MRB exam
High yield points in Dermatology
-Dr. Bandhala Rajan M, MD (AIIMS), DNB, MRCP SCE (UK)
Dermatology Faculty
ADrPlexus
Dermatology basics
Layers of epidermis
• Stratum corneum
• Stratum lucidum
• Stratum granulosum
• Stratum spinosum
• Stratum basale
Origin Layer Function Other features
• Keratinocytes
• Melanocytes
• Merkel cells
• Langerhan cells
• Desmosome
• Hemidesmosome
• Rete ridges
• Dermal papilla
Sensory receptors in skin
• Pacinian corpuscle
• Meissner corpuscle-
Fast adapting mechanoreceptor
• Ruffini ending
• Krause bulb: Temperature sense
Histopathology terms
Hyperkeratosis Parakeratosis
Hypergranulosis
Spongiosis
Acantholysis
Acanthosis
Skin lesions
Comedones
Burrows
Configuration of skin lesions
Papulosquamous and
eczematous dermatoses
Psoriasis
• Gene associated – (psoriatic arthritis- HLA-)
• Drugs triggering psoriasis-
• Pathogenesis:
• Epidermal hyperproliferation- Turnover time-
• Plaque psoriasis:
• Nature of scales:
• Guttate psoriasis
• Age
• Trigger
• Pustular psoriasis
• Types:
• Pregnancy:
Important findings
• Grattage test
• Auspitz sign
• Woronoff ring
Koebner phenomenon
• Pseudokoebner phenomenon
• Histopathology:
• Nail changes:
• Psoriatic arthritis
• Severe form:
• Xray-
Lichen planus
• 6Ps
• Trigger:
• Sites:
• Wickham striae
• Oral LP
• Genital LP
• Hair
• Nail
• Histopathology
Max joseph spaces
Treatment
Pityriasis rosea
• Caused by
• Morphology
• Pattern
• Treatment
Lichen nitidus
• Grouped shiny pin head sized papules over Dorsum of hands, feet,
periumbilical area, Penile shaft
• Histology:
• Claw clutching a ball appearance
Pityriasis rubra pilaris
• Special features:
• Follicular keratotic papules with islands of sparing
• Orange palms
Contact dermatitis
Irritant contact dermatitis to betadine Allergic contact dermatitis to hairdye
Patch test
• Based on
• Applied over
• Read after
• Use
Infections in dermatology
Bacterial infection
Impetigo
Bullous impetigo Non-bullous impetigo
Folliculitis, Furuncle and carbuncle
Erythrasma
• Causative
• Clinical features
• Woods lamp
• Treatment
Cutaneous tuberculosis
• Lupus vulgaris
• Diascopy
• Scrofuloderma
• Tuberculosis verrucosa cutis
Atypical mycobacterial infections
• Fish tank granuloma
• Buruli ulcer
Erythema migrans Erythema marginatum
Viral infections
Molluscum contagiosum
• Causative
• Mode of transmission
• Clinical features
• Histopathology
• Treatment
Viral warts
• Causative
• Mode of transmission
• Clinical features
• Histopathology
• Treatment
Herpes simplex infection
• HSV-1
• HSV-2
• Tzanck smear
Eczema herpeticum
Chicken pox
“Dew drop on rose petal
appearance”
Herpes zoster
Hutchinson sign
Other viral exanthems
• Koplik Spots are seen in
• Forschhiemer spots are seen in
• ‘Islands of white in the Kaposi sarcoma
sea of red’ rash seen in
• Hand foot and mouth
disease caused by
Chickungunya
fever
Fungal infections
Tinea corporis
Candidiasis
Pityriasis versicolor
Deep fungal infections
Sporotricosis
Chromoblastomycosis Mycetoma
Mucormycosis
Protozoal infection
Scabies
Cutaneous leishmaniasis
Cutaneous larva migrans
PKDL
Vesiculobullous disorders
Antibodies against desmosomes and blistering
Pemphigus vulgaris Pemphigus foliaceous
Antibody
against
Sites
involved
Clinical
features
Tzanck smear
Pemphigus vulgaris Pemphigus foliaceous
HPE
DIF
Treatment
Variants
Para neoplastic pemphigus
Antibodies against Hemidesmosomes and related proteins
Linear IgA disease (Chronic
Bullous pemphigoid Bullous disease of
Childhood)
Antibody
against
Sites involved
Clinical features
Tzanck smear
Histopathology
DIF
Treatment
Dermatitis herpetiformis
Antibody against
Associated with
Clinical features
Histopathology
DIF
Treatment
Darier disease
• Mutation- ATP2A2
• Clinical features
• Nails
• Histopathology
• Treatment
Hailey hailey disease
• Mutation- ATP2C1
• Clinical features
• Nails
• Histopathology
• Treatment
Mechanobullous disorder
• Epidermolysis bullosa- types
Pigmentary disorders
Piebaldism+Heterochromia iridis+ SNHL= Waardenburg syndrome
Freckles Versus Lentigens
Café au-lait macules
Dermal melanocytosis
Vitiligo
• Pathogenesis
• Clinical features
• Associated diseases
• Prognostic factors
Chemical leukoderma
Melasma
Chickungunya fever
Becker nevus
Hair
Anatomy
Diffuse hairfall
• Anagen effluvium
• Telogen effluvium
Alopecia areata
Trichotillomania
5
Tinea capitis
Investigation Treatment
Scores/criteria in trichology
