2. Which malignancy is Associated
with Acanthosis nigricans ?
1a
Dr. Sherif
Badrawy
Digitally signed by Dr. Sherif
Badrawy
DN: cn=Dr. Sherif Badrawy,
o=KKUH, ou=Critical Care,
email=sherif_badrawy@yahoo.c
om, c=SA
Date: 2015.05.29 03:20:36
+03'00'
25. ♕ SUN, BIOPSY AND REMOVE.
❐ All dermal malignancies occur more
frequently in those with pale skin on more
SUN-EXPOSED AREAS.
❐ Diagnosis is by BIOPSY and the
treatment is with surgical REMOVAL.
❐ No form of skin has effective
chemotherapy.
12b
27. ABCDE
A: asymmetry
B: border irregularity
C: color irregularities
D: diameter > 6 mm
E: evolution (changing in appearance over time)
Worst prognosis with growing lesions.
The diameter of melanoma has not shown to be a
poor prognostic factor.
Surface ulceration is a poor prognostic factor.
13b
33. ✿ Surgical removal with Good safety
margin.
✿ Interferon IV in widespread
disease.
✿ Melanoma has a strong tendency
to metastasize to the brain.
16b
35. ☀ SUN-EXPOSURE 〘UV light is the most
common cause〙
☀ organ transplant dt long-term use of
immunosuppressants.
☀ chronically draining infectious sinuses (as in
osteomyelitis).
☀ Most SCCs occur in older adults (peak age is
66 years) with sun-damaged skin, arising from
actinic keratoses.
17b
45. Mohs micrographic surgery.
〈Removal of skin cancer under a
dissecting microscope with
immediate frozen section〉This
doesn't give a chance for a big safety
margin as no need to remove a wide
margin routinely.
22b
49. reddish/purplish because it is more vascular than
other forms of skin cancer. KS is also found in the GI
tract and in the lung.
oedema of the lower limb dt lymphatic obstrucion
➜may spreasd to LNs
Only AIDS acquired through sexual contact is
associated with KS;
AIDS from injection drug use is rarely associated
with KS.
Incidence of KS is decreasing since 90s
24b
51. ✿ Treat the AIDS with antiretrovirals and the
majority of KS will disappear as the CD4 count
improves.
✿ judicious local Radiotherapy can contain them +
Surgical resection may be used but can't contain
them
✿ Intralesional vincristine or interferon are very
successful.
✿ If these fail, use chemotherapy with liposomal
doxorubicin.
25b
55. ★ premalignant skin lesions from high-intensity
sun exposure in fairskinned people.
★ 【Small, crusty or scaly, lesions
,Multiple】lesions may be present
★ small risk of squamous cell cancer
transformation.
★ slow to progress, but must be removed with
curettage, cryotherapy, laser, or topical 5-
fluorouracil or imiquimod
27b
57. These lesions are extremely common in
the elderly
HYPERPIGMENTED lesions commonly
referred to as liver spots. They give a
"STUCK ON" appearance.
may look like melanoma to some
people,but seborrhoeic keratoses
have no premalignant potential
28b
61. ✿ overactivity of mast cells and the
immune system
✿ Asthma
✿ Allergic rhinitis
✿ Family history of atopic disorders
✿ Onset before age 5, very rare to
start after age 30
30b
63. ✿ PRURITUS and scratching is the most common
presentation.
✿ LICHENIFIED SKIN :scaly rough areas of
thickened skin on the face, neck, and skin folds of
the popliteal area behind the knee.
✿ SUPERFICIAL SKIN INFECTIONS from
Staphylococcus are common because
microorganisms are driven under the epidermis by
scratching. This, in turn, leads to more itching.
31b
65. ✿ Dx is mainly CLINICAL.(Diagnostic Criteria for Atopic
Eczema)
❃ AN 【ITCHY SKIN 】CONDITION IN THE LAST 12
MONTHS
❃ Plus three or more of
☀ Onset below age 2 years
☀ HISTORY OF FLEXURAL involvement
☀ VISIBLE FLEXURAL dermatitis
☀ History of generally DRY skin
☀ history of other ATOPIC disease
✿ lgE levels are elevated in atopic dermatitis.
32b
67. ✿ 【Topical corticosteroids】are used in flares of disease.
