Dermatology

DR. JAZEER ABDUL KHADER

WHERE THE ART OF MEDICINE

IS LOVED, THERE IS ALSO LOVE
FOR HUMANITY.
HIPPOCRATES
Dr. Jazeer Abdul Khader MBBS, MD Dermatology is a
distinguished educator with extensive experience in the
field of dermatology. For several years, he has been
actively involved in teaching postgraduate aspirants and
FMGE students,
Employing a distinctive teaching methodology based on
visual aids. The innovative approach, utilizing images to
enhance learning, has garnered widespread recognition.
His profound knowledge and effective teaching style
have earned him high regard among scholars, benefiting
numerous individuals in their academic and professional
journeys.

drjazeerdermatology
 INDEX
Topic Page No.

1. INTRODUCTION TO DERMATOLOGY 1
2. APPENDAGEAL DISORERS 27
3. ECZEMA & DERMATITIS 42
4. PAPULOSQUAMOUS DISORDER 52
5. URTICARIA, ANGIODERMA & REACTIVE ERYTHEMAS 65
6. PIGMENTARY DISORDER 70
7. VESICULOBULLOUS DISORDERS 78
8. BACTERIAL SKIN INFECTIONS 90
9. VIRAL SKIN INFECTION 98
10. FUNGAL SKIN INFECTIONS 106
11. MYCOBACTERIAL SKIN INFECTIONS 114
12. PARASITIC SKIN DISEASES 124
13. SEXUALLY TRANSMITTED INFECTIONS 127
14. GENODERMATOSIS 138
15. NUTRITIONAL DERMATOSES 145
16. NEVI, HAMARTOMA & BEGIGN SKIN TUMORS 149
17. PRE-MALIGNANT & MALIGNANT CONDITIONS OF SKIN 156
18. CUTANEOUS DRUG REACTIONS 160
17. MISCELLANEOUS 163
Introduc�on to Dermatology

Stratum
corneum

Stratum
lucidum

Stratum
granulosum

Stratum
spinosum

Stratum
basale

1
Stratum Basale

Stratum germinativum

Stratum Spinosum
Prickle cell layer

Stratum Malpighi

2
Stratum Granulosum

Stratum Lucidum Clear cell layer

Stratum Corneum Horny cell layer

3
 Epidermal Turn over time

Melanocytes

4
Why do all of us have different skin colors?

5
Why do we have a uniform skin color in our body, except for
areas of tanning?

6
 Merkel Cells

Langerhan Cell

7
DERMIS

8
Subcutaneous Layer

9
 Summary

Vitamin D production

The layer deficient in preterm baby

Layer in which Langerhans cells are seen

Stratum malpighi

Epidermal melanin unit

Melanocytes derived from

Inflammation of subcutaneous lobules

Type 1 Skin type Always tans , Never

Burns

Prickle cell layer

Stratum germinativum

10
Primary Skin Lesions

11
12
13
Extravasation of blood into the skin

14
Secondary Skin Lesions

15
16
17
18
Special Skin Lesions

19
Inves�ga�ons in Dermatology

20
21
22
 Histopathology

Stratum Corneum

Hyperkeratosis

Parakeratosis

Stratum Granulosum

Hypergranulosis

Hypogranulosis

Stratum Spinosum

Acanthosis

Acantholysis

23
Rete Ridges

Regular elongation

Saw toothing

Microabscess

Neutrophils

Lymphocytes

Eosinophils
Other findings

Ballooning

Spongiosis

24
Skin Lines

25
 Summary

Macule >1 cm diameter

Elevated fluid-containing lesion < 1cm

Edematous transient lesion that lasts <24 hours

Special skin lesion seen in acne vulgaris

Filter in wood's lamp

Skin Lines important for surgical incision

Investigation in suspected superficial fungal infection

Patch test is best interpreted at

Erythema blanches on diascopy

Basket weave HPE

Presence of nucleus in stratum corneum in oral and

vaginal mucosa is Normal (true or false)