Nails
Lindsay nail
• Due to
Terry nail
• Due to
Mees lines
• Due to
Muehrckes nail
• Due to
Green nail
Yellow nail
Other nail findings
Nail pitting
Nail pterygium
• Due to
Onycholysis
• Definition
Onychomycosis
• Caused by
Beau lines
• Due to
Koilonychia
Clubbing
Drugs in skin
Various drug formulation
Various routes of topical drug entry
Sunscreens
Sunscreens
• SPF
Topical steroids
Systemic steroids
Sexually transmitted diseases
Chancroid
Herpes genitalis
Donovanosis
Lymphogranuloma venereum
Syphilis
• Primary
• Secondary
Lymphadenopathy
Snuffles
• Congenital syphilis
• Early
Vesiculobullous
lesions over palms
Hepatosplenomegaly
and soles (Syphilitic
pempnphigus)
Wimberger sign (Specific finding) - B/L erosion of medial aspect of upper end of tibia
• Late
Investigations
• Dark ground microscopy
• Non-treponemal tests
• Treponemal tests
Urethral/ cervical discharge
Nature of discharge
Diagnosis
Caused by
Lab diagnosis
Complications
Vaginal discharge
Nature of discharge
Other clinical findings
Diagnosis
Caused by
Investigations
Syndromic approach of STD
13 Specific findings in
Leprosy
Inverted saucer Swiss cheese pattern Leonine facies,
Lesion with Buddha ears
pseudopodia and plaques
Satellite lesions
Shiny papules/ nodules over
normal skin
Hypopigmented
macules
Histopathology
• Tuberculoid pole leprosy
• Lepromatous pole leprosy
• Virchow cells/Lepra cells-
• Grenz zone is seen in
14 Treatment of Leprosy
Characteristics Paucibacillary leprosy Multibacillary leprosy
Skin lesions
Number nerves
thickened
Slit skin smear
Treatment
Duration of treatment
Treatment of Leprosy
15 Leprosy reactions
Characteristics Type 1 lepra reaction Type 2 lepra reaction
Spectrum of leprosy
Pathogenesis
Skin lesions
Nerve involvement
Other systemic
involvement
Constitutional features
Treatment
Leprosy reactions
Skin tumours
Basal cell carcinoma
• Pathogenesis:
• Common site:
• Clinical features:
• Histopathology
• Treatment
Squamous cell carcinoma
• Clinical feature
• Histopathology
• Marjolin ulcer
Melanoma
Triggers:
Features
A
B
C
D
E
• Hutchinson sign
• Breslow thickness
• Clarke Level
• Histopathology- IHC
• Treatment
Cutaneous T cell Lymphoma
• Stages
• Sezary syndrome
Histopathology
• Pautrier microabscess
• Toy soldier sign
Miscellaneous topics
Nutritional deficiencies- Kwashiorkor
Phrynoderma
Pellagra
Vitamin B12 deficiency
Scruvy
Acrodermatitis enteropathica
• SLC39A4
• Skin lesions-
• Diarrohea
• Alopecia
Eccrine sweat glands
• Eccrine sweat glands are numerous in palms and soles
• Acrosyringium
• Function
• Obstruction to the duct
Miliaria
• Miliaria crystalline
• Miliaria rubra
• Miliaria profunda
Apocrine sweat glands
• Numerous in
• Active after puberty
• Function:
• Modifications:
Sebaceous gland
• Type of
• Numerous in
• Active after
• Fordyce spots
Opening of the glands:
• Eccrine sweat glands
• Apocrine sweat glands
• Sebaceous glands
Acne vulgaris
• Pathogenesis
• Hormone
• Infection
• Grading
• Treatment
• Grade 4 acne-
Rosacea
• Pathogenesis
• Organism
• Types
• Treatment
Hidradenitis suppurativa
• Follicular occlusion
Neurofibromatosis
• Type- 1: Chromosome 17 (Neurofibrin)
• Type- 2: Chromonsome 22 (merlin or Schwannomin)
• Schwannoma- Acoustic neuroma
• Meningioma
• Ependymoma
Neurofibromatosis type 1
Skeletal
Tuberous sclerosis (Bournville disease)
• EPILOA (Vogt triad)
• TSC-1 (9th chromosome- Hamartin), TSC-2 (16th chromosome-
Tuberin)
Skin manifestations
• Dental enamel pits
• Confetti like hypopigmentation
• Gingival fibroma
Other systems
• Renal angiomyolipoma
• Pulomonary lymphangio leiomyomatosis
• Cardiac rhabdomyoma
CNS-
• Cortical tubers
• Subependymal nodule
• Subependymal giant cell astrocytoma
Sturge weber syndrome (Encephalotrigeminal
angiomatosis)
• Eye- • Leptomeningeal angioma-
Tram track appearance
Drug reactions
Erythema multiforme
SJS-TEN
• Triggers
• Atypical target lesions
• Pseudo-nikolsky sign
Skin ulcers due to vascular causes
Venous ulcer
Arterial leg ulcer
Vasculitis
Small vessel vasculitis
Henoch Scholein purpura
Cutaneous polyarteritis nodosa
Urticaria
• Pathogenesis
• Types
• Clinical features
Dermatographism
Angioedema
• Triggering drugs
• Hereditary angioneurotic edema:
• Due to
Dermatomyositis
SLE
Acanthosis nigricans
Signs of diabetes mellitus
• Granuloma annulare
• Necrobiosis lipoidica Diabetic dermopathy
Signs of thyroid disorder
• Pretibial myxedema
Thank you