Oral steroids are used only in the most severe acute flares of
disease.
✿ Tacrolimus and pimecrolimus are T cell-inhibiting agents
➜ longer-term control and help get the patient off
steroids.used topically for atopic dermatitis dt immune
system hyperactivity.
✿ Antihistamines
✿ Antibiotics when impetigo occurs
✿ Ultraviolet light (phototherapy) for severe recalcitrant
disease
33b
71. ☀ Simple emollients
☀ TOPICAL STEROIDS (high-potency): fluocinonide, triamcinolone,
betamethasone, clobetasol
⋆ NB :Flexural psoriasis➜ emollients ,topical steroids
☀ VITAMIN A AND VITAMIN D OINTMENT help get the patient off steroids.
The vitamin D agent is CALCIPOTRIENE. Steroids cause skin atrophy.
☀ COAL TAR preparation (probably inhibit DNA synthesis)
☀ Dithranol: inhibits DNA synthesis, wash off after 30 mins, SE: burning,
staining
☢ Phototherapy Narrow band ultraviolet B light is now the treatment of choice
☢ PUVA (psoralen + ultraviolet A light)(Photochemotherapy) is also used
35b
73. hypersensitivity reaction to a dermal
infection with noninvasive
dermatophyte
organisms.(Pityrosporum ovale)
It is increased in:
• AIDS
• Parkinson disease
37b
75. ❀ preparations containing【zinc pyrithione 】('Head
& Shoulders') and tar ('Neutrogena T/Gel') are first-
line.
❀ Antifungal agents (ketoconazole) are second-line
❀ topical steroids (hydrocortisone, alclometasone)
best used for short periods.
✈ Face and body management ketoconazole & topical
steroids Difficult to treat - recurrences are common
38b
77. idiopathic autoimmune form and a drug induced form.
dt Autoantibodies split the epidermis (which is a very thin
layer ➜ easily rupture ➜ uncovered skin which acts like a
burn) ,(Anti-Desmoglin Abs) (> é Ashkenazi Jewish
population)
drugs associated with Pemphigus:
• ACE inhibitors
• Penicillamine
• Phenobarbital
• Penicillin
39b
79. • Bullae easily rupture because they are thin
walled
• Involvement of the MOUTH = Vulgaris ( as
nothing is more vulgar than mouth involvement)
• Fluid loss and infection if widespread; they ACT
LIKE A BURN.
The most characteristic finding is 【NIKOLSKY
SIGN】. which is the loss or "denuding, of skin
from just mild pressure.
40b
83. Without treatment, pemphigus is a
fatal disease.
1. Systemic steroids (prednisone)
2. Azathioprine or mycophenolate to
wean the patient off steroids
3. Rituximab (anti-CD20 antibodies)
or IVIG in refractory cases
42b
85. In Bullous Pemphigoid:-
❏ Abs against the Dermo-epidemal junction
❏ milder disease than pemphigus Vulgaris
❏ Bullae stay intact,they're itchy and there is less
loss of fluid and infection.
❏ NO Mouth involvement
❏ Nikolsky sign is absent
❏ more common in ELDERLY while Pemphigus
is middle-aged or older people.
43b
87. ❐ Biopsy with immunofluorescent
stain ➳ IgG and C3 at the
dermoepidermal junction
❐ antibodies against
hemidesmosomal proteins BP180
and BP230. 44b
93. ❀ a BLISTERING skin disease of sun-exposed
areas ( backs of the hands and the
face).HYPERTRICHOSIS,
HYPERPIGMENTATION.
❀ associated with Liver disease (HEPATITIS C,
alcoholism) Estrogen use & Iron overload
(hemochromatosis).
❀ HEPATITIS C is the most frequently tested
association with PCT.
47b
105. acute infection of the upper dermis and
superficial lymphatics, usually caused by
STREPTOCOCCUS bacteria.
Erysipelas is more severe disease than
impetigo because it occurs at a deeper
level in the skin.more superficial than
cellulitis, and is typically more RAISED
AND DEMARCATED.
53b
106. Complications of Skin infections
with group A beta hemolytic
Streptococcus in Erysipelas ?
54a
107. ✸ BACTEREMIA➜ septic arthritis,
GLOMERULONEPHRITIS, but NOT
RHEUMATIC FEVER.
✸ Recurrence of infection—Erysipelas can
recur in 18-30% of cases even after
antibiotic treatment.
✸ Lymphatic damage
✸ Necrotizing fasciitis
54b
109. a bright, red, hot swollen (RAISED
& DEMARCATED) lesion on the
FACE. "St. Anthony's fire"
bacteremia, leukocytosis, fever, and
chills. Untreated disease can be
fatal.
55b
111. ✸ Although erysipelas is more often from
streptococci, you must treat for
Staphylococcus as well unless you have a
definitive diagnostic test such as blood
cultures .
✸ The treatment of all skin infections is
similar. the same answers as for cellulitis,
folliculitis, furuncles, and carbuncles.
56b
119. severe inflammation of dermal and SUBCUTANEOUS layers
of the skin dt bacteria. Group A STREPTOCOCCUS AND
STAPHYLOCOCCUS are the most common of these bacteria
& often occurs where the SKIN HAS PREVIOUSLY BEEN
BROKEN: CRACKS in the skin, cuts, blisters, burns, insect
bites, surgical wounds,or sites of intravenous catheter
insertion. Skin on the FACE or LOWER LEGS is most
commonly affected by this infection, though cellulitis can
occur on any part of the body. Ludwig's angina is a common
example.
60b
121. The skin is warm, red, swollen, and
tender.. Cellulitis does not have
collections of walled-off infection;
that is an abscess.
Cellulitis involves the legs more
often than the arms.
61b
123. No diagnostic testing is needed to
establish a diagnosis of cellulitis.
The most accurate test is to inject
sterile saline into the skin and
aspirate it for culture.
62b
125. ✩ Topical antibiotics will not cover cellulitis. The infection is below
the dermal/ epidermal junction and topical antibiotics will not reach
it.
✩ Drugs are Same as Erysipelas
☼ Mild disease: Use ORAL medications:
• Dicloxacillin, cephalexin, cefadroxyl
• Penicillin allergic: erythromycin, clarithromycin, or clindamycin
• MRSA: doxycycline, dindamycin, Bactrim
☼ Severe disease (fever present): Use INTRAVENOUS medications:
• Oxacillin, nafcillin, cefazolin
• Penicillin allergic: clindamycin, vancomycin
• MRSA: vancomycin, linezolid, daptomycin, tigecycline, ceftaroline
63b
127. ❀ Polymorphic eruption of pregnancy
〚PRURITIC Lesions first appear in
abdominal STRIAE associated with last trimester..Rx
emollients ➜ topical steroids➜ oral corticosteroids〛
❀ Pemphigoid gestationis
〚PRURITIC BLISTERING lesions in PERI-
UMBILICAL region ➜ spread to the trunk, back,
buttocks and arms ,2nd or 3rd trimester.
Rx ORAL CORTICOSTEROIDS〛
64b
128. Skin disorders associated with TB ?
65a
Lupus Vulgaris
Scrofuloderma: breakdown of skin
overlying a TB focus
129. ❅【 LUPUS VULGARIS】 ( 50% of cases) 『in
the FACE erythematous flat plaque ➜ elevated
➜ulcerate』
❅ ERYTHEMA NODOSUM
❅ Scarring alopecia
❅ Scrofuloderma: breakdown of skin overlying a
TB focus
❅ Verrucosa cutis
❅ Gumma
65b
135. skin condition dt deposition of
immune complex (mostly IgM) in the
superficial microvasculature of the
skin and oral mucous membrane that
usually follows an infection or drug
exposure.usually in second and third
decades of life.
68b
139. PINK-RED BLOTCHES, with the
classical "TARGET LESION"
appearance,with a pink-red ring
around a pale center ,mild itching,
symmetrically arranged and starting
on the extremities. . Resolution
within 7-10 days.
70b
141. ❂ Erythema multiforme minor - Typical 【TARGET
LESION】 distributed acrally
❂ Erythema multiforme major - Typical【TARGET
LESION】 distributed acrally with MUCOUS MEMBRANE
involvement + epidermal detachment < 10% of TBSA
❂ SJS/TEN - Widespread 【BLISTERS】 predominant on
the trunk and face, ERYTHEMATOUS OR PRURITIC
MACULES and MUCOUS MEMBRANE erosions; epidermal
detachment is less than 10% TBSA for Steven-Johnson
syndrome and 30% or more for TEN.
71b
147. ♂-pattern baldness
Drugs: Cytotoxic drugs, Carbimazole,Colchicine,
Contraceptive pill,
heparin
Nutritional: IRON AND ZINC DEFICIENCY
Autoimmune: ALOPECIA AREATA
Telogen efluvium (hair loss following stressful period
e.g. Surgery)
TRICHOTILLOMANIA "hair loss from a patient's
repetitive self-pulling of hair"
74b
157. Inflammation of the fat cells under
the skin, resulting in tender red
nodules or lumps that are usually
seen on both SHINS (Forearms,
thighs) Usually resolves
spontaneously within 6 weeks
Lesions heal without scarring
79b
161. a condition that causes tissue to become necrotic➜ deep ulcers
usually on the legs.➜ chronic wounds. Ulcers initially look like small
bug bites or papules,➜ later deep, red, necrotic ulcers with a
violaceous border. Though the wounds rarely lead to death, they can
cause pain and scarring.
81b
163. ✿ not well understood➜ thought to be due to immune
system dysfunction, and particularly improper functioning
of neutrophils.
❐ Idiopathic in 50%
❐ IBD: ulcerative colitis > crohn's
❐ Rheumatoid arthritis, SLE
❐ MULTIPLE MYELOMA
❐ Lymphoma, myeloid leukemias
❐ Monoclonal gammopathy (IgA)
❐ Primary biliary cirrhosis
❐ can occur in diabetes mellitus but it is rare
82b
165. ❍ First-line therapy is systemic
CORTICOSTEROIDS AND CYCLOSPORINE.
❍ topical and intralesional steroids, Mupirocin,
and Gentamicin alternated with Tacrolimus can
be effective.
❍ If ineffective ➜ combinations of
CORTICOSTEROIDS ,cyclosporine
,mycophenolate mofetil ,infliximab; or
plasmapheresis.
83b
167. Eczematous lesions on the sebum-
rich areas: scalp (Cradle
Crap) (may cause dandruff),
periorbital, auricular and nasolabial
folds. Otitis externa and blepharitis
may develop.
84b
171. Ankle-brachial pressure index (ABPI) is
important in non-healing ulcers to assess for
poor arterial flow which could impair healing
..'normal' ABPI may be regarded as between 0.9
- 1.2. Values below 0.9 indicate arterial disease.
values above 1.3 may also indicate arterial
disease, in the form of false negative results
secondary to arterial calcification (e.g. In
diabetics).
86b
173. ☸ COMPRESSION BANDAGING, usually four
layers (only treatment shown to be of real
benefit)
☸ Oral pentoxifylline (Trental®), a peripheral
vasodilator, improves healing rate
☸ Little evidence base for ( flavinoids
,hydrocolloid dressings, topical growth factors,
ultrasound therapy and intermittent pneumatic
compression)
87b
175. the invasion depth of a tumour
(Breslow depth) is the single most
important factor.
< 1 mm 5 year survival 95-100%
1 - 2 mm 5 year survival 80-95%
2.1 - 4 mm 5 year survival 60-75%
> 4 mm 5 year survival 50%
88b
176. Definition of Erythema ab igne ?
89a
reticular pigmented rashon shins + slow relaxing
reflexes → Hypothyroidism (sitting near the fire)
177. ❂ a skin disorder caused by over exposure
to HEAT (HEAT = IGNE) ➜
RETICULATED ERYTHEMA,
HYPERPIGMENTATION, scaling and
telangiectasias in the affected area.
❂ A typical history would be an elderly
women who always sits next to an open
fire (ovens)
89b
181. ✿ NECROBIOSIS LIPOIDICA DIABETICORUM ➜ Shiny,
painless areas of yellow/red/brown skin typically on the
shin with surrounding telangiectasia ✿ INFECTION ➜
Candidiasis, Staphylococcal
✿ NEUROPATHIC ULCERS
✿ VITILIGO
✿ LIPODYSTROPHY
✿ GRANULOMA ANNULARE➜
Papular lesions that are often slightly
hyperpigmented with central depression
91b
GRANULOMA ANNULARE
185. ❀ Itchy, papular RASH most common on the PALMS,
SOLES, genitalia and flexor surfaces of arms.
❀ Red scaly/violaceous
❀ MUCOUS MEMBRANE involvement
❀ Rash often polygonal in shape, 'white-lace' pattern on the
surface (wickham's striae)
❀ Koebner phenomenon seen
❀ Nails: thinning of nail plate, longitudinal ridging.
❀ Age mostly bw of 30 and 60, but it can occur at any age.
❀ may be associated with other autoimmune diseases
93b
187. a disease of UNKNOWN CAUSE that
results in ITCHY white patches on
the skin, which may cause scarring on
and around GENITAL
SKIN➜atrophy of the epidermis with
white plaques forming. common in
elderly ♀s
94b
191. is a contagious skin infection caused by the mite
Sarcoptes scabiei.
Severe itching is dt in the parasite which burrows
under the host's skin, causing intense allergic
itching dt a delayed type IV hypersensitivity
reaction to mites/eggs which occurs about 30
days after the initial infection.
typically affects children and young adults. 〘
THE SCABIE BABY 〙
96b
193. ⋆ Widespread ITCHING
⋆ Linear BURROWS on the side of fingers,
INTERDIGITAL WEBS and flexor aspects
of the wrist
⋆ In infants the face and scalp may also be
affected
⋆ Secondary features are seen due to
scratching: excoriation, infection
97b
197. ⋆Avoid close physical contact with others until treatment is complete
⋆All household and close physical contacts should be treated at the
same time, even if asymptomatic
⋆Launder, iron or tumble dry clothing, bedding, towels, etc., on the
first day of treatment to kill off mites
⋆Apply the insecticide cream to cool, dry skin➜ between fingers and
toes, under nails, armpit area, creases of the skin such as at the wrist
and elbow➜Allow to dry and leave on the skin for 8-12 hours for
permethrin, or for 24 hours for malathion, before washing off
➜Reapply if insecticide is removed during the treatment period, e.g.
If wash hands,➜Repeat treatment 7 days later
99b
199. ☠ Type 1
⋆ Presents < 40 years old
⋆ Positive family history
⋆ Associated with HLA-CW6
☠ Type 2
⋆ Presents > 50 years old
⋆ No family history
100b
201. ❑ Abnormal T cell activity
stimulates keratinocyte proliferation
(rather than an actual primary
keratinocyte disorder)
❑ Mediated by type 1 helper T cells
❑ associated with HLA-CW6.
101b
209. unstable form, sudden appearance of
innumerable monomorphic psoriasiform
papules (Scaly) on trunk and proximal
extremities (Tear drop papules) usually in
young adults.Preceded by streptococcal
infection 2-4 weeks, usually an upper
respiratory tract infection
105b
211. ❂ Most cases resolve spontaneously
within 2-3 months
❂ no antibiotics
❂ Topical agents as per psoriasis
❂ UVB phototherapy
❂ Tonsillectomy may be necessary
with recurrent episodes
106b
213. ❏ end of a spectrum of skin disorders which includes
erythema multiforme and Stevens- Johnson
syndrome.
❏ SJS/TEN - Widespread 【BLISTERS】
predominant on the trunk and face,
ERYTHEMATOUS OR PRURITIC MACULES and
MUCOUS MEMBRANE erosions; epidermal
detachment is less than 10% TBSA for Steven-
Johnson syndrome and 30% or more for TEN.
❏ Positive Nikolsky's sign.
107b
217. ❂ Stop precipitating factor
❂ intensive care unit
❂ IV IG effective and is now
commonly used first-line
❂ immunosuppressive agents
(Cyclosporin and cyclophosphamide),
plasmapheresis
109b
223. ❂ More common in young, black, male
adults, rare in the elderly
❂ Common sites (in order of decreasing
frequency): sternum, shoulder, neck, face,
extensor surface of limbs, trunk
❂ Keloid scars are less likely if incisions
are made along relaxed skin tension lines
112b
227. ❂ symmetrical, hyperpigmentation
(brown), velvety plaques often
found on the neck, axilla and groin.
❂ Pts < 40 y, may be genetically
inherited, and is associated with
obesity or endocrinopathies
114b
231. a type of eczema which affects both
the hands and the feet . It is also
known as dyshidrotic eczema. dt
unknown cause (may be an Allergic
reaction).
116b
237. a skin rash begins with a single "HERALD
PATCH" lesion (usually on trunk), and
then disseminates ➜1 or 2 weeks by a
generalized body rash. It can look like
secondary syphilis but it SPARES THE
PALMS AND SOLES. (common in spring
season). SPRING = ROSEA
119b
247. ★ Topical antifungal
e.g.Clotrimazole or Terbinafine or
selenium sulphide
★ If extensive disease or failure to
respond to topical treatment then
consider oral itraconazole
124b
251. ☯ Typically affects nose, cheeks and
forehead
☯ Flushing is often first symptom
☯ Telangiectasia are common
☯ Later develops into persistent erythema
with papules and pustules
☯ Rhinophyma
☯ Ocular involvement: blepharitis
126b
253. ❃ Topical metronidazole may be used for mild
symptoms
❃ More severe disease is treated with systemic
antibiotics e.g. Oxytetracycline.
❃ Oral isotretinoin: severe acne only under specialist
supervision.
❃ Recommend daily application of a high-factor
sunscreen
❃ Camouflage creams may help conceal redness
❃ Laser therapy esp. in prominent telangiectasia
127b
255. a common skin disorder which usually
occurs in adolescence. It typically affects
the face, neck and upper trunk and is
characterized by the obstruction of the
pilosebaceous follicle with keratin plugs ➜
comedones, inflammation and pustules.
128b
257. ⋆ Follicular epidermal hyperproliferation
➜ keratin plug➜ obstruction of the
pilosebaceous follicle. Activity of
sebaceous glands may be controlled by
androgen, although levels are often
normal in patients with acne
⋆ Colonisation by the anaerobic bacterium
propionibacterium acnes➜ Inflammation
129b
259. ❅ Single topical therapy (topical retinoids, benzyl peroxide)
❅ Topical combination therapy (topical antibiotic, benzoyl peroxide,
topical retinoid)
❅ Oral antibiotics: e.g. Oxytetracycline, doxycycline. need 3-4
months to work. Minocycline considered second line treatment due
to the possibility of irreversible pigmentation.
❅ Gram negative folliculitis may occur as a complication of long-
term antibiotic use - high-dose oral trimethoprim is effective if this
occurs
❅ Oral isotretinoin: severe acne only under specialist supervision dt
SEs.a very effective Rx of severe acne (2/3 of patients have a
long term remission or cure following a course of oral isotretinoin
❅ no role for dietary modification in patients with acne
130b
261. ❃ Teratogenicity: ♀s MUST be using two forms of
contraception (e.g. Combined oral contraceptive pill and
condoms)
❃ DRY skin, eyes and lips: THE MOST COMMON SE of
isotretinoin
❃ Depression
❃ Nose bleeds (caused by dryness of the nasal mucosa)
❃ Raised triglycerides
❃ Hair thinning
❃ BENIGN INTRACRANIAL HYPERTENSION: isotretinoin
treatment should not be combined with tetracyclines for this
reason
131b
275. Flesh-white or colored, dome-shaped,
and pearly in appearance .sometimes
called water warts 1-5 millimeters in
diameter, with a DIMPLED
(UMBILICATED) CENTER. They are
generally not painful, but they may
itch or become irritated.
138b
279. ITCHY, vesicular skin lesions on the extensor
surfaces〚spares the flexor surfaces〛 (e.g.
Elbows, knees ,buttocks & may be the shoulders)
➜ Skin biopsy: direct immunofluorescence shows
deposition of IgA in a granular pattern in the
upper dermis
Colonoscopy➜ 90 % show abnormalities
Small intestinal biopy➜ villous atrophy
140b
283. ▲ Irritant contact dermatitis:non-allergic due to weak acids
or alkalis (e.g. Detergents).common on the hands. Erythema
is typical, crusting and vesicles are rare
▲ Allergic contact dermatitis: type IV hypersensitivity
reaction. 〈ex. Nickel Dermatitis〉➜jewellery such as
watches,also dt hair dyes➜acute weeping eczema at the
margins of the hairline rather than scalp itself. Dx by (skin
patch test). Topical treatment with steroids
▲ Cement Common cause of contact dermatitis. The
alkaline nature of cement ➜ irritant contact dermatitis & the
dichromates in cement ➜ allergic contact dermatitis
142b
289. Spontaneous regression of
keratoacanthoma within 3 months is
common, often resulting in a SCAR. Such
lesions should however be urgently
excised as it is difficult clinically to exclude
squamous cell carcinoma. Removal also
may prevent scarring.
145b
291. chronic dermatological autoimmune
condition Papular lesions that are
often slightly hyperpigmented and
depressed centrally
Typically occur on the dorsal surfaces
of the hands and feet, and on the
extensor aspects of the arms and legs
146b
297. PINK OR BROWN RASH asymptomatic,
flat, slightly scaly, usually found in the
groin or axillae. It is caused by an
overgrowth of the Gram +ve bacterium
DIPHTHEROID CORYNEBACTERIUM
MINUTISSIMUM Common in diabetics
and the obese, and in warm climates; it is
worsened by wearing occlusive clothing.
149b
299. by Wood's light
The ultraviolet light of a Wood's lamp
➜ organism fluoresce a coral red
color, DDfrom other bacterial
infections and other skin conditions.
(fungal infections will also be
fluorescent)
150b
303. dermatophyte fungal infections ..Dermatophytes live only in
tissues with keratin (i.e., the skin, nails, and hair) and are a
common cause of infection. Causative organisms include
Microsporum,
Trichophyton, and Epidermophyton. The immune response
to the
dermatophyte, rather than the organism itself.
nomeculature according to part of the body is infected.
☆ Tinea capitis - scalp
☆ Tinea corporis - trunk, legs or arms
☆ Tinea pedis - feet
152b
327. ★ weight loss if overweight
★ Cosmetic techniques such as
waxing/bleaching
★ combined oral contraceptive pills
★ Facial hirsuitism: topical
EFLORNITHINE - contraindicated in
pregnancy and breast-feeding
164b
329. a very rare medical syndrome that includes
PLEURAL EFFUSIONS, LYMPHEDEMA (due to
lymphatic hypoplasia) and YELLOW
DYSTROPHIC NAILS ( characteristic thickened
and discolored nails). 40% will also have
BRONCHIECTASIS. It is also associated with
CHRONIC SINUSITIS and persistent coughing.
It usually affects adults.
165b
335. ☢ oral TERBINAFINE is currently
recommended first-line with oral
itraconazole as an alternative. Six
weeks therapy is needed for
fingernail infections whilst toenails
should be treated for 12 weeks
168b
337. are benign ganglion cystson the
distal, dorsal aspect of the finger.
There is usually osteoarthritis in the
surrounding joint.
more common in middle-aged
women
169b
341. ❍ Melanoma (By protective clothing
such as hats, tightly woven clothes).
No role of SPF 15-30.
❍ Squamous cell carcinoma (By SPF
15-30)
171b
342. Throbbing pain over pulp with non-
purulent vesicles. Tzanck smear
shows multinucleated giant cells ?
172a
343. Herpetic whitlow (HSV 1 of 2).
Common in health care workers/
dentist comes in contact with
orotracheal secretions . Spread
through direct inoculation into
broken skin.
172b
347. Squamous cell carcinoma that arise
from actinic keratoses rarely
metastasize, but those that arise on
the lips and on ulcers are more
likely to metastasize by
LYMPHATIC channels.
174b
348. The most common skin tumor of the
Lips ?
175a
Basal cell carcinoma of the eyelidSquamous cell carcinoma of
the lip
349. Squamous cell carcinoma occurs on
the lip far more commonly than
does Basal cell carcinoma.
175b
355. ★ short, intense bursts of sun exposure
★ congenital melanocytic nevi, an ↑
number of nevi, or dysplastic nevi.
★ familial atypical mole and melanoma
(FAM-M) syndrome.
178b
357. ★ Not a fungus, but a slow,
progressive tumor of T cells.
★ related to chronic
immunostimulation ➜ helper T cells
gather in the epidermis.
★ Industrial exposure to irritating
chemicals appears to ↑ risk.
179b
374. Red cutaneous papules in aging
adults. Don't regress. Increase in
number with age . Light microscopy
shows proliferation of capillaries
and venules ?
188a
375. ✿ Cherry Angiomas
NB:Other types of Blood vessel tumer
✿ Strawberry Hemangiomas➜ 1st week of life,
regresses by 5-8 years of life.
✿ Spider angiomas ➜outward radiating vessels
(Estrogen dependent )
✿ Cavernous Hygromas ➜lymphatic cysts at
birth (lateral neck). Associated with Turner
Syndrome and Down's Syndrome.
188b
381. increased number of malanocytes at
EPIDERMODERMAL JUNCTION It's
premalignant lesion and the factor most
important in determining prognosis is
thickness of the lesion.
it takes the same risk factors of malignant
melanoma (ABCDE) with D > 6 cm more
likely to be malignant.
191b
385. a skin disease ➜ the sudden onset of fever,
leukocytosis, and tender, erythematous,Characteristic
plum colored papules and plaques that show dense
infiltrates by neutrophil granulocytes on histologic
examination.
Classified as: Idiopathic SS, malignancy-associated
SS, and drug-induced SS.
193b
387. RASH often seen in the early stage of Lyme
disease. Present anywhere from 1 day to1 month
after a tick bite. This rashisn't dt an allergic
reaction to the bite, but rather an actual skin
infection with the Lyme bacteria, BORRELIA
BURGDORFERI
"Erythema migrans is the only manifestation of
Lyme disease allow clinical diagnosis in the
absence of laboratory confirmation."
194b
388. Dog breeder has a bald patch on
scalp with inflammation and
scaling. Wood's lamp shows bright
green fluorescence ?
195a
390. Old woman presents with mildly
itchy white atrophic plaque on vulva
and abdomen ?
196a
391. Lichen sclerosus (Diagnosed by
biopsy showing thinning of
epidermis, acanthosis with
elongation of ridges. Increased risk
of vulvar squamous cell CA).
196b
392. Dome shaped lesion on nose with
pearly white look and raised edge ?
197a
393. nodular basal cell carcinoma. Major
risk factor is sun exposure. Most
common cutaneous neoplasm.
197b
394. Patient with complaints of difficulty
to get up from chair has purplish
non itchy rash of the eyelids ?
198a
402. University student in a spring
season complains of red patch over
chest with scaly skin followed by
oval macules on rest of trunk, arms
and legs after 3 days ?
202a
411. small, sharply demarcated, depigmented
MACULES or patches on otherwise normal skin,
often on the hands, face, or genitalia ➜
expand, sometimes in dermatomal patterns ➜
include large segments of skin.
The disease is usually chronic and progressive,
with some patients becoming completely
depigmented.
206b
413. Topical or systemic PSORALENS and exposure
to sunlight or PUVA may be helpful.
Patients must wear sunscreen because
depigmented skin lacks inherent sun protection.
Dyes and makeup may be used to color the skin,
or the skin
may be chemically bleached to produce a
uniformly white color.
207b
431. a genetic disease ( autosomal recessive)
that causes fragmentation and
mineralization of elastic fibers in some
tissues. The most common problems arise
in the skin and eyes, and later in blood
vessels in the form of premature
atherosclerosis & mitral valve prolapse.
216b
436. Burning stingy rash over shoulders,
elbows and buttocks(biopsy shows
papillary neutrophilic inflammation
and abscess). Past history of
thyroiditis is present ?
219a
438. Pale pink non itchy symmetrical
rash on palms/soles and limbs in a
patient with generalized
lymphadenopathy and joint pains.
White erosions in mouth are also
seen ?
220a
453. an autosomal dominant disease characterized by Itchy
crusty patches (greasy brown papules) on the skin of chest,
neck, back, ears, forehead, and groin, but may involve other
body areas. The rash associated with Darier's disease often
has a distinct odor. Finger nails become fragile and this
helps in diagnosis of the disease.
227b
454. A person noticed unsightly skin over
chest and scapula (greasy brown
papules) while sun bathing
228a
461. ◢ bilateral (abcesses, cyst, pustules,
papules) affects areas bearing
apocrine sweat glands or sebaