocutaneous albinism Type I is associated with tyrosinase gene, type II is
associated with P gene
Feature of ocular albinism Color vision is normal
Albinism what to do next Ophthalmological consultation
Piebaldism is associated with Shah Waardenberg syndrome, Waardenberg syndrome
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DERMATOLOGY
Wood’s lamp is used for diagnosis of Versicolor, vitiligo, porphyria

Wood’s lamp is used in diagnosis of Ethylene glycol
Screening evaluation of vitiligo involves CBC, differential count, blood and urine
sugar examination, TSH
NOT a screening evaluation of vitiligo Antinuclear antibodies
Demelanising agent Monobenzene
VITILIGO
Increased incidence of vitiligo in Diabetes mellitus

MC endocrine disturbance among vitiligo Diabetes
Vitiligo is associated with Alopecia areata, Grave’s disease,
Addison’s disease
NOT associated with vitiligo Nelson disease
In a patch of vitiligo Melanocytes are absent
Vitiligo Associated with absence of melanocytes, albinism is
associated with normal number of melanocytes
Vitiligo is seen with Vogt Koyanaga Harada syndrome, Scleroderma,
Onchocerciasis, Melanoma associated leukoderma
NOT true about vitiligo Leukotrichia has good prognosis
Psolaren A used for treatment of Vitiligo
Best treatment for Vitiligo vulgaris PUVA
Treatment of vitiligo vulgaris PUVA, steroids, coal tar
PITYRIASIS ROSACEA
Drug induced pityriasis rosacea like Arsenic, bismuth, metronidazole

eruption
Acne Rosacea differentiated from Acne Vulgaris by Lack of Comedones
Main pathogenesis in acne rosacea Unknown
Viral association with Pityriasis rosacea HHV 7
ACE inhibitors induced rosacea like skin eruption Drug may be the cause and discontinuation may
improve the skin condition
Pityriasis rosacea is Self limiting
Collarette of scales Pityriasis rosacea
Herald Patch Pityriasis rosacea
Fir tree appearance Pityriasis rosacea
16 year old boy presented with asymptomatic multiple Pityriasis rosacea
erythematous, annular lesion with a collarette of scales
at the periphery of the lesions present on trunk
Multiple round to oval erythematous Pityriasis rosacea
patches with fine central scale distributed
along the skin tension lines on the trunk is
highly suggestive of
Persistent Erythema & telangiectasia punctuated by Rosacea
acute episodes of swelling, papules & pustules, Facial
Convexities
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DERMATOLOGY
Lesions of pityriasis rosacea mainly on Trunk

Rosaceae is associated with Ocular involvement
Features of rosacea Rhinophyma, flushing, stye, chalazia
NOT a feature of rosacea Genital ulceration
NOT used as a topical treatment of Steroids
rosacea
PITYRIASIS RUBRA PILARIS
Pityriasis Rubra Pilaris Elderly, 40-60, Erythematous Scaly Macules &

Perifollicular Hyperkeratotic Papules in Cephalocaudal
Direction, Orange Hue, Islands of Normal Skin (Nappes
Claires), Waxy Yellow Palms & Soles (PRP sandal)
Pityriasis rubra pilaris Palmar thickening, island of white spared skin, follicular
eruption
Pityriasis rubra pilaris Isolated patch of normal skin, cephalocaudal
distribution, methotrexate is effective
TINEA VERSICOLOR
Tinea versicolor is caused by Malassezia furfur

Adult, oval hypopigmented macules over chest and Tinea versicolor
back
Feature of pityriasis versicolor Pale or brown pink scaly macule, macule start around
the hair follicle
Coup angle sign Tinea versicolor
Hypopigmented lesions on trunk and back, coalesce fine KOH examination of scales
scaling
Golden Yellow/Apple Green on Wood’s lamp Tinea versicolor
Sphagetti meat ball appearance Tinea versicolor
Banana grape appearance in KOH Tinea versicolor
Hypopigmentation in Tinea versicolor is Azelaic acid
due to
Treatment of tinea versicolor Cotrimoxazole, sodium thiosulphate, selenium sulphide,
micanazole
Treatment of Tinea versicolor Ketoconazole
Most serious adverse effect of ketoconazole Liver injury
NOT a treatment for Tinea versicolor Griseofulvin
PITYRIASIS ALBA
Young Children, Cheek & Face, Scaly Hypopigmented Pityriasis Alba

Macules
5 year boy, asymptomatic oval hypopigmented macules Pityriasis alba
with fine scaling on his face
Pityriasis alba No active treatment required, common over face,
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FUNGAL INFECTIONS OF SKIN 17
DERMATOLOGY
presents as scaly white macules
FUNGAL INFECTIONS OF SKIN
GENERAL FEATURES OF FUNGAL SKIN INFECTIONS
Dermatophytes live in Stratum Corneum

Fungal infection of skin Tinea, madura foot, sporotrichosis
Dermatophytes cause Superficial infection
NOT true about dermatophytes Candida usually cause systemic infection
Black dot ring worm caused by Trichophyton
Ringworm infection in scalp Trichophyton
Annular ring lesion is caused by Trichophyton rubrum
30 year female with itching under right breast. annular Trichophyton rubrum
ring lesion
Severe itching and white scaly lesions in the groin for Trichophyton rubrum
one month
Tinea incognito is due to inappropriate use of Steroids
Study fungal morphology in tissue section PAS
Wood’s lamp is used for Microsporum auduini
Test likely to help in diagnosis of a patient who presents Potassium hydroxide mount
with an itchy annular plaque in face
Investigation for Dermatophytosis(Tinea) KOH Smear
Drug used to treat both dermatophysis and candidial Ketoconazole
infection
Ciclopirox oleamine used in Dermatophytosis
Econazole is used in treatment of Tinea pedis, tinea corporis, Cutaneous candidiasis
Treatment of Dermatophytosis EXCEPT Tinea Versicolor Griseofulvin
Griseofulvin for nail dermatophytosis for 3 months
NOT used topically Griseofulvin
TINEA CAPITIS
MC cause of Tinea capitis Microsporum canis, 2nd Trichophyton tonsurans

Agent for tinea capitis T.violaceum
Epidemic tinea capitis is caused by Trichophyton tonsurans
Tinea capitis in children in caused by Microsporum audouni
Tinea Capitis Localised non cicatrical alopecia itch scaly with/without
boggy swelling of scalp & easily pluckable hair
Boggy swelling, easily pluckable hair, non cicatrical Tinea capitis
alopecia
NOT associated with Tinea capitis Epidermophyton
Wood’s lamp light is used in diagnosis of Tinea capitis
Tinea capitis due to Microsporum under Wood’s Lamp Yellow fluorescence
Most appropriate line of treatment of tinea capitis in 11 Oral griseofulvin therapy
year old boy
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FUNGAL INFECTIONS OF SKIN 18
DERMATOLOGY
TINEA CORPORIS
Features of Tinea corporis Asymmetrical, Circinate, Good response to Tolnaftate

Central clearing is associated with Tinea corporis
TINEA CRURIS
Features of Tinea cruris Well defined annular itchy red scaling patch on medial
surface of both groin, Central Clearing
Itchy annular scaly plaques in both groins, Tinea cruris
corticosteroid application led to temporary relief but
the plaques continued to extend at the periphery
Dhobi’s itch Tinea cruris
MC age group to suffer in T.cruris Adult male
TINEA BARBAE
Tinea barbae is caused by T.mentagrophytes
TINEA PEDIS
MC cause of Athlete’s foot Trichophyton

th
Tinea pedis is commonly is seen in 4 toe web
Tinea pedis is commonly seen in Shoes and socks wearers
TINEA UNGUIM
Tinea unguim affects Nail palate

Treatment of tinea ungum Itraconazole, terbinafine
Drug of choice for tinea unguim Griseofulvin
CANDIDIASIS
Creamy curd like white patch on tongue in healthy male Candidiasis

Candidiasis is associated with Satellite pustule
Drug of choice in systemic candidiasis Amphotericin
SPOROTRICHOSIS
Linear lesion Sporotrichosis
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PAPULOSQUAMOUS DISORDERS 19
DERMATOLOGY
WOOD’S LAMP AND UV LIGHT
Wavelength of light produced by wood’s lamp 360 nm

Wood’s lamp filter is made of Nickel oxide and silica
Wood’s lamp Black light
Coral red fluorescence on wood’s lamp Erythrasma
Pinkish red fluorescence of urine with wood’s lamp Porphyria
Wood’s lamp is not useful in diagnostic of Wart
Visible range in electromagnetic spectrum 370 – 740 nm
Range of light causing maximum skin damage 290-360 nm
UV B 280 – 320 nm
Wavelength of solar radiation responsible 290 – 400 nm
for photoaging
Soret Band in Porphyria 400 nm
Medically most important UV light UV B
Sunlight spectrum responsible for Skin carcinogenesis UV B
Circulating lymphocytes are most sensitive to UV C
PAPULOSQUAMOUS DISORDERS
GENERAL FEATURES OF PAPULOSQUAMOUS DISORDERS
Autoimmune diseases Psoriasis, lichen planus, acne vulgaris

Papulosquamous lesion Psoriasis, Parapsoriasis, Squamous cell carcinoma,
Mycosis fungoides
Plaque formation is seen in Psoriasis, Lichen planus, Pityriasis rosacea
Exfoliative dermatitis can be due to Drug hypersensitivity, Pityriasis rubra pilaris, Psoriasis
Exfoliative dermatitis is not associated with Pityriasis rosacea
Gold poisoning leading to exfoliative dermatitis treated Steroid
by
Erythroderma is seen in Psoriasis, Lichen planus, Eczema
Violaceous papules Lupus pernio, Cutaneous lupus
Pigmented pretibial papules is associated with Diabetes mellitus
Koebner Phenomenon-Isomorphic phenomenon Vitiligo, Psoriasis, Lichen Planus, warts
Pseudokoebner phenomenon Plane warts, molluscum contagiosum
PSORIASIS
Psoriasis is exacerbated by Antimalarials, lithium, beta blockers

Psoriasis affects Extensors
Turn over time in Psoriasis 4 days
Interleukin dominant in psoriasis IL 2
Important feature of psoriasis Scaling
Psoriasis clinically manifests as Scaly Plaques
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DERMATOLOGY
Psoriasis is characterized by Auspitz sign

Bleeding spots seen on removal of scale in psoriasis Auspitz sign
Auspitz sign Plaque psoriasis
Bulkley membrane Psoriasis
Thimble pitting of nails Psoriasis
Kogoj pustule Psoriasis of nail
Woronoff ring sign Psoriasis
Ballooning, Munro’s microabscess Psoriasis
Munro microabscess is seen in Psoriasis, in stratum corneum, contains neutrophils only
MC type of psoriasis Plaque
Patient with psoriasis was started on systemic steroids, Pustular psoriasis
after stopping the treatment, patient develops
generalized pustules all over the body
Psoriasis is associated with Polyarthritis
Features of psoriasis Oligoarticular pathology with nail
involvement in 50% of cases, red non scaly
lesions are seen in natal cleft and
submammary area, onycholysis and
pitting nail are seen
Guttate psoriasis Children and young adult, caused by beta hemolytic
streptococci
Guttate psoriasis Eruptive psoriasis
Antibiotic is used in treatment of Guttate Psoriasis
Inverse psoriasis Occurs in intertriginous region including axilla, groin and
submammary region
Rupoid psoriasis Scalp
Least common involvement is Psoriasis CNS
HPE finding in Psoriasis Micromunro abscess, suprapapillary thinning,
hyperkeratosis
Histology of psoriasis Acanthosis, vascular proliferation
Clinical index used in Psoriasis PASI
HLA CW 6 is associated with Psoriasis
NOT true about psoriasis Premalignant, very pruritic
NOT true about Psoriasis Head, neck and face NOT involved
Immunomodulator for Psoriasis Alefacept
Most effective treatment of psoriasis in uremia Ultraviolet rays
Photochemotherapy is useful in treatment of Psoriasis
FDA approved systemic therapy for Psoriasis Methotrexate, Acitretin, Cyclosporine
Treatment of psoriasis PUVA, methotrexate
Calcitriol is used in treatment of Psoriasis
Treatment of choice for plaque psoriasis PUVA
Treatment of choice for erythrodermic psoriasis Methotrexate
Drugs used for treatment of Methotrexate, PUVA, etretinate
erythrodermic psoriasis
NOT used for treatment of erythrodermic Chloroquine
psoriasis
Treatment of pustular psoriasis Retinoids
Drug of choice for pustular psoriasis Methotrexate
Only definitive indication for giving systemic steroids in Extensive lesions
pustular psoriasis
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DERMATOLOGY
Drug of choice for a pregnant woman in 2nd trimester Prednisolone

with pustular psoriasis -Impetigo herpetiformis
Tacrolimus ointment is most effective in Facial and intertriginous psoriasis
Efalizumab acts by disrupting interaction LFA 1 and ICAM 1
between
PSORIATIC ARTHRITIS
Joint Characteristically involved in Psoriatic arthritis DIP

Psoriatic arthritis Arthritis mutilans, Ankylosis of small joints, Sacroilitis
Terminal interphalangeal joints characteristically Psoriatic arthropathy
involved in
Involvement of DIP,PIP and metacarpophalyngeal joint Psoriatic arthropathy
with sparing of wrist and carpometacarpal joints
Pencil in cup deformity Psoriatic arthropathy
Sausage shaped digits Psoriatic arthropathy
Tufting of distal phalanx Psoriatic arthritis
Psoriatic arthritis Asymmetric
Psoriatic arthritis is associated with Whiskering
Resorption of terminal phalanx Reiter syndrome, Scleroderma, Psoriasis
Erosion of ungula tufts in terminal phalanges of hand Psoriasis
may be due to
Severe form of psoriatic arthritis Arthritis mutilans
CASPAR criteria for Psoriatic arthritis
HLA associated with Psoriatic Arthritis HLA B27
NOT true about Psoriatic arthritis Lengthening of digit known as telescoping
Treatment of Psoriatic Arthritis Methotrexate
Approved for psoriatic arthritis Alefacept (Anti CD2 i.m), Anti TNF alpha – Etenercept (sc),
Infliximab (iv), Adalimumab (sc)
PUVA THERAPY
PUVA therapy is useful in Vitiligo, Psoriasis, Cutaneous T Lymphoma, pigmented

purpuric lesion, lichenoid dermatitis of Gougerot and
Blum
Psorlaen A is used in treatment of Vitiligo
Mechanism of action of Psoralen Binding to DNA
NOT a complication of PUVA Exfoliation
LICHEN PLANUS
Not photosensitive Lichen planus

Lichen planus is associated with HCV
Pruritic lesion Lichen planus, sunburn, pemphigoid, psoriasis
Civatte Bodies Lichen Planus
Wickham’s striae appearance is seen in Lichen planus
Violaceous itchy Polygonal Plaques Lichen planus
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BULLOUS DISORDERS 22
DERMATOLOGY
Scarring alopecia Lichen planus

Pterygium of nail Lichen planus
Max Joseph’s space Lichen planus
Alopecia, thinning of nails, hypopigmented macular Lichen planus
lesion over trunk and oral mucosa
Single warty lesion in a farmer on leg Lichen planus hypertrophicus
Spontaneously disappearing Lesion Lichen Planus
Mouth lesion Lichen planus
Percentage of oral lesion in Lichen planus 30 – 70%
Mucosa involved in Lichen planus
Lichen Planus Skin, Oral and genital mucosa
Lichen planus Central scarring
Lichen planus Pruritis, purple, papule
Lichen planus Autoimmune disease, colloid bodies seen, Basal cell
degeneration, epidermal hyperplasia in chronic cases
Lacy white lesion in mouth with pterygium of nail Lichen planus
Most characteristic feature of lichen planus Basal cell degeneration
Lichen planus Resolve over time
NOT true about lichen planus Hypopigmentation in residual disease
Histology of lichen planus Interface dermatitis
Treatment of Lichen planus Topical Steroids followed by Systemic Steroids
Drug of choice in generalized Lichen Planus Systemic steroids
BULLOUS DISORDERS
GENERAL FEATURES OF BULLOUS DISORDERS
Drug induced bullous eruption Lithium

Separation of epidermal cells with loss of Acantholysis
desmosomes
Acantholysis is seen in Pemphigus vulgaris, Darrier’s disease, Hailey Hailey
disease, Steven Johnson syndrome, Toxic
epidermonecrolysis
Acantholysis is seen in Epidermis
Acantholysis is due to destruction of Intercellular substance
Acantholytic cells are Keratinocytes
Tzanck cell is a Keratinocyte
Patient on bullous lesion on Tzanck smear Acantholysis
Bullous lesion on Tzanck smear Acantholysis
Bedside Diagnostic Test For Bullae Showing acantholysis Tzank test
Showing Numerous acantholytic keratinocyte Cell
Tzank test for Pemphigus
Tzanck smear helps in diagnosis of Herpes viral infection
Diagnostic method useful for herpes infection DNA analysis
Multinucleated cells in Tzanck smear Chickenpox
Intraepidermal blister Pemphigus vulgaris, pemphigus foleaceus, bullous
impetigo, carcinomatous pemphigus
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DERMATOLOGY
Sub epidermal lesion Bullous pemphigoid, dermatitis herpetiformis

Darrier’s disease is also known as Keratosis follicularis
Drug induced pemphigus Penicillin, Phenophthalein, Iodine
Blister formation in burns Subepidermal
Dyskeratosis means Premature keratinisation
Dyskeratosis is a characteristic feature of Darrier’s disease, Bowen’s disease, Hailey hailey disease
Nicholsky sign is positive in Staphylococcal scalded skin syndrome, Toxic
epidermonecrolysis, Pemphigus,herpes zoster, herpes
simplex, leukemia, Epidermolysis bullosa
Pseudonicholsky sign Lyelle’s disease
Hailey Hailey disease Benign familial chronic pemphigus
Hailey Hailey disease is inherited as Autosomal dominant
Skin disease NOT showing direct immunofluorescence Darrier’s disease, Hailey hailey disease
NOT a bullous lesion Scabies
PEMPHIGUS
Drug induced pemphigus is associated with Penicillamine, Captopril, Enalapril

NOT associated with drug induced Frusemide
pemphigus
25 year old female, palatal ulcer, skin blister Pemphigus vulgaris
24 year female, flaccid bullae in skin and oral erosion. Pemphigus vulgaris
HPE intradermal acantholytic blister
Persistent painful oral lesions Pemphigus vulgaris
Young boy with multiple flaccid bullae and oral mucosal IgG in epidermis
lesion, most likely finding
Autoimmune disease Pemphigus vulgaris
Commonest variety of pemphigus Pemphigus vulgaris
Pemphigus vulgaris Blister on skin and mucosa, intracellular IgG deposits in
epidermis,
Antibodies in pemphigus vulgaris are present against Intercellular substance
Autoantibodies against desmoglein 1 Pemphigus foleaceus
Fogo selvagem Endemic form of pemphigus folaceous
Paraneoplastic pemphigus Antibodies against plakins
Paraneoplastic pemphigus is associated with NHL, CLL, thymoma, Spindle cell tumor, Waldenstorm
macroglobulinemia, Castleman disease
Blistering disease associated with Paraneoplastic pemphigus
castlemann disease
Row of tombstones appearance Pemphigus
Bulla spread sign Pemphigus vulgaris
Mucous lesions are seen in Pemphigus
Acantholysis PRESENT in Pemphigus Only
Acantholysis is characteristic of Pemphigus vulgaris
Acantholytic cell in pemphigus Cell with hyperchromatic nucleus and perinuclear halo
Acantholytic cell in pemphigus derived from Stratum spinosum
Associated with pemphigus Thymoma, CLL, Myasthenia gravis, Non hodgkin’s
lymphoma
Rarest variety of pemphigus Pemphigus vegetans
NOT a variant of pemphigus Pemphigus neonatorum
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DERMATOLOGY
IgG deposits on Keratinocyte surface Fishnet Pattern Pemphigus Vulgaris

Flaccy bullae lesions with oral mucosal lesion. finding in Fishnet IgG in epidermis
immunofluorescence
Intercellular IgG deposition in epidermis Pemphigus
Direct immunofluorescence is positive in Pemphigus
Intracellular IgG deposits in the epidermis and Pemphigus vulgaris
suprabasal split with acantholytic cells
Intraepidermal IgG deposition Pemphigus
NOT true about Pemphigus Subepidermal
Rituximab is used in treatment of Pemphigus
EPIDERMOLYSIS BULLOSA
Epidermolysis bullosa is a Immunomediated bullous disorder

Genetic predisposition is seen in Epidermolysis bullosa
Non Herlitz Junctional Epidermolysis Bullosa-gene LAMB3
In congenital dystrophic variety of epidermolysis bullosa Collagen type 7
mutation in gene coding for
Epidermolysis Bullosa Congenita Sacrum, Elbow Knee. Linear homogenous Fluorescent
band of IgG & C3 on Dermoepidermal Junction
8 year old, child, no consanguinity in parents, mother Congenital epidermolysis bullosa
reports blisters and bleeding off the skin at the site of
handling and pressure. similar history in previous child
proved to be fatal
Bullae without erythema on elbows, knee, sacrum EB acquisita
followed by crust formation, scarring and milia. He had
no photosensitivity and negative family history for
bullous disease, IgG deposition at dermoepidermal
junction with no blood vessel involvement
Epidermolysis bullosa acquisita Associated with inflammatory bowel disease, antibodies
against type 7 collagen, HLA DR2
NOT diagnosed by amniocentesis Epidermolysis bullosa
PEMPHIGOID
Drug induced bullous pemphigoid is associated with Furosemide

Painful bullae in lower limb in elderly Bullous pemphigoid
Linear IgG deposit along Dermoepidermal Bullous pemphigoid
Junction/EBM, basement membrane
Cluster of jewel appearance Bullous pemphigoid
In Bullous pemphigoid, antibodies against BPAG 1 and BPAG 2
HLA associated with bullous pemphigoid HLADQ B1
In Pemphigoid gestationalis, antibodies against BPAG2
DERMATITIS HERPETIFORMIS
HLA associated with Dermatitis herpetiformis HLA B8
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SCABIES AND PEDICULOSIS 25
DERMATOLOGY
Dermatitis herpetiformis Young adult, intense pruritis, autoantibodies against

epidermal transglutaminase
Granular IgA deposit in Dermal Papilla & EBM Dermatitis Herpetiformis
Lupus band test Granular deposit of IgA or IgM at
dermoepidermal junction
IgA deposition in dermal papilla Dermatitis herpetiformis
Multiple grouped papillovesical lesions over both Dermatitis herpetiformis
elbows, knees, buttocks, upper back a/w severe itching
Picket fence appearance Dermatitis herpetiformis
Treatment of dermatitis herpetiformis Gluten free diet with minerals and vitamins, Dapsone
LINEAR IGA DISEASE
Linear IgA deposits in EBM Linear IgA disease

Linear IgA disease Subepidemal involvement, severe itching
SCABIES AND PEDICULOSIS
SCABIES
Scabies is a Waterwashed disease

Caused by mite Scabies
Scabies is caused by Itch mite
Site of predeliction of scabies Circle of hebra
MC Site of Scabies Interdigital Space, Anterior Wrist
Incubation period of scabies 4 weeks
Characteristic feature of Scabies Burrow
Burrow in scabies in Stratum corneum
Nodular scabies found in Scrotum
Most Severe form of Scabies Norwegian Scabies (Hyperkeratotic)
Norwegian scabies/Crusted scabies Hyperinfestation with thousands of mite. No burrows and No
itch. But contagious
Scabies in children differs from adults by Involvement of face
Scabies in Children Scalp, Face, Palms, Soles affected
Burrow, Follicular papules
Pustules, Eczemated exudate
Scabies in Adults Scalp, Face, Palms, Soles SPARED
Webs of fingers, Anterior axillary fold, Umbilicus,
Periumbilical fold, Genitals
6 month old infant ,itchy erythematous papules and Scabies
exudative lesions on scalp, face, groin, axillae for one
month, vesicular lesions on palm
Child, multiple itchy popular lesions on genitalia and Scabies
finger. Similar lesion also in younger brother
Silvery papules on penis wrist and forearm in children Scabies
Drugs used for scabies Sulphur ointment, benzyl benzoate, gamma benzene
hexachloride, crotamiton
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SYSTEMIC AND PHOTOSENESITIVE DISORDERS 26
DERMATOLOGY
Treatment of Scabies (Children < 2 years & Pregnancy) Precipitated Sulphur

Treatment of Scabies 5% Permethrin, 2nd – 1% GBHC
GBHC is used in treatment of Scabies
Permethrin is used in treatment of Scabies
Permethrin Less toxic than lindane
Ivermectin is indicated in treatment of Scabies
NOT used in scabies Ciclopirox oleamine
Mass chemoprophylaxis NOT for Scabies
NOT a treatment of scabies IV antibiotics
PEDICULOSIS
Pediculosis palpebrum is caused by Body Louse

Body lice lays eggs In the seams of clothing
Macula cerulea is seen in Pediculosis
10 year school girl, recurrent episode of boils on scalp. Pediculosis capitis
boils subside on antibiotic therapy but recur
Vagabond disease is Pediculosis corporis
Treatment of choice for pediculosis corposis Disinfection of all clothing and beddings,3 application of
gamma benzene hexachloride
Head shaving is NOT necessary for treatment in Human pediculosis
SYSTEMIC AND PHOTOSENESITIVE DISORDERS
GENERAL FEATURES OF SYSTEMIC AND PHOTOSENSITIVE DISORDERS
Kikuchi disease is Necrotizing lymphadenitis

Eosinophilic abscess in lymph nodes is characteristically Kimura disease
seen in
Neutrophilic dermatosis Subcorneal pustular dermatosis, sweet syndrome,
pyoderma gangrenosum
Neutrophilic infiltration in dermis Sweet syndrome
Sweet syndrome Neutrophilic and histiocytic infiltration in dermis,
neutrophilia, may be a/w high fever, may be a/w
dermatological malignancy, pseudovesication, tender
erythematous nodule are plaque
NOT a feature of sweet syndrome Lymphadenopathy
Drug of choice for Sweet syndrome Corticosteroids
Neonatal fat necrosis resembles Post steroidal panniculitis
Forms of panniculitis Weber Christian disease, Erythema nodosum, Erythema
induratum
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DERMATOLOGY
DERMATOMYOSITIS
Dermatomyositis is associated with Malignancy

Shawl sign, Helicotrope rash, Gottron’s patch Dermatomyositis
Gottron patch shows Lichenoid reaction
Holter sign Dermatomyositis
Gottron sign Over knuckles of hand
40 year old woman, 8 month history of erythema and Dermatomyositis
swelling of periorbital region and papules and plaques
on dorsolateral aspect of forearm and knuckles
withragged cuticles. no muscle weakness
Feature of Dermatomyositis Proximal muscle wasting
Dermatomyositis is associated with Perifascicular atrophy
NOT a dermatological manifestation of Salmon rash
dermatomyositis
IgG in dermis of skin NOT seen in Dermatomyositis
Polymyositis is associated with Virus, drugs (zidovudine), parasites
Features of Polymyositis Pharyngeal muscle involvement, Proximal muscle
involvement, Pain in limbs, Muscular atrophy
Clinical finding excluding diagnosis of polymyositis Extraocular muscle involvement
Primary idiopathic polymyositis does NOT involve Ocular muscles
NOT a feature of polymyositis Gottron patch
Diagnostic feature in muscle biopsy of polymyositis. CD8/MHC I complex
Antibody strongly associated with polymyositis Anti Histidyl tRNA Synthetase (Anti Jo)
Most diagnostic test of polymyositis Muscle biopsy
Inclusion body myositis is commonly seen in Elderly age
Both proximal and distal muscle involvement is seen in Inclusion body myositis
PORPHYRIA
Porphyrins are synthesized mainly in Liver and bone marrow

Drugs causing porphyria Barbiturate, sulfonamide, chloramphenicol
NOT a cause of porphyria Aspirin
40 year old female, recurrent porphyria and Porphyria
maculopapular rash when exposed to sun, symptoms
exaggerated in summer
Schizophrenia like picture Porphyria
Type of Peripheral Neuropathy in Acute Porphyria Motor
Recurrent abdominal pain, Normal serum bilirubin, Porphyria
positive Ehrlich aldehyde test
Hoesch test Porphyria
MC Type of Porphyria Porphyria Cutanea Tarda
Acute intermittent porphyria is precipitated by Phenobarbitone, Thiazides, Loop diuretics
Girl on sulfonamide developed abdominal pain seizure Acute intermittent porphyria
Abdominal pain, vomiting, psychiatric symptoms and Intermittent porphyria
visual hallucinations
Porphyria in which patient not photosensitive Acute Intermittent Porphyria
Hepatomegaly is NOT a feature of Hepatic porphyria
Splenectomy NOT useful in Porphyria
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DERMATOLOGY
Photosensitive rash is common in Erythropoiteic photoporphyria

Drug of choice in cutaneous complication of Porphyria Beta carotene
Treatment of Choice for Non Acute Porphyria Phlebotomy
(PCT, Erythropoietic tarda)
CHLOASMA
19 year old girl presents with light brown pigmentation Chloasma

over malar eminence
Non erythematous malar rash in women of child Chloasma
bearing age
Concentration of hydroquinone for treating chloasma 2-5%
POLYMORPHIC LIGHT REACTION
Itchy papules and papulovesicles on sun exposed areas Polymorphic light reaction
particularly of forearm with history of seasonal
variation. more severe in summer, improved in winter
Polymorphic light reaction is confirmed by Skin biopsy
PHOTOSENSITIVE DERMATITIS
Photosensitive dermatitis Psoriasis, Pellagra, Pemphigus, SLE, congenital

erythropoietic porphyria, liver spot, porphyria cutanea
tarda
Pellagra causes Photosensitive dermatitis
FIXED DRUG ERUPTION
Sexually active male recurrent ulcer over glans which Fixed drug eruption
heals with hyperpigmentation
Drug commonly producing fixed drug reaction Sulphonamide
Fixed drug eruption Tetracycline, Ibuprofen, Sulfonamides
Fixed drug eruptions frequently seen with Sulfonamides
ERYTHEMA NODOSUM
Erythema nodosum occurs with Leprosy, Tuberculosis, Sarcoidosis, Histoplasmosis, Sulfa

therapy, OCP, Streptococcal Pharyngitis, rheumatoid
arthritis, enteric fever, penicillin
Erythema nodosum is seen in Pregnancy, Tuberculosis, SLE
Erythema nodosum is characteristic of Cutaneous TB
Lesion of erythema nodosum NEVER ulcerate, atrophy or scar
Young female, fever and nodular lesion over shin. Erythema nodosum
Foamy histiocytes and neutrophilic infiltration. NO
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INFECTIVE DISEASES OF SKIN 29
DERMATOLOGY
evidence of vasculitis
25 year old male having fever and malaise since 2 Erythema nodosum
weeks, arthritis of ankle joint and tender erythematous
nodules over skin
NOT true about erythema nodosum Non tender nodules
SKIN TUBERCULOSIS
Tuberculosis of skin Erythema induratum, Erythema nodosum, Lupus

vulgaris
Exclusive of allergy to primary tuberculosis Phylcten, Erythema nodosum
Skin disease of Tuberculous etiology Lupus vulgaris
MC Skin TB in Adults Lupus Vulgaris
Lupus vulgaris Apple jelly nodule at root of nose, TB of skin and
mucosa, ATT is helpful
Lupus Vulgaris, Tuberculosis Verrucosa cutis Central scarring
Investigation of Lupus Vulgaris Biopsy
Post Primary skin TB with good Resistance Tuberculosis Verruca Cutis
Single warty lesion on leg in a farmer Tuberculosis verruca cutis
A farmer who had a single verrucous indurated plaque Tubercular verrucosa cutis
on the dorsum of the right foot, diagnosis is
MC Skin TB in Children Scrofuloderma
Cutaneous tuberculosis secondary to underlying tissue Scrofuloderma
Skin tuberculosis secondary to underlying lymph node Scrofuloderma
Form of Cutaneous TB associated with caseation Scrofuloderma
MC focus of Scrofuloderma Lymphnode
Tuberculides seen in Scrofuloderma
Tuberculides Lichen scrofulosum
Tuberculids characterized by involvement of sweat Lichen scrofulosum
gland and hair follicles with non caseating epithelioid
granuloma
Lichen Scrofulosum Superficial epithelial dermal granuloma
INFECTIVE DISEASES OF SKIN
COMMON INFECTIVE DISEASES OF SKIN
Erythematous lesion on cheek with central crusting Cutaneous leishmaniasis

20 year old from Jaipur presents with erythematous Cutaneous leishmaniasis
lesion on cheek with central crusting
Commonest skin infection in children Impetigo contagiosa
Impetigo Erythematous weeping eruption
Honey coloured crusts are characteristically seen in Impetigo
Impetigo contagiosa commonly due to Staphylococcus
Bockhart’s impetigo is characterized by Lesions on legs, thigh, forearm
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DERMATOLOGY
Impetigo is a Contagious bacterial infection

NOT true about impetigo Scar on healing, erythromycin is the drug of choice
Bullous impetigo Seen in newborn, caused by staphylococcus
aureus, subside in 2-3 days, vesicle do not
rupture
NOT true about bullous impetigo Yellow brown honey colored crust when
vesicle rupture
Best coverage for impetigo in children by Azithromycin
Erythema marginatum Serpigenous, evanescent, rash worsens on application
on heat, NOT itchy
Erythema marginatum commonly seen over Extremities
Presentation of Erythema marginatum Early, Serpiginous
Roseola infantum is caused by HHV 6
After 3 days of fever patient developed Roseola infantum
maculoerythematous rash that lasted for 48 hours
Fever stops rash begin Roseola infantum
Parvo virus B19 does NOT cause Roseola infantum
Primary pyoderma Impetigo contagiosa, Ecthyma, furuncle
Ecthyma Superficial bacterial infection
Toxic shock syndrome is caused by Staphylococcal infection
Erysipeloid is transmitted by Contact with animals
Strawberry tongue, swollen lips Scarlet fever
Pastia line, sand paper skin Scarlet fever
Dick test is for Scarlet fever
Mycobacterium causing skin ulcer M.ulcerans, M.marinum
Skin hazards of swimming Verrucae, M.marinum infection
Sea bather eruption is associated with bite Jelly fish
of
Desquamation of skin occurs in Kawasaki disease, Scarlet fever, Toxic shock syndrome
NOT a parasitic infection Ecthyma
NOT caused by Staphylococcus Erysipelas
Staphylococcus does NOT cause Scarlet fever
ERYTHEMA MULTIFORME
Commonest etiology of erythema multiforme Viral

Erythema muliforme Due to herpes simplex, due to sulfonamide, lesion are
symmetrical
Erythema multiforme Regions of face and neck, vesicles and
target lesion, sign of internal malignancy
Erythema multiforme Hemorrhagic crust may form on lips,
lesions resolve over 3 weeks to 6 weeks
Erythema multiforme is associated with Drug reaction, Malignancy, Ulcerative colitis
Target lesion /Iris lesion Erythema multiforme
EM major is due to HSV, Mycoplasma pneumonia
EM minor is due to HSV
NOT true about erythema multiforme No vesicles
NOT a photosensitive disease Erythema multiforme
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DERMATOLOGY
NOT a photosensitive disease Gaucher’s disease
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
Bulla in Staphylococcal Scalded Skin Syndrome Intraepidermally

3 month old male, otitis media for which he had given a Staphylococcal scalded skin syndrome
course of cotrimoxazole. Few days later extensive
peeling. No mucosal lesion. nontoxic
STEVEN JOHNSON SYNDROME
Acute Steven Johnson Syndrome present as Membranous Conjunctivitis

Drug causing Steven Johnson Syndrome in HIV affected Thiacetazone
individuals
TOXIC EPIDERMONECROLYSIS
Toxic epidermonecrolysis is caused by Phenytoin, penicillin, sulphonamide, oxicam

NOT true about TEN Corticosteroids are primary part of therapy
NOT a drug for treatment of TEN Corticosteroids
MOLLUSCUM CONTAGIOSUM
Molluscum contagiosum is caused by Pox virus

Children, Face & Genitals, Extremely small pink shiny Molluscum Contagiosum
pearly white skin coloured umbilicated papule
containing grayish plug
Molluscum contagiosum STD, viral infection, central umbilication, treatment is
extirption
Pearly umbilicated lesions in face Molluscum contagiosum
Henderson Patterson bodies are seen in Molluscum
NOT a type of Pyoderma Molluscum contagiosum
HERPES ZOSTER
Herpes Zoster is caused by HHV 4

Herpes zoster is caused by Varicella
Virus reactivates and involve eye Herpes zoster
MC nerve involves in Herpes zoster Ophthalmic nerve V1
Least likely nerve involved in herpes zoster Chorda tympani
Most common site of affection of herpes simplex Thorax
Ballooning is characteristic of Herpes zoster
56 year old man, Painful weeping rashes over upper Herpes zoster
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MALIGNANT SKIN DISEASES 32
DERMATOLOGY
eyelid and forehead for last 2 days along with ipsilateral

acute punctuate keratopathy. He had chemotherapy for
non hodgkin’s lymphoma
Dermatome, Painful closely grouped red papules rapidly Herpes Zoster
becoming vesicular
Multiple vesicular lesion over T10 dermatome Herpes zoster
associated with pain
Lesion on T3 dermatome-Diagnosis is VZV
NOT a feature of Herpes Zoster Recurrence
NOT a criteria in AIDS defining illness Herpes Zoster
Ocular symptom NOT seen in Herpes Zoster Glaucoma
NOT seen in herpes zoster Occulomotor nerve involvement
Drug of choice in herpes zoster Acyclovir
MALIGNANT SKIN DISEASES
GENERAL FEATURES OF MALIGNANT SKIN DISEASE
Underlying internal malignancy is shown by Acanthosis nigricans, Annular erythema, migratory

nectotizing erythema gyratum repens, bullous
pemphigoid
Underlying internal malignancy is NOT shown by Bullous pyoderma
Signs of internal malignancy Tuberous sclerosis, clubbing, dermatomyositis
Multiple sebaceous tumours Muir Torr syndrome
Multiple Cutaneous sebaceous adenoma Muir torre syndrome
Predisposing factor for skin carcinoma Lichen planus, Bowen’s disease, UV rays, DLE
Premalignant condition of skin Pagets disease of nipple, Bowen’s disease, solar
keratosis, Leukoplakia
Premalignant lesions of skin Bowen disease, Paget’s disease of nipple, Leukoplakia,
Solar keratosis
Skin cancer predisposed by Smoking, UV rays, Chronic ulcer
Carcinoma in situ persists for 8 years
White people when compared to black are more prone Basal cell carcinoma, Melanoma
for
NOT a premalignant ulcer Bazin ulcer
Actinic keratosis seen in Squamous cell carcinoma
Parakeratosis most frequently occur with Actinic keratosis
Related to sunlight exposure Actinic keratosis
Child linear verrucous plaques on trunk with Verrucous epidermal nevus
vacuolization of keratinocytes in S.spinosum and
S.granulosum
Commonest site of necrobiosis lipoidica diabeticorum Leg
Fibrous histiocytoma is classified as Sclerosing hemangioma
Tricholemmoma Adnexal tumor of skin that differentiate
towards hair follicle
Fabry’s disease X linked recessive, Multiple angiokeratoma, Cornea
verticillata (opacity), maltese crossing on urinalysis
Treatment of solar keratosis Topical 5 FU
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DERMATOLOGY
Child with erythematous non blanching bosselated Flashed light pumped dye laser
lesion on right side of face
Minimal scar is associated with Nd Yag LASER
Peeling agent of choice to treat Baker Gordon formula
precancerous lesion of skin
Chemical peeling uses Alpha hydroxy acid, beta hydroxyl acid,
salicylic acid
Chemical peeling is NOT done by Phosphoric acid
Soft tissue fillers Collagen, hyaluronic acid, poly L lactic
acid
Most commonly used for laser therapy for Q switched Nd : YAG laser
pigmented lesions
Most suitable laser for Port wine stain on Pulsed dye laser
face
Laser treatment of skin Fractional laser treatment works by
targeting both dermis and epidermis,
fractional laser treatment can create
micro thermal zones, ablative treatment
acts mainly on epidermis
Photodynamic therapy is effective for Extensive superficial basal cell carcinoma,
multiple actinic keratosis, bowen’s disease
Photodynamic therapy is NOT used for Advanced squamous cell carcinoma
ACANTHOSIS NIGRICANS
Acanthosis nigricans is indicative of Internal malignancy, endocrine disorder, Bloom’s

syndrome, Pigmentation of face and neck
Acanthosis nigricans Prognostic indicator, velvety plaques on dirty
hyperpigmentation, gastric adenocarcinoma
commonest malignant association, indicate
hyperandrogneic state, NOT a confirmatory sign of
malignancy
Acanthosis is Cutaneous marker of Malignancy
Acanthosis nigricans is common for GI malignancy
Acanthosis nigricans Seen in axilla and flexural areas, associated with
obesity, associated with insulin resistance, PCOD,
acromegaly, Cushing syndrome
Acanthosis nigricans is NOT associated Ovarian cancer
with
Acanthosis nigricans is NOT associated Adenocarcinoma of breast
with
Acanthosis nigricans histologically show Papillamatosis
Soft velvety, verrucous hyperpigmentation of axilla in Acanthosis
an adult with ca stomach
NOT premalignant Acanthosis nigricans
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DERMATOLOGY
MYCOSIS FUNGOIDES
MC malignancy associated with erythroderma Cutaneous T cell lymphoma

Mycosis fungoides Most common form of Cutaneous lymphoma, Pautrier’s
microabscess, erythroderma seen and spreads to
peripheral circulation
Mycosis cells are altered T cells
Key difference between mycosis fungoides Three stages in mycosis fungoides
and sezary syndrome (premycotic, plaque, tumor)
Cerebriform nuclei is seen in Leukemia of Sezary syndrome
NOT an intermediate grade of NHL Mycosis fungoides
NOT of B cell origin Sezary syndrome
NOT true about mycosis fungoides Indolent course, easily amenable to treatment
NOT true about Mycosis fungoides Indolent course and easily amenable to treatment
Treatment of choice in mycosis fungoides Full skin electron therapy
Whole body electron therapy is useful in management Mycosis fungoides
of
Radiation used for treating Mycosis Fungoides Beta rays
HISTIOCYTOSIS
Langerhan cells in skin are Antigen presenting cells

Langerhan cells express CCR-6
MC site of histiocytosis Bone
Langerhan’s histiocytosis Common before 3 years of age, radiosensitive, letterer
Siwe disease is systemic manifestation, testis NOT
commonly involved
Langerhan’s histiocytosis X Can be associated with diabetes mellitus, Birbek’s
granules in langerhan’s cells, Proliferation of antigen
presenting cells, Associated with specific HLA DR
Langerhan cell histiocytosis Papular trunk lesions with scaling and crusting,
ulcerative nodules in mucosa, calvarial defect with map
lesions and floating teeth
MC endocrinal abnormality in patients Diabetes insipidus
with Langerhan cell histiocytosis
One year old boy presented with hepatosplenomegaly Birbeck granules in the cytoplasm
and delayed milestones. Liver and bone marrow biopsy
revealed presence of histiocytes with PAS positivity.
electron microscopy of this histiocytes are most likely to
reveal the presence of
A child presents with seborrhoic dermatitis, lytic skull Histiocytosis X
lesions, ear discharge and hepatosplenomegaly
Tinnitus, SNHL, progressive deafness, NOT a differential Histiocytosis X
diagnosis
Seborrhoeic dermatitis, polyuria, hepatosplenomegaly Langerhan cell histiocytosis
Floating tooth Histiocytosis X
X ray dorsolumbar spine reveals a solitary collapsed Histiocytosis
dorsal vertebra with preserved disc spaces. No
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DERMATOLOGY
associated soft tissue shadow

Histiocytosis associated with 80% skeletal involvement
Birbeck granules Histiocytes
Silver dolly vertebra Eosinophilic granuloma
Best prognosis in histiocytosis X Eosinophilic granuloma
NOT true about langerhan cell histiocytosis Gonodal involvement occurs
Used for refractory histiocytosis Clardabine
Treatment of refractory histiocytosis Cladrabine
BASAL CELL CARCINOMA
Incidence of Basal cell carcinoma More common

Commonest site of rodent ulcer Inner canthus
Rodent ulcer common in Face
Common type of basal cell carcinoma Nodular
Field fire basal cell carcinoma Superficial
Morphoic basal cell carcinoma High recurrence
Pigmented basal cell carcinoma Pearly black
Fibroepithelioma of pinkus Papilloma with scaling or ulceration
Basal cell carcinoma Direct spread
Cutaneous malignancy do NOT metastatize through Basal cell carcinoma
lymphatics
MC Malignant ulcer of Nasal Skin Basal cell carcinoma
Cutaneous malignancy that do not metastasise through Basal cell carcinoma
lymphatics
A 48 year old sports photographer noticed a small Basal cell carcinoma
nodule over upper lip from 4 months. nodule is pearly
white with central necrosis and telangiectasia
Characteristic of basal cell carcinoma Nuclear palisades
NOT true about basal cell carcinoma More aggressive than melanoma
NOT true about basal cell carcinoma Involves basal layer of epidermis
Diagnostic procedure for basal cell carcinoma Wedge biopsy
Treatment of choice for basal cell carcinoma Moh’s micrographic surgery
Moh’s micrographic excision for BCC Recurrent tumour, Tumor with aggressive histology,
Tumor with perineural invasion
Treatment of morphoic lesion of basal cell Wide local excision
carcinoma
Treatment of choice for pigmented basal cell carcinoma Excision
FEATURES OF MALIGNANT MELANOMA
Potential precursor for malignant melanoma Dysplastic nevus

Congenital nevocellular nevi 3-5% lifetime risk of undergoing
malignancy
Malignant change of nevus Itching, Change in color, Increase in size, Appearance of
Pain
MC site of origin of melanoma Junctional melanocytes
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DERMATOLOGY
MC type of malignant melanoma Superficial spreading

MC type of melanoma in Blacks, Asians and Hispanics Acral lentiginous melanoma
Most malignant form of malignant melanoma Nodular
MC site of lentigo malignant melanoma Face
Hutchinson sign is seen in Subungual melanoma
Pigmented lesion with poor prognosis Nodular melanoma
Worst prognosis of malignant melanoma Amelanotic
Least malignant Lentigo maligna
New type of melanoma Desmoplastic melanoma
Melanoma Amelanotic melanoma worst prognosis, Thinner
melanoma good prognosis
Malignant melanoma Lymphatic spread, Lymphnode biopsy is done always,
Block dissection to be done when sentinel node is
involved, Microsatelletism
Malignant melanoma Better prognosis in females, stage IIA stellate deposits,
MC type superficial spreading
Biopsy from mole of foot, cytologic atypia of Melanoma clark IV
melanocytes and diffuse epidermal infiltration by
anaplastic cells also present in papillary and reticular
dermis
Staging of melanoma done by Breslow
Inguinal lymph node enlargement is seen in Malignant melanoma of foot
Rate of metastasis of melanoma correlates Thickness of tumor
with
MANAGEMENT OF MALIGNANT MELANOMA
Prognosis of malignant melanoma depends on Stage, Depth of melanoma on biopsy, Site

Prognosis of malignant melanoma Depth of invasion
Most important prognostic factor in assessing Thickness of Primary tumour
Malignant melanoma
Prognosis in malignant melanoma is better in Females
Biopsy from a mole on foot shows cytologic atypia of Melanoma clark level IV
melanocytes and diffuse epidermal infiltration by
anaplastic cells, which also present in papillary and
reticular dermis
Biological treatment used in treatment of IL-2
melanoma melanoma
New drug used in treatment of metastatic Pembrolizumab
melanoma
Only FDA approved chemotherapy for melanoma Dacarbazine
A 35 year old developed 1.5 cm pigmented lesion on Excision biopsy
back. next investigation
Melanoma should be excised with a margin of 1-2 cm
NOT included in treatment of malignant melanoma Radiation
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GENODERMATOSES 37
DERMATOLOGY
GENODERMATOSES
XERODERMA PIGMENTOSA
DNA repair defective repair Fanconi anemia, Bloom syndrome, Xeroderma

pigmentosa
NOT a familial cancer syndrome Xeroderma pigmentosa
Xeroderma pigmentosa produced as a result of DNA polymerase I >DNA ligase
Xeroderma pigmentosa is due to closely related Nucleotide excision repair
abnormalities in
Defect in Xeroderma Pigmentosa Nucleotide excision repair
Primary defect in Xeroderma pigmentosa Formation of thymidine dimmers
Person highly prone for malignancy Xeroderma pigmentosa
Patient present with skin bullae on sun exposure. The Thymidine dimmers
defect is of
INCONTINENTIA PIGMENTI
Inheritance of Incontinentia pigmenti X linked dominant inheritance

Incontinentia pigmenti X linked dominant, primary skin abnormality,
avascularity of peripheral retina
2 year girl child with verrucous plaques on trunk, linear Incontinentia pigmenti
bands of hyperkeratotic papules and nodules followed
by whorled pigmentation. mother had history of in
utero death and hypopigmented atrophic linear lesion
NEUROFIBROMATOSIS
Button hole sign Neurofibroma

Sphenoid wing dysplasia is seen in Neurofibromatosis
Pathognomic of neurofibromatosis Axillary freckling
Neurofibromatosis associated with Phaeochromocytoma
Lisch nodule Von Recklinghausen disease
Neurofibromatosis I Peripheral NF, Von Recklinghausen Disease, Café Au Lait
Spot, Axillary Freckling, Iris Lisch Nodule, Neurofibroma,
Distinct Osseous Lesion, Optic Glioma
MC Orthopaedic Manifestation of Neurofibromatosis 1 Scoliosis
MC tumour associated with type I neurofibromatosis Optic nerve glioma
MC tumour associated with Neurofibromatosis I Juvenile myelomonocytic leukemia
Empty Orbit, Widening of Neural foramina, Axillary Neurofibromatosis Type I
Freckle (Crowe Sign)
th
Neurofibromatosis II B/L 8 Nerve Mass Consistent With Acoustic Neuroma,
Schwannoma, Juvenile Posterior Subcapsular Lens
Opacities
MC type of Leukemia in Neurofibromatosis type II Juvenile Myelomonocytic Leukemia
Café au lait spot Rough borders (Coast of Maine) is seen in McCune Albright
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GENODERMATOSES 38
DERMATOLOGY
syndrome, Smooth borders (Coast of california) is seen in NF

I
NOT true about Neurofibromatosis Autosomal recessive
Least useful investigation in Echocardiography
neurofibromatosis
TUBEROUS SCLEROSIS
Chromosomes associated with tuberous sclerosis Chromosome 9 (hamartin) and chromosome 16 (tuberin)
Mentally retarded child with flank mass and liver Tuberous sclerosis
swelling
Child with seizures, oval hypopigmented macules on Tuberous sclerosis
trunk, subnormal IQ
Child with mental retardation , seizures and Tuberous sclerosis
angiomyolipoma in kidney diagnosis
Lesions in liver and kidney with contract enhancement, Tuberous sclerosis
patient with seizures
Hypopigmented macule on back, infantile spasm, Tuberous sclerosis
delayed milestones
Seizures hypopigmented patches on face and mental Tuberous sclerosis
retardation
Ash leaf macule Tuberous sclerosis
Ash leaf spot is also known as Fitzpatrick pustule
Tuberous sclerosis is associated with Retinal astrocytoma
Koenen’s Periungual fibroma Tuberous sclerosis
Koenen’s periungual fibroma more than 50% in Tuberous sclerosis
Earliest feature of tuberous sclerosis Ash leaf macule
Adenoma sebaceoum Tuberous sclerosis
Mental retardation, Seizures, Café au lait spots Tuberous Sclerosis
Shagreen patch Lumbosacral
Confetti lesion Tuberous sclerosis
Tuberous sclerosis Autosomal dominant sporadic transmission, vogt triad
of epiloia, fibrous facial plaque, stippled confetti spots
Insulinoma and gastrinoma is associated Tuberous sclerosis
with
Most strongly supports the diagnosis of Cortical tubers and facial angiofibroma
tuberous sclerosis
NOT a cutaneous lesion of Tuberous sclerosis Kinked hair
NOT true about Tuberous sclerosis Iris nodule
NOT a triad of tuberous sclerosis Hydrocephalus
ICHTHYOSIS
Netherton syndrome Autosomal recessive, ichthyosis, very

short hair, erythroderma
Icthyosis is associated with Hodgkin’s disease, AIDS, Hypothyroidism
Icthyosis caused by Refsum’s disease
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LEPROSY 39
DERMATOLOGY
Inheritance of icthyosis vulgaris Autosomal dominant

Crocodile skin of sauroderma Icthyosis vulgaris
Granular layer absent in Icyhyosis vulgaris
Male child, cryptorchidism, large black scales on body X linked icthyosis nigra
flexures, skin biopsy show hypergranulosis and steroid
sulfatase deficiency
LEPROSY
MYCOBACTERIUM LEPRAE
Microorganism that does not obey Koch’s postulates Mycobacterium Leprae

Leprosy incubation period 3-5 years
Viability of M. leprae after exit from 38 – 46 days
human body through nasal route
Leprosy bacilli survive outside human body up to, 12 days
Generation time of Leprosy bacilli
Doubling time of lepra bacilli 12days
Generation time of leprosy bacilli 15 days
Leprosy commonly spreads by Droplet
Leprosy bacilli is transmitted from person to person by Intact skin, open sore, discharge from nasal mucosa
Maximum lepra bacilli are seen in Lepromatous Leprosy
NOT a mode of transmission of leprosy Transplacental spread
EPIDEMIOLOGY OF LEPROSY
Leprosy Eliminated from India, Can be transmitted through

breast milk, Lepromin test in NOT diagnostic, MDT can
be given in pregnancy
Leprosy Multibacillary leprosy is diagnosed when there are
more than 5 skin patches, New case detection rate is an
indicator for incidence of leprosy, Target for elimination
of leprosy is to reduce the prevalence to less than 1 per
10,000 population
Defaulters in Leprosy Defaulters are leprosy patients under treatment who
does not complete the treatment within the specified
period of 6 BCP in 9 months by PB and 12 BCP in 18
months by MB cases.
Leprosy in India Prevalence in Orissa is decreased, Insect can transmit
disease
True about leprosy in India MDT coverage 90%
Which of the following measurement indicate whether Prevalence rate of disease
leprosy cases are being detected early or not
Leprosy is considered as a major health problem if 1 per 10,000
prevalence of leprosy more than
As per WHO, leprosy is a major health problem, if 0.01%
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LEPROSY 40
DERMATOLOGY
prevalence is
If prevalence of leprosy less than 1% of Contact survey
1000
If prevalence of leprosy greater than 1% of Group survey
1000
If prevalence of leprosy greater than 10% Mass survey
of 1000
Type of Survey conducted when Leprosy prevalence is Group survey
4/1000
Screening method of choice in an area where the Group survey
prevalence of leprosy is 1/1000 is
Effective leprosy control programme indicated by Low MDR resistant multibacillary cases, high new
casedetection rate, decreased grade 2 disability
Leprosy eradication programme is best evaluated by Detection of new cases
Leprosy eradication is to be achieved by 2005
Disease that cannot be eradicated Leprosy
Efficacy of antileprotic treatment is indicated by Relapse rate
Leprosy is not yet eradicated because Long incubation period
CLASSIFICATION OF LEPROSY
Ridley Jopling Leprosy classification based on Clinical bacteriological histopathology and immunology
Ridley Jopling Classification does NOT include Neuritic type
NOT included in Madrid classification but included in Purely neuritic
Indian classification
Dharmendra and Jopling classification deals with Leprosy
Dharmendra antigen and Jopling classification deals Leprosy
with
MC Type of Leprosy in India & Africa TT
FEATURES OF LEPROSY
Least communicable disease Leprosy

Disease altering finger prints Leprosy
MC cause of Mononeuritis Multiplex in India Leprosy
MC glomerulonephritis in Leprosy MPGN
MC mode of transmission of Leprosy Droplet infection
Earliest sensation to be lost in leprosy Temperature
Melanin pigmentation decreased in Leprosy
Characteristic finding in a case of leprosy Long contact with tuberculoid leprosy can transmit
disease
Neuropathic joint of foot and ankle is common with Leprosy
Diasability that occurs due to facial nerve Lagophthalmos
involvement in leprosy
Lagophthalmos is due to involvement of Orbicularis oculi
Developmental blindness in Leprosy is commonly due Lagophthalmos
to
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LEPROSY 41
DERMATOLOGY
Treatment of lagophthalmos Lateral tarsorraphy

Common nerves involved in leprosy High ulnar and low median
MC Nerve involved in Leprosy Posterior Tibial Nerve, 2nd Ulnar Nerve
Lepra cells Histiocytes
Virchow’s cell Leprosy
In a patient with claw hand due to leprosy, deformity Grade II
would be classified as
Abnormalities in leprosy Abnormal EMG, voluntary muscle wasting, decreased
response to tactile sensation, increased response to
tactile sensation
MC visceral organ involved in leprosy Liver
Licked candy stick appearance of bone Leprosy
Iris pearls are seen in uveitis of Leprosy
8 year old boy from Bihar presented with 6 months Indeterminate leprosy
history of an ill defined hypopigmented slightly atrophic
macule on face
Hypopigmented lesion on cheek in a child, no sensory Indeterminate leprosy
loss, no scale
Diagnostic feature of indeterminate Periadnexal lymphocyte
leprosy
Tuberculoid leprosy is characterised by Non caseating granuloma in nerve
Lepromatous leprosy Presence of globi, subepidermal free zone, decreased
cell mediated immunity
Cell mediated immunity maximally suppressed in LL
Most infectious form of Leprosy Lepromatous
Globi is seen in Lepromatous leprosy
Leonine facies is seen in Acute Lepromatous leprosy
Suppression of cell mediated immunity Lepromatous Leprosy
Histoid leprosy is a type of LL
Foamy change LL
Corneal bleeding is associated with LL
NOT a feature of lepromatous leprosy Perforating ulcer
Characteristic feature of borderline lepromatous Inverted saucer shaped lesion
leprosy
Satellite lesion Borderline tuberculoid leprosy
45 year old male, multiple hypoaesthetic mild Borderline lepromatous leprosy
erythematous large plaque with elevated margins on
trunk and extremities. ulnar and popliteal nerves
enlarged
Tuberculoid leprosy is characterized by Non caseating granuloma in nerve
Single skin Lesion in Leprosy TT
Neurological involvement in Tuberculoid leprosy
Long contact with tuberculoid leprosy Can transmit disease
patient
NOT seen in Tuberculoid leprosy Leonine facies
Leprosy with Slit Smear & Infectivity Negative Neuritic Type
Diffuse lepromatosis Dermis only involved
Myelopathy does NOT occur in Polyneurotic leprosy
Lazarine leprosy Severe ulcerative phenomenon
Tongue is involved in Wade’s leprosy
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LEPROSY 42
DERMATOLOGY
Abnormality NOT seen in leprosy Decreased proprioception

Leprosy do NOT involve CNS
Lepromatous Leprosy does NOT involve Lungs, Ovaries and CNS
NOT involved in leprosy Uterus
Lesions NOT seen in leprosy Vesicles
NOT true about peripheral neuritis in leprosy Decreased tendon reflexes
LEPROMIN TEST
Lepromin test is positive in Tuberculoid

Lepromin test Negative in most children in first 6 months of life,
important to classify type of leprosy, BCG vaccination
convert to positive
Mitsuda reaction in Leprosy read after 4 weeks
Indeterminate Leprosy which is negative for Mitsuda Lepromatous Leprosy
test is most likely to progress to
Lepromin test in negative in Purely neuritic leprosy
Lepromin test is used for Prognosis
NOT used for diagnosis of leprosy Lepromin test
DIAGNOSIS OF LEPROSY
Test for identification of subclinical Fluorescent leprosy antibody absorption

infection in leprosy test
Only objective way of monitoring benefits of treatment Bacteriological index
of leprosy
Leprosy bacterial index 1+ means 1 or less than 1 bacilli in each hpf
Bacterial index in multibacillary leprosy is more than 2
Bacterial index in paucibacillary leprosy Less than 2
Tests used to detect cell mediated immunity in leprosy Lepromin test, Lymphocyte transformation test,
Leukocyte migration test
For experimental work, lepra bacilli are cultured in Mouse foot pad
Mycobacterium leprae can be cultivated Chimpanzee, foot pad of mice, branded
in armadillo
Minimum bacterial load in split smear to be positive in 10,000 bacilli per gram of tissue
Leprosy
Number of bacilli per field for diagnosing leprosy 10 per filed
Percentage of Sulphuric acid in Ziehl Neelson technique 5%
for diagnosing Leprosy
Skin biopsy in leprosy is characterized by Periappendageal lymphocytosis
Skin smear negative in Neuritic leprosy
Globi in patient with lepromatous leprosy Consists of macrophages filled with AFB
Fite stain Leprosy
TREATMENT OF LEPROSY
Control of TB and leprosy by Early diagnosis and treatment
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LEPROSY 43
DERMATOLOGY
Best indicator of efficacy of drug regimen Relapse rate

in leprosy
Treatment of single macular lesion in Leprosy according Rifampicin, Ofloxacin, Minocycline
to ROME programme
Duration of multidrug therapy for paucibacillary leprosy 6 months
Duration of treatment of paucibacillary leprosy 6 months-100 mg dapsone daily, 600 mg rifampicin
monthly
In paucibacillary leprosy, single drug dapsone is 180 days
continued for
WHO recommended duration for Leprosy treatment 1 year
Multibacillary Leprosy treatment of Leprosy Dapsone 100 mg/day, Rifampicin 600 mg/month,
Clofazimine 50 mg daily
In multibacillary leprosy, follow up examination after 5 years
adequate treatment should be done yearly for
Treatment of lepromatous leprosy Rifampicin, dapsone, clofazimine
Best method of treatment of ulnar nerve abscess in Incision and drainage
leprosy
Acute Neuritis in Leprosy is treated by Prednisolone
Treatment of severe ulnar neuritis in borderline leprosy MDT + steroid
Can produce dramatic improvement in patient with Thalidomide
type II lepra reaction
Thalidomide NOT used in HIV associated neuropathy
Mass chemoprophylaxis in endemic area NOT Leprosy
recommended for
Bactericidal drug active against leprosy Rifampicin
MC drug used in leprosy Dapsone
NOT administered under supervision Dapsone
Half life of dapsone 24 hours
Commonest side effect of dapsone Hemolytic anemia
Dose of dapsone 1-2 mg/kg
Histoid nodule is a side effect of Dapsone
Minimum lethal dose of Dapsone in mice 0.3 mg/dl
Treatment modalities of Dapsone poisoning Ascorbic acid, Exchange transfusion, Metyhlene blue
Treatment of dapsone poisoning Methylene blue, Ascorbic acid, exchange transfusion
NOT an antifungal Clofazimine
Drug useful in lepra reaction Clofazimine
Antileprotic drug also used in lepra reaction Clofazimine
Skin pigmentation and iccthyosis like side effects Clofazimine
Side effects of clofazimine Skin pigmentation, GI disturbance, ichthyosis
Side effects of clofazimine Icthyosis, Pigmentation of skin, Gastrointestinal
tolerance
Side effect of clofazimine Hyperpigmentation, discolouration of body secretion,
icthyosis
NOT a first line antileprotic drug Thiacetazone
NOT used in treatment of leprosy Penicillin
LEPRA REACTIONS
Type of hypersensitivity in Leprosy Type IV hypersensitivity
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SEXUALLY TRANSMITTED DISEASES 44
DERMATOLOGY
Exacerbation of lesion in borderline leprosy ENL, Lepra reaction type I

Paucibacillary leprosy, completed 6 months of Stop the treatment and watch
multidrug therapy, response is good. but lesion NOT
healed completely, according to WHO
Exacerbation of lesion in patients of Type I lepra reaction
borderline leprosy is
Downgrading reaction Type I lepra reaction
Type I Lepra reaction Type IV Hypersensitivity
Drug used in Lepra reaction Clofazimine
Reverse Lepra reaction shows response to Clofazimine, Steroids
NOT a treatment in acute neuritis in type I lepra Incision and drainage
reaction
NOT used in type I lepra reaction Thalidomide
Reverse lepra reaction show no response to Thalidomide
Type II lepra reaction Type III hypersensitivity
Main cytokine involved in ENL TNF alpha
Type II lepra reaction in LL
ENL occurs in those with Lepromatous leprosy
ENL is seen in LL and BL
NOT a manifestation of ENL Pancreatitis, arthritis
Thalidomide can be used in Erythema nodosum leprosum
Thalidomide is drug of choice for Lepra type II reaction
Daily dose of thalidomide for controlling ENL 200-300 mg
Drug of choice for type II Lepra reaction Steroids
Reversal reaction of lepra is treated by 12 weeks of prednisolone
NOT indicated in treatment of Lepra reaction type II Cyclosporine
Lucio phenomenon is mediated by Immune complexes
Drug of choice for Lucio reaction Steroids
SEXUALLY TRANSMITTED DISEASES
GENERAL FEATURES OF SEXUALLY TRANSMITTED DISEASES
nd
MC cause of STD in developed countries Chlamydia, 2 Neisseria Gonorrhoea
MC cause of PID Gonococcus, Chlamydia
MC cause of Non gonococcal urethritis Chlamydia
Non gonococcal urethritis caused by Chlamydia, Ureaplasma
Ureaplasma urealyticum Ability to metabolize urea in to ammonia
and CO2
Sexually active male with simultaneous Atypical chancre
infection of spirochete and hemophilus
ducreyi
Drug of choice for Non gonococcal urethritis Doxycycline
Syndrome approach is used in India in management of Chancre, chancroid, herpes genitalis
Syndromic management of urethral discharge includes Neisseria gonorrhea and Chlamydia trachomatis
treatment of
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DERMATOLOGY
A sexually active, long distance truck driver’s wife Metronidazole, Azithromycin, Fluconazole
comes with vaginal discharge. Under Syndromic
Approach, which drug should be given?
Painful lymphadenopathy Chancroid ,herpes simplex
Genital ulcers in industrial countries are commonly Chlamydia trachomatis
caused by
Method of detection of STD control programme if one Cluster testing
case names a person within a mobile sociosexual
environment
Cluster testing comes under Intervention Strategy
Cluster testing is used in detecting cases of STD
Treatment of both partners NOT recommended in Herpes>candida
Recurrent balanoposthitis seen in Diabetes mellitus
Induration of seminal vesicle is seen in Syphilis
A middle aged male with an ulcerative granulomata on Calymmatobacterium granulomatis
his glans - wright giemsa stained specimen shows 1-2
rounded structures vacuolated within macrophages.
What is the causative organism?
Urethral discharge, pus cells , no organism McCoy cell culture
24 year male, STD clinic, single painless ulcer on Scrapping from ulcer for dark field microscopy
external genitalia.lab test
Treatment of non specific urethritis Tetracycline
Chlamydia + gonorrhea infection Spectinomycin
NOT sexually transmitted Echinococcus granulosus
NOT a cause of urethritis Hemophilus ducreyi
WARTS
MC Type of Wart in Children Verruca plana

MC Type of Wart Verruca vulgaris
Human Papilloma virus causes Verruca plana
Juvenile papillamatosis HPV
Myrmecia Wart/Deep Plantar Wart/Verruca Plantaris HPV – 1
MC Type of HPV causing Wart HPV 2
Butcher’s Wart HPV – 2,7
Epidermodysplasia verruciformis is HPV 5
caused by
Genital wart HPV 6
Anogenital wart/Condyloma acuminata HPV -6,11
Penile warts HPV 6,11
Verrucous carcinoma of penis is caused by HPV 11
Viral warts Basophilic stippling, koilocytes are characteristic,
spontaneous regression common in children,
perinuclear vacuolation
True about warts Viral warts spontaneously resolve, Callosity are formed
occupationally
Mosaic Warts are Plane warts
Myrmecia are Deep Palmoplantar warts
Treatment of Warts 20% Podophyllin/Glutaraldehyde
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DERMATOLOGY
Condyloma acuminata in pregnancy is treated by Trichloroacetic acid

Condyloma acuminata IFN alpha
Podophyllin is used in treatment of Condyloma acuminata
Immunomodulator used in genital warts Imiquomod
Warts in women during Pregnancy Trichloroacetic acid, 2nd – Imiquomod
Treatment of Choice for Warts in Pregnancy Cryotherapy/Destructive Procedures
Treatment of genital warts in pregnancy Cryotherapy
HPV vaccine Both bivalent and quadrivalent
GONORRHOEA
MC Veneral disease in India Gonorrhoea

MC STD in India Gonorrhea
Gonococcus is Intracytoplasmic gram negative
Gonococci Infect Epididymis and TESTIS is SPARED
N.gonorrhoea & N.meningitidis differentiated by Maltose fermentation
Asymptomatic carriage of gonococcal infection Endocervix
Gonococci has affinity for Columnar Epithelium
Gonorrhoea does not affect Vagina
Gonococcus is NOT involved in Testis
Main feature of gonorrhoea Purulent discharge per vagina
MC Site of Post Gonococcal Stricture Bulbar Urethra
MC cause of Hydrosalpinx Gonococcal infection
MC manifestation of Gonococcal infection in males Acute Urethritis
MC manifestation of Gonococcal infection in females Cervicitis
Bartholin’s cyst caused by Gonococcus
Acute swelling of vagina in young woman Gonococcal bartholinitis
Bartholins abscess Often caused by Gonococci
Ophthalmia neonatarum is caused by Gonococci
Gonococcal infection spread by Involvement of adjacent structures, lymphatics
Uncomplicated Gonococcal Infection Single dose Ceftriaxone i.m (or) Oral Cefixime
+ Single dose Azithromycin/Doxycycline
Gonococcal infection Penicillin
Drug of choice for penicillin resistant gonorrhoea Ceftriaxone
Drug used in treatment of resistant gonorrhea Spectinomycin
FALSE about management of Gonococcal epididymitis Immediate Surgical intervention
LYMPHOGRANULOMA VENERUM
LGV is caused by Chlamydia trachomatis

Serotype D-K cause Urethritis
Incubation period of LGV 3-10 days
Incubation period for LGV 3 day to 6 weeks
Bubos with multiple sinuses discharging into inguinal LGV
lymphnodes
Painless non bleeding ulcer with painful suppurative LGV
lymphadenopathy
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DERMATOLOGY
Genital elephantiasis is caused by Lymphogranuloma venerum

Sign of groove LGV
Safety pin appearance Granuloma inguinale
Esthiomine LGV
Genital ulcer NOT seen in LGV
Frei test LGV
Miyagawa bodies Lymphogranuloma venerum
MC diagnostic test in LGV Cell culture
Treatment of LGV Doxycycline
Treatment of Granuloma inguinale/venerum Tetracycline, erythromycin, streptomycin
DONOVANOSIS
Donovanosis is caused by Calymmatobacterium granulomatis

Calymmatobacterium granulomatis Non motile, gram negative
Donovanosis is also known as Granuloma inguinale
Incubation period of donovanosis 3-20 days
Incubation period for donovanosis 1-4 weeks
Beefy red ulcer, bleeds on touch, foul smelling and Donovanosis
granuloma of genitals
30 year, large spreading exuberant ulcer with bright red Calymmobacterium granulomatis
granulation tissue over glans penis. no
lymphadenopathy
Male patient granulomatous penile ulcer. Wright Calymmatobacterium granulomatis
giemsa stain tiny organisms of 2 microns within
macrophage
Painless bleeding ulcer without lymphadenopathy Donovanosis
Ulcer resembling carcinoma penis Donovanosis
Pseudobubo Donovanosis
Lymphadenopathy is NOT seen in Donovanosis
Donovanosis is best diagnosed by Microscopy
Donovan bodies Monocyte that containing organism
Calymmatobacterium granulomatis
Pund cells are seen in Donovan bodies
Treatment of Donovanosis Doxycycline
Drug NOT used for donovanosis Streptomycin
CHANCROID
Incubation period of chancroid Less than 7 days

Chancroid may be caused by Herpes virus hominis
Multiple painful ulcer after 5 days of contact is seen in Chancroid
infection of
Multiple non indurated painful ulcer with undermined Chancroid
edges and enlarged lymphnode 5 days after exposure
Coalescing, highly painful, excavated Chancroid
ulcers with and ragged undermined edge
is characteristic of
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SYPHILIS 48
DERMATOLOGY
Urethritis, urethral discharge, gram stain no Hemophilus ducreyi

microorganisms numerous cells. culture negative on
routine laboratory media
Tender bubos are characteristic of Chancroid
Lymph node involvement in chancroid Tender suppurative Loculated unilateral
Chancroid (Soft chancre) is caused by Hemophilus ducreyi
Soft sore is due to infection by Hemophilus ducreyi
School of fish appearance Hemophilus ducreyi
Ito Reensteirna Intradermal test Chancroid
Investigation for Chancroid Gram Staining
Reliable test for chancroid detection Culture
Treatment of Chancroid Azithromycin, erythromycin
Treatment of chancroid Erythromycin
Cotrimoxazole NOT useful for Chancroid
NOT an indication of cotrimozole Chancroid
HERPES
Spontaneous remission is most frequent with Herpes gestationalis

Commonest site of herpes gestationalis Periumbilical region
Skin lesions are almost always intensely Pemphigoid gestationalis (Herpes
pruritic in gestationalis)
MC cause of recurrent genital ulceration in a sexually Herpes genitalis
active male
Recurrent lesion on glans which heal with residual Herpes genitalis
pigmentation
Herpes genitalis is caused by HHV 2
“Fever Blister” is due to Primary HSV 1 infection
Herpes ulceration of oral cavity Epitheliolysis, change into geographic ulcer, vesicles
may appear
Features of herpes genitalis Multiple painful lesions, superficial
erythematous lesions, no induration
Polycyclic erosions Herpes genitalis
Lipshutz inclusion bodies Herpes simplex
Herpes Gladiatorum Seen in wrestlers
Acyclovir resistant herpes Foscarnet
Foscarnet inhibits Viral DNA polymerase
SYPHILIS
TREPONEMA PALLIDUM
Spirochetes Outer surface protein A (express midgut of tick), outer

surface protein B (express salivary gland of tick)
Treponema pallidum is associated with 6 axial filaments
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SYPHILIS 49
DERMATOLOGY
Invasion of treponema pallidum is Hyaluronidase

enhanced by
Treponema pallidum when inoculated in rabbit Produced progressive disease
Maculopapular rash 2 weeks after healing of a painless Treponema pallidum
genital ulcer
Painless ulcer in labia majora Treponema pallidum
Freezing of blood for 2 days cause destruction of Treponema pallidum
Pneumonia alba is due to Treponema pallidum
th
Treponema pallidum mostly transmitted during 28 week of pregnancy
NOT true about Treponema pallidum Motile by peritrichate flagella
GENERAL FEATURES OF SYPHILIS
Syphilis was first identified by Schaudinn and Hoffman

Incubation period for syphilis 9-90 days
Primary Syphilis Incubation period 1 month
Young man aged 19 years developed a painless penile Chancre
ulcer 9 days after sexual intercourse with a professional
sex worker, likely diagnosis
30 year male, history of sexual exposure, painless Syphilis
indurated ulcer in penis with everted margins
Painless non bleeding ulcer with painless Syphilis
lymphadenopathy
A mentally retarded child aged 12 years has multiple Syphilitic condyloma
painful discharging shiny white lesion around anus
Chancre redux Early relapsing syphilis
STD causing fetal anomaly Syphilis
Attack of vertigo over 6 year old children Syphilis
Testis are involved earlier than epididymis in Syphilis
Orchitis without epididymitis Syphilis
Syphilis most commonly affects Ascending Aorta
Endarteritis obliterans Syphilis
Hepar Lobulatum is seen in Syphilis affecting Liver
Cor bovinum Syphilis
Linear calcification of ascending aorta is seen in Syphilis
Follman’s balanitis Syphilis
Moon’s Molar Syphilis
Moth eaten alopecia, Moon’s molars Syphilis
Olympian brow Congenital syphilis
Gummatous ulcer Punched out edges, Syphilitic in nature, Wash leather
slough, Non erythematous base
MC cause of perforated palate Gumma
Follman’s balanitis Syphilis
Calcification of aortic valve Syphilis
Tree barking appearance of Thoracic aorta Syphilis
Tree bark appearance is seen in Syphilitic aneurysm
Syphilis transmitted during pregnancy to offspring if Early latent, Primary, Secondary syphilis
mother is having
Fetal affection NIL in First Trimester Syphilis
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SYPHILIS 50
DERMATOLOGY
Maximum risk of Infection if after 20 weeks Syphilis

In a patient with syphilis, semen is infective for 4 years
Tuskegee study was done for Syphilis
CONGENITAL SYPHILIS
Kassowitz law Late congenital syphilis, if a woman with

untreated syphilis has series of
pregnancies, the likelihood of infection of
fetus in later pregnancies becomes less)
Congenital Syphilis Clutton’s Joint, Parrot’s joint, Frontal bossing (Olympian
brow), Sabre tibia, Higouemenak’s Sign
Earliest sign of Congenital Syphilis Snuffles
Hutchinson’s teeth is a feature of Congenital Syphilis
Hutchinson’s triad a feature of Late Congenital Syphilis
NOT a feature of Hutchinson’s syphilitic triad CVS anomalies
Primary bullous lesion seen in Congenital syphilis
Painless effusion in joints in congenital syphilis Clutton’s joint
Characteristic feature of early congenital syphilis Vesicular rash with bulla over palm and soles
Thymus gland abscess seen in congenital syphilis is Dubois abscess
called
Rhagades seen in Congenital syphilis
Parrot pseudoparalysis Congenital syphilis
Hot cross bun sign Congenital syphilis
st
NOT true about congenital syphilis Infection of fetus most commonly in 1 trimester
NOT seen in early congenital syphilis Keratitis
NOT true about congenital syphilis Osteochondritis occurs after 6 months
Investigation for Congenital Syphilis IgM FTA-ABS
Treatment of Congenital Syphilis Penicillin G
PRIMARY SYPHILIS
Primary chancre Painless ulcer, painless lymphadenopathy, covered with

exudates, indurated lesion
Characteristic of primary chancre Painless punched out ulcer
Treponema pallidum can be found in CSF in Primary syphilis
Treatment of Early syphilis Benzathine penicillin 2.4 mU im single dose
Treatment of syphilis 2.4 million IU im penicillin
SECONDARY SYPHILIS
40 year female numerous non itchy erythematous scaly Secondary syphilis

papules on trunk with few oral white mucosal plaques.
Erosive lesions in perianal area
Mucocutaneous lesions are seen in Secondary Syphilis
Secondary syphilis Painless lymphadenopathy, mucosal erosion, mostly
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SYPHILIS 51
DERMATOLOGY
asymptomatic
Condyloma lata Secondary syphilis
MC presentation of syphilis in HIV Condyloma lata
infected patient
Lues maligna Severe necrotic lesion in secondary syphilis
Lues maligna Rare in syphilis with HIV
Ollendorf sign is seen in Secondary syphilis
Rash in secondary syphilis Asymptomatic
Treponema pallidum isolation from CSF is maximum in Secondary syphilis
Jarisch Herxheimer reaction is common in Secondary Syphilis
Jarisch Herxheimer reaction 90% of patient in secondary syphilis
NOT seen in secondary syphilis Interstital keratitis
NOT true about secondary syphilis Intensely pruritic, vesicular lesion
NOT used in secondary syphilis Benzathine penicillin
TERTIARY SYPHILIS
Perforation of Hard Palate Tertiary Syphilis
DIAGNOSIS OF SYPHILIS
Most reliable method of detecting primary Dark field examination of chancre

chancre material
Nichol’s treponemes are used in TPI
Dark ground microscopy is used for TPI
Evaluation of therapy of Syphilis VDRL
VDRL is a Slide flocculation test
Prozone phenomenon is associated with VDRL
VDRL is most sensitive in Secondary and latent stages of syphilis
Premature baby of 34 weeks. Bullous lesion on skin, VDRL for mother and baby
periostitis, next investigation
23 year college student, asymptomatic and VDRL
hyperpigmented macules over both palms for 3 weeks
VDRL Sensitive NOT specific, Titre decreased with treatment,
become positive after 21 days of infection, HIV patients
are less likely to become VDRL non reactive after
treatment
VDRL Slide flocculation test
Test to monitor response to treatment VDRL
Standard test with CSF for Syphilis VDRL
False positive for VDRL Lepromatous leprosy, yaws, malaria
False Positive VDRL Test For Syphilis Anti cardiolipin
False positive VDRL test Infectious mononucleosis, Malaria, Relapsing fever, IV
drug user, HIV infection, collagen diseases
False positive test against treponemal antigen is seen Infectious mononucleosis
with
FTA ABS Specific test, secondary syphilis, may be positive in
Lyme disease, remains positive after treatment
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SYPHILIS 52
DERMATOLOGY
Most sensitive investigation for syphilis FTA-ABS (earliest to become positive)

Specific test for spirochetal infection Fluorescent treponemal antibody absorption test
Rapid Diagnosis of Syphilis RPR
Past and recent syphilis is diagnosed by THPA
False negative results for TPHA is most commonly seen Primary syphilis
in
Painless indurated ulcer on gland. non tender Dark field microscopy of ulcer discharge
enlargement of inguinal lymph nodes
Silver Impregnation technique is seen in Treponema pallidum
Neurosyphilis activity is best correlated with CSF Pleocytosis
Past or current indication indicated by EIA ,RPR
False positive non treponemal serological test HIV, Collagen test
Treponema pallidum is very difficult to demonstrate in Gumma
TREATMENT OF SYPHILIS
Drug of choice for treatment of neurosyphilis Procaine penicillin G

Drug of choice for syphilis Benzathine penicillin
Jarisch Herxheimer reaction is seen in syphilis with Penicillin
Duration of antibiotic therapy for neurosyphilis 2 weeks
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DERMATOLOGY

WOOD’S LAMP AND UV LIGHT................................................................................................................................ 19

HERPES ZOSTER ....................................................................................................................................................... 31

GENERAL FEATURES OF SYPHILIS ............................................................................................................................ 49

KEY TO THIS DOCUMENT

Text in normal font – Must read point.

Text in bold font – Point from Harrison’s

Text in italic font – Can be read if

GENERAL ANATOMY AND APPENDAGEAL DISORDERS

Normal Skin Cycle (Turn over time of epidermis) 28 days

Normal commensals of skin Candida, Propionibacterium acne

GENERAL FEATURES OF SKIN DISEASES

Calcifying epithelioma Dermatofibroma

Iodine toxicity causes Acne like eruption

Treatment of acne 13 cis retinol, minocycline, erythromycin

DISEASES OF SWEAT GLAND

Key role in sweating Hypothalamic preoptic nucleus

Hair bulb is situated in Upper part of subcutaneous fat

After death, hair become loose by 72 hours

Maturity of fetus is most reliably decided by Nail growth

MC Site of Onychomycosis Toe Nails

GENERAL FEATURES OF ALLERGIC DISORDERS OF SKIN

Principal cause of Hay fever Pollen

pruritis involving face and convexities, numerous

MC site of atopic dermatitis Antecubital fossa

Investigation of choice for Atopic Dermatitis Clinical Examination

Utricarial lesions Utricaria pigmentosa (mastocytosis),

Quincke’s disease is popularly known as Angioneurotic edema

Pruritic erythema on eating sea food Localized anaphylaxis

DISORDERS OF SKIN PIGMENTATION

GENERAL FEATURES OF PIGMENT RELATED SKIN DISORDERS

Hyperpigmented lesions Melanoma, dyskeratosis congenital, lentigenes lichen

Wood’s lamp is used for diagnosis of Versicolor, vitiligo, porphyria

Increased incidence of vitiligo in Diabetes mellitus

Drug induced pityriasis rosacea like Arsenic, bismuth, metronidazole

Lesions of pityriasis rosacea mainly on Trunk

PITYRIASIS RUBRA PILARIS

Pityriasis Rubra Pilaris Elderly, 40-60, Erythematous Scaly Macules &

Tinea versicolor is caused by Malassezia furfur

Young Children, Cheek & Face, Scaly Hypopigmented Pityriasis Alba

presents as scaly white macules

FUNGAL INFECTIONS OF SKIN

GENERAL FEATURES OF FUNGAL SKIN INFECTIONS

Dermatophytes live in Stratum Corneum

MC cause of Tinea capitis Microsporum canis, 2nd Trichophyton tonsurans

Features of Tinea corporis Asymmetrical, Circinate, Good response to Tolnaftate

Tinea barbae is caused by T.mentagrophytes

MC cause of Athlete’s foot Trichophyton

Tinea unguim affects Nail palate

Creamy curd like white patch on tongue in healthy male Candidiasis

Linear lesion Sporotrichosis

WOOD’S LAMP AND UV LIGHT

Wavelength of light produced by wood’s lamp 360 nm

GENERAL FEATURES OF PAPULOSQUAMOUS DISORDERS

Autoimmune diseases Psoriasis, lichen planus, acne vulgaris

Psoriasis is exacerbated by Antimalarials, lithium, beta blockers

Psoriasis is characterized by Auspitz sign

Drug of choice for a pregnant woman in 2nd trimester Prednisolone