Example of neutrophilic microabscess

Spongiosis in histopathology is characteristic of

26
Appendageal Disorders - HAIR

Anagen

Telogen Catagen

27
Androgenic Alopecia

28
Alopecia Areata

29
Trichotillomania

30
Anagen Effluvium Telogen Effluvium

31
 Summary

Duration of anagen phase

Duration of telogen phase

Miniaturization of hair is a hallmark

of

Christmas tree pattern hair loss in

female

Nail pitting in alopecia areata

Treatment of traction alopecia

Increased hair loss after

surgery/pregnancy/anaemia

32
Diseases of the Nail

33
 Leukonychia

Apparent Leukonychia

34
35
Diseases of sweat glands and sebaceus glands

36
Acne Vulgaris

37
38
39
Rosacea

40
 MCQ

Q. A 24-year old unmarried woman has Q. A male patient presents with patchy hair
multiple nodular, cystic, pustular and loss of hair on scalp, eyebrows and beard.
comedonal lesions on face, upper back He has also history of rapid graying of hair
and shoulders for 2 years. The drug of in few areas. Likely diagnosis is:
choice for her treatment would be:
A. Alopecia effluvium
A. Acitretin B. Alopecia areata
B. Isotretinoin C. Telogen effluvium
C. Doxycycline D. Androgenetic alopecia
D. Azithromycin

Q. A 17 year old girl with Acne has been Q. A patient presented to the clinic with red
taking a drug for the last two years. She rashes over her face. After the lab tests, she
now presents with blue black pigmentation was found to have anti-nuclear antibody
of nails. The likely medication causing the positive. These rashes are called as;
above pigmentation is:

A. Tetracycline
B. Doxycycline
C. Minocycline
D. Azithromycin

Q. Alopecia universalis is ? A. Heliotrope rashes

B. Allergic rashes
A. Loss of all the scalp hair C. Malar rashes
B. Loss of all body hair D. Rosacea rashes
C. Loss of hair at the scalp margin
D. Male pattern hair loss

41
 Eczema
IRRITANT CONTACT ALLERGIC CONTACT DERMATITIS
DERMATITIS

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

42
 • Bindi dermatitis
• PTBP (para tertiary butyl phenol)

• Footwear dermatitis- PPD (paraphenylenediamine)

43
 Summary

MC cause of Irritant
Contact Dermatitis

MC cause of Allergic
Contact Dermatitis

MC metal causing ACD

MC topical drug causing

ACD

44
 Chemical Leukoderma

MONOBENZYLETHER OF
HYDROQUINONE

PARA TERTIARY BUTYLPHENOL –

PTBP

PARA TERTIARY BUTYL CATECHOL –

PTBC
PARA PHENYLENEDIAMINE - PPD

Atopic Derma��s

45
INFANTILE AD CHILDHOOD AD ADULT AD

46
47
Endogenous Eczema

48
49
 Summary

Chronic erythematous itchy condition with

sharply marginated lesions covered by
yellowish greasy scales

Single coin like clearly demarcated eczematous

plaque

Scalp Seborrheic dermatitis in infant

Lack of skin surface lipids, dry skin with crazy

paving reticulate pattern with minimal
inflammation

Crops of clear vesicles with severe itching over

the palms and soles with sago-grain appearance

Eczema associated with venous insufficiency

and chronic edema involving lower limb

50
 MCQ

Q. This phenomenon is seen in Q. A 15 year old girl comes with itchy lesions on
elbow . Her family history is positive for Asthma,
what could bw the probable diagnosis?

A. Seborrhoeic dermatitis
B. Atopic dermatitis
C. Allergic contact dermatitis
D. Erysepalas

A.Chronic Urticaria
B. Atopic dermatitis Q. Most common cause of skin infection in
C Angioedema atopic dermatitis
D. Pressure dermatitis
A. Staphylococcus aureus
B. HSV
C. Fungal infections
Q. Spongiosis is seen in : D. Streptococcus

A. Acute eczema
B. Chronic eczema
C. Psoriasis
D. Pemphigus

51
Papulosquamous Disorders
Plaque Psoriasis

52
Pustular Psoriasis

53
Psoriatic Arthritis

Radiological changes in Psoriasis

P Pencil in cup deformity

O Osteolysis

I Ivory Phalanx

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

54
Nail Findings in Psoriasis

55
56
 Histopathology
Munro’s Microabscess

Spongiform Pustule of Kogoj

Suprapapillary thinning

Management

TOPICAL PHOTOTHERAPY SYSTEMIC AGENTS

Corticosteroid
Methotrexate
Clobetasol

Keratolytic agents:
Narrowband UVB
- Salicylic acid Cyclosporine
Broadband UVB
- Coal tar PUVA

Vit D analogues:
-Calcitriol Acitretin
-Calcipotriol

Topical retinoid:
-Tazarotene Systemic Steroids

57
 BIOLOGICAL AGENTS

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

Adalimumab
Etanercept TNF alpha inhibitor
Infliximab

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

NOTE:

SYSTEMIC STEROIDS ARE C/I IN PSORIASIS

Use of Systemic steroids in Psoriasis leads to -

If patient develops Von-Zumbusch Reaction, DOC -

Teratogenicity of Acitretin -

ONLY INDICATION OF SYSTEMIC STEROIDS IN PSORIASIS -

58
 SUMMARY

Pathognomic nail change in psoriasis

DOC for pustular psoriasis

DOC for pustular psoriasis in pregnancy

MC joint involved in psoriatic arthritis

Lake of pus

Dermatological emergency in
psoriasis
Neutrophilic abscess seen in
psoriasis

Teratogenicity of acitretin

Pinpoint bleeding points seen on

removal of the scales in psoriasis

59
Pityriasis Rosea

60
Lichen Planus

61
 Histopathology

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

62
Pityriasis rubra pilaris

63
 MCQ
Q. A patient with psoriasis was started on Q. Lichen planus associated with all
systemic steroids. After stopping the except
treatment, patient developed generalized
pustules all over the body. Most likely A. Pterygium
cause of this condition will be: B. Thickened nail bed
C. Trachyonychia
A. Bacterial infection D. Tented nail
B. Septicemia
C. Drug induced reaction
D. Pustular Psoriasis Q. A 35 year old male presents to your clinic
with deep seated pustular lesions on the palms
and soles. The pustules are sterile on
Q. All of the following regarding Lichen examination. What is the most probable
Planus are true except : diagnosis :

A. Does not involve mucous membrane

B. Associated with Hepatitis ‘C’
C. Topical Steroid are the Mainstay
of Therapy
D. Spontaneous Remissions 6 months
to 2 years A. Lichen Planus
B. HSV infection
C. Palmoplantar Psoriasis
Q. Psoralen + Ultraviolet light (PUVA) D. Contact Dermatitis
therapy is useful in the treatment of :

A. Psoriasis Q. A young lady presents with white lacy

B. Vitiligo lesions in oral cavity and her proximal nail fold
C. Mycosis Fungoides has extended onto the nail bed. What is the
D. All of the above likely diagnosis?

A. Psoriasis
Q. DOC for a pregnant woman in 2nd B. Lichen planus
trimester with pustular psoriasis is C. Pityriasis rosea
D. Candidiasis
A. Prednisolone
B. Dapsone
C. Acitretin
D. Methotrexate

64
 Ur�caria

Lesions disappear <24hrs Lesions disappear >24hrs

Chronic Spontaneous Physical

Stimuli Type of urticaria

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

65
 Red dermographism

White dermographism

Black dermographism

Angioedema

66
Ur�caria Pigmentosa

67
Reac�ve Erythemas

68
 Summary

Urticarial lesion persisting for more

than 24 hours

Urticaria developing after sun

exposure

Urticaria developing after sweating

Darier’s sign is seen in

Treatment choice for Anaphylaxis

69
Pigmentary Disorders
Vi�ligo

70
71
72
Differential diagnosis of Child with hypo pigmented patches over face

INDETERMINATE
PITYRIASIS ALBA LEPROSY

Summary

Vitiligo that doesn’t cross midline

and runs along dermatome

Disease showing Koebner's

phenomenon

Vitiligo like patches with white

forelock

Hypopigmented scaly patches over

face of child without any sensory
deficit

73
74
Cafe au lait macules

75
Ceruloderma

76
 MCQ
Q. year old boy presents with recurrent, Q. All are true about this condition except
scaly, hypopigmented patch on face,
diagnosis is :

A. Genetic predisposition is known

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

Q. Diagnose the underlying pigment Q. Identify the image given below?

disorder shown in the pregnant lady;

A. Lentigines A. Nevus of Ito

B. Freckles B. Melasma
C. Phototoxic reaction C. Mongolian spot
D. Chloasma D. Nevus of Ota

77
 Vesiculobullous Disorders
- attaches one keratinocyte to other

Examples of Desmosomes :

Desmosome abundant in Upper epidermis -

Desmosome abundant in Lower epidermis -

Thin layer between Epidermis and Dermis -

- Attaches Basal keratinocytes to BMZ / DEJ

Examples of Hemidesmosomes -

78
79
 Pemphigus Vulgaris

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

80
Pemphigus Vegetans

81
 Pemphigus Foliaceous

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

82
 Bullous Pemphigoid

AGE

TARGET
ANTIGEN

SITE

LEVEL OF SPLIT

BULLA

MUCOSAL
INVOLVEMENT

TZANCK SMEAR

HPE

DIF

MANAGEMENT

83
 Pemphigoid Gesta�onis

Herpes Gestationis

Linear IgA Disease

Chronic bullous disease of childhood

84
 Derma��s Herpe�formis

Duhrings disease

85
 Summary

Most common blistering disease in

children
Blistering disease in young adults
presenting with papulovesicles

Blistering disease in middle age 40-60

years old with positive Nikolsky sign

Blistering disease in elderly pts with

negative nikolsky sign

Blistering disease in pregnancy

Cerebriform tongue
Desmoglein-3 and desmoglein-1
defect
Site of lesion in pemphigus foliaceus

String of pearl appearance

Blistering disease where dapsone is
used in the treatment

DIF in Dermatitis herpetiformis

DIF in Linear IgA disease

86
Inherited Bullous diseases
Darier’s Disease

87
Hailey-Hailey Disease

Benign familial pemphigus

88
 MCQ

Q. Dyskeratosis is seen in: Q. A 30 year old man had severely itchy papulo-
vesicular lesions on extremities, knees, elbows
A. Darier’s disease and buttocks for one year.
B. Pemphigus vulgaris Direct Immunofluorescence staining of the
C. Eczema lesions showed IgA deposition at
D. Epidermolysis bullosa dermoepidermal junction. The most probable
diagnosis is :

Q. Identify the skin disorder in a 70 year A. Pemphigus Vulagris

old male? B. Bullous Pemphigoid
C. Dermatitis Herpetiforms
D. Nummular Eczema

Q. Eruptions of herpes gestationalis begins from

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

89
Bacterial Skin Infec�ons

90
91
 Impe�go

NON-BULLOUS IMPETIGO BULLOUS IMPETIGOGO

STREP. > STAPH AUREUS STAPH. AUREUS

ERYTHROMYCIN DICLOXACILLIN

92
 Ecthyma

Ecthyma Pyogenicum

Ecthyma Gangrenosum

Ecthyma contagiosum

93
 ERYSIPELAS CELLULITIS

CAUSATIVE
ORGANISM

BORDERS

94
Necro�zing fasci�s

95
Staphylococcal Scalded Skin Syndrome

Scarlet Fever

96
 Summary

Crops of pustules

Causative of Ecthyma
Gangrenosum

Golden yellow, honey

coloured crusts

Varnish crust

Chocolate crust

Necrotising fasciitis localized

to scrotum

Tissue paper like wrinkling of skin,

Potato chips desquamation.

Boiled lobster appearance,

Sunburn with goose pimples.
Sandpaper rash, strawberry tongue.

Pseudomonas infection of the nail.

Green nail syndrome.

97
Viral Skin Infec�ons

HPV infec�ons (warts)

98
99
 Summary

Characteristic HPE finding in Molluscum

contagiosum

Characteristic HPE finding in HPV

Treatment of Choice of Genital warts

Treatment of Choice of Genital warts in

pregnancy

100
HSV Infec�ons

101
Varicella infec�on

102
 Post-herpetic Herpes Zoster Herpes Zoster Oticus
Neuralgia Ophthalmicus

Rx: Hutchinson’s sign: Ramsay Hunt

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

103
Fever + Arthralgia

104
 Summary
Grouped vesicles on an
erythematous base

Grouped vesicles on an
erythematous base on a dermatomal
distribution

Painful vesicles over the fingertips

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

MCQ
Q. Where does the latent varicella zoster Q. A 45 year old male has multiple grouped
virus resides in the body: vesicles on T 10 dermatome associated with
pain. What is the most probable diagnosis ?
A. Lymph nodes
B. T-cells A. Scabies
C. Nerve ganglion B. Herpes simplex
D. Skin C. Herpes zoster
D. Dermatitis herpetiformis
Q. A 3 year old girl develops multiple
umbilicated papules over the face. Q. Forchheimer spots are seen in:
The characteristic histopathological
feature would be ? A. RUBELLA
B. ROSEOLA
A. Russel Bodies C. ERYTHEMA INFECTIOSUM
B. Molluscum Body D. MEASLES
C. Henderson Patterson Body
D. Sclerotic Body Q. Bushke - Lowenstein Tumor is:

Q. Identify the sign marked on the A. HIGH GRADE

given image : B. HISTOLOGICALLY MALIGNANT
C. HPV 16, 18
A. Darrier sign D. LOCALLY INVASIVE
B. Auspitz sign
C. Hutchinson sign
D. Nikolsky sign

105
 Fungal Skin Infec�ons
DERMATOPHYTOSIS

SKIN HAIR NAIL

TRICHOPHYTON

EPIDERMOPHYTO
N
MICROSPORUM

CENTRAL CLEARING

CENTRAL SCARRING

CENTRAL CRUSTING

106
TINEA CAPITIS

107
TINEA UNGUIUM

108
 Tender boggy swelling in scalp + lymphadenopathy

Shield like scutulum,Endemic in kashmir

Steroid Modified Tinea

Most common type:

TINEA
UNGUIUM Most common in HIV patients:

Drug of choice in Tinea Capitis

Drug of choice in Tinea Corporis, Tinea Cruris, Tinea

Pedis

109
Candidiasis

110
 Pityriasis Versicolor

Deep Fungal Infec�ons

Sporotrichosis

111
Chromoblastomycosis

Madura Foot

112
 MCQ

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

A. Biopsy and Giemsa evaluation

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

113
Mycobacterial Skin Infec�ons

114
115
 TREATMENT OF CUTANEOUS TB

HRZE HRE

2 months 4 months

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

Summary

Warty type of cutaneous TB

Ulcerative type of cutaneous TB

Plaque type of cutaneous TB

MC Cutaneous TB in Children

116
 Leprosy

LEPROMATOUS
TUBERCULOID TYPE
LEPROSY

SKIN
LESIONS

SIZE

SENSATION

SSS
SKIN
SMEAR

LEPROMIN
TEST

117
118
119
 MDT

Paucibacillary Multibacillary

6 months 12 months

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

Type of patient
affected :

Skin lesions :

Treatment:

120
 NERVE DISABILITY

Ulnar nerve

Median nerve

Radial nerve

Lateral popliteal
nerve

Posterior tibial
nerve

Trigeminal nerve

Facial nerve

121
 Summary
MC type of leprosy

Rarest type of leprosy

Saucer right way up
appearance
Satellite lesions
Pseudopodia( finger like
projections)

Inverted saucer
appearance
Swiss cheese appearance

Almost symmetrical
lesions in leprosy

Glove & stocking pattern

sensory loss

Saddle Nose deformity,

Leonine Facies

MC cranial nerve
involved
MC peripheral nerve
involved
First sensation lost in
leprosy
Globi in SSS
Lepra reaction is the
adverse drug reaction

122
 MCQ

Q. A 12 year old boy had a gradually Q. The image given below demonstrates
progressive plaque on the buttocks for involvement of which nerve in leprosy.
the last 3 years. The plaque was 15 cm
in diameter, annular in shape with crusting
and induration at the periphery and
scarring at the centre. What is the most
likely diagnosis ?

A. Tinea Corporis
B. Granuloma Annulare
C. Lupus Vulgaris
D. Borderline Leprosy A. Facial Nerve
B. Optic Nerve
C. Oculomotor Nerve
Q. Scrofuloderma most commonly arises D. Trigeminal Nerve
from the following underlying structure:

A. Subcutaneous tissue Q. What is the indication of Thalidomide

B. Lymph nodes use in leprosy :
C. Joint
D. Bone A. Tuberculoid leprosy
B. Type-1 reaction
C. Erythema nodosum leprosum
Q. Which form of leprosy shows the D. All of the above
pattern of lesion shown in image?

Q. The average incubation period of Leprosy is :

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

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

123
Parasi�c Skin Infec�ons

124
125
 Summary
Circle of Hebra

Pathognomic skin lesion in scabies

Scabies seen in immunosuppressed individuals like

HIV, malignancy or neurological diseases

Creeping eruptions / Lesions that moves few mm

every day

126
 Sexually Transmi�ed Infec�ons

GENITAL ULCERS

PAINLESS PAINFUL

SYPHILIS CAUSATIVE SYPHILIS

Treponema pallidum Haemophilus ducreyi

INCUBATION PERIOD:

9 – 90 days 3-5 days

Primary Syphilis Chancroid

127
Primary Syphilis Chancroid
CHARACTERISTICS OF ULCER

LYMPHADENOPATHY

128
Primary Syphilis Chancroid

129
 LGV Donovanosis
CAUSATIVE

Chlamydia trachomatis Klebsiella granulomatis

L1, 2 ,3

INCUBATION PERIOD:

3 – 30 days 8 – 80 days

CHARACTERISTICS OF ULCER

LYMPHADENOPATHY

130
 LGV Donovanosis

INVESTIGATIONS

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

TREATMENT:

Doxycycline Azithromycin

Azithromycin Doxycycline

COMPLICATIONS

131
Herpes Genitalis

132
 SUMMARY

A genital ulcer on smear shows

closed safety pin appearance
Ulcer not concomitant with
lymphadenopathy
Genital ulcer showing gram-ve
coccobacilli in a
School of fish pattern or
railroad track appearance
An STI with multiple pearly
white dome shaped umbilicated
papules in the groin
Painless ulcer + painless
lymphadenopathy

Painless transient ulcer followed

by painful lymphadenopathy

Multiple painful ulcer with

undermined edge + unilateral
painful lymphadenopathy

Polycyclic erosions, Multiple

painful ulcer + bilateral painful
lymphadenopathy

Ulcer that bleeds to touch with

subcutaneous inguinal swelling

133
Syndromic Management of STI

134
Secondary Syphilis

135
Early Congenital Syphilis

Late Congenital Syphilis

136
 MCQ
Q. A young man presents with Q. Which among the following STI`s exhibit the
asymptomatic macules and erythematous type of alopecia as shown in the image:
painless lesion over glans with generalized
lymphadenopathy. Treatment of Choice in
this condition:

A. Ceftriaxone
B. Benzathine penicillin C. Acyclovir
D. Fluconazole

A. Primary Syphilis
B. Chancroid
Q. The most frequent cause of recurrent C. LGV
genital ulceration in a sexually active D. Secondary Syphilis
male is:

A. Syphilis Q. Diagnose the STD shown on the Image?

B. Herpes Genitalis
C. Aphthous Ulcer
D. Chancroid

Q. A man presents with maculopapular

rash 2 weeks after having a genital ulcer
as shown below. Causative organism of A. Chancroid
the condition is: B. HIV
C. Donovanosis
D. LGV

A. H. ducreyi
B. Treponema pallidum
C. Granulomatis
D. Chlamydia

Q. School of fish appearance is shown by

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

137
 Genodermatoses
Neurofibromatosis I
Diagnostic Criteria NF1

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

in children )

R Relative with NF1

A Axillary or inguinal freckles

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

B

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

N Neurofibromas (2 or more) or 1 plexiform neurofibroma

G Glioma of optic nerve

2 out of 7 required for confirmation

Von Reckling Hausen Disease

138
139
 Diagnostic Criteria NF2

MI Multiple Inherited

S Schwannoma

M Meningioma

E Ependymoma

• Most classical feature :

• Presence of Bilateral acoustic neuroma – certainly indicate

NF2

• C/F common to NF1 & NF2 :

140
Tuberous Sclerosis
Bourneville disease

141
 Xeroderma Pigmentosum

P Photosensi�vity

P Premature ageing

P Pigmentary changes

P Pre-malignant & malignant changes

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

Incon�nen�a Pigmen�

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

142
 Ichthyosis

Ichthyosis X Linked Lamellar

Vulgaris Ichthyosis Ichthyosis
AD XLR AR
Defect of
Defect of steroid
Defect of filaggrin transglutaminase
sulfatase enzyme
-1 enzyme

143
 Summary

Pathognomonic sign of NF1

Clinical feature common in

NF1 & NF2

Bag of worms

Vogt’s triad

Dryness of skin +
photosensitivity +
photophobia

VVHH

Defect of filaggrin

Ash leaf macules

Q. Regarding X-linked Ichthyosis all Q. A boy presents with history of severe sunburn
are true except : after only a few minutes exposure to sunlight.
There is freckling over the sun exposed areas,
A. Steroid sulfatase deficiency dry skin and some pigmentary changes in the
B. Extensor distribution sparing flexures skin as given in image. What is the most possibl
C. Large dark brown scales diagnosis
D. More common in males

Q. 30 year old female presents with

seizures, Her past history reveals that she
is on antiarrhythmic drugs, On General
Examination she has skin lesions as
shown in the figure below. What other
findings is associated in this patient?

A. Port wine stain A. Icthyosis

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

144
Nutri�onal Dermatosis

145
Pellagra

146
 Scurvy

Acroderma��s Enteropathica

147
 Summary
Casal’s necklace

Phrynoderma and Bitot’s spot

Flag sign

Monkey facies, alopecia and severe

muscle wasting

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

Periorificial dermatitis presenting during

weaning periods

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

Q. Which of the following feature are true

regarding the marasmus child in the given
image?
A. Beriberi
B. Pellagra
C. Porphyria Cutanea Tarda
D. Scurvy

A. Crazy pavement /Flaky dermatoses

B. Flag sign
C. Monkey facies
D. Diffuse edema

148
Nevi, Hamartoma and Benign Skin Lesions

Congenital Melanocy�c Nevus

149
Acquired Melanocy�c Nevus

150
 Hypopigmented or pale Lesions present since birth

NEVUS DEPIGMENTOSUS NEVUS ANEMICUS

Aka: Nevus achromicus

Hypopigmented lesions since birth

Hypopigmented lesions over face in a

child

Hypopigmented / Depigmented
lesions in middle aged patient -
absence of melanocytes
Generalized depigmented skin since
birth

151
Vascular Anomalies

152
153
154
 Summary

Emptying sign is demonstrated in

Port Wine stain regresses by 1 year of
age
Sudden multiple eruption of seborrheic
keratosis
MC cyst in the skin
Universal tumor
Skin lesion seen in Peutz jeghers
syndrome
Dimple sign
Small raised nodular lesion that bleeds
on touch on trivial trauma

155
PRE-MALIGNANT & MALIGNANT CONDITIONS OF SKIN
Basal Cell Carcinoma

Squamous Cell Carcinoma

156
 Malignant Melanoma

TYPESOF MM (SANAL)

SUPERFICIAL ACRAL AMELANOTIC LENTIGO

SPREADING LENTIGINOUS NODULAR MM MELANOMA MALIGNA
MM MELANOMA

157
 MYCOSIS FUNGOIDES

HPE :

Localized collection of T-
lymphocytes in the epidermis

Atypical lymphocytes in the

epidermis & dermis

158
 Summary

ABCDE

Most common type of malignant

melanoma in India

Most common type of skin cancer

Type of BCC that destroys the
tissue underneath it
Typical HPE finding in BCC
Most common skin cancer in dark
pigmented races
SCC developing over burns or
scars
MC primary lymphoma of skin
Lymphocyte abscess seen in
mycosis fungoides

159
Cutaneous Drug Reac�ons
Fixed Drug Erup�ons

SJS & TEN

160
161
 MCQ
Q. A 55 year old woman has well Q. A 3-month old male infant developed a
demarcated reddish brown macular rash furuncle. A few days later, he developed blisters,
on her arm. The lesion occurs periodically peeling of the skin; there were no mucosal lesions
and resolves slowly, with some persisting The most likely diagnosis is?
hyperpigmentation. She is otherwise
healthy and takes no medications except A. Infantile pemphigus
an occasional laxative B. Stevens Johnson syndrome
C. Staphylococcal scalded skin syndrome
D. Toxic epidermal necrolysis

A. Urticaria
B. Lichen Planus
C. Pemphigus
D. Fixed drug eruption

Q. What is not true about Erythema

multiforme ?

A. Associated with Herpes simplex

B. Involves distal parts of extremities
C. Target lesions
D. No vesicle

162
Miscellaneous Topics

163
Dermatomyosi�s

164
165
 Woods Lamp Findings
Disorder Fluorescent colour

Brilliant green
Tinea capitis
Green

Pityriasis versicolor Pale yellow to Apple green

Erythrasma Brilliant coral red

Tuberous sclerosis Pale white (bluish)

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

Porphyria cutanea tarda Red/pink

KOH Findings
Disorder Finding

Dermatophytosis Fungal hyphae

Candidiasis Pseudo-hyphal filaments

Banana & grapes appearance

Pityriasis versicolor Spaghetti & meatballs appearance

Tzanck Smear Findings

Conditions Type of cells

Pemphigus vulgaris Tzanck cell / Acantholytic cells

Multinucleated giant cells (MNG) and

Herpes simplex, varicella & herpes zoster
Tzanck cells

166
 Diascopy Findings
Disorder Sign

Pure erythema due to vasodilation Blanching

RBC extravasation petechiae/purpura Non–blanching

Lupus vulgaris Apple jelly nodules / Golden brown nodules

Sarcoidosis Sago grain appearance

Nevus Depigmentosus Non Blanching

Nevus anemicus Blanching

167
 INTERPRETATION DIRECT IMMUNOFLUORESCENCE :

Disorder Pattern seen

Pemphigus vulgaris IgG and C3 deposition in epidermis

Pemphigus foliaceus showing a fishnet pattern

Linear deposits IgG and C3 at

Bullous pemphigoid
dermo epidermal junction

Linear deposits IgA at dermo-

Linear IgA disease
epidermal junction

Granular IgA deposits at papillary

Dermatitis herpetiformis
tips

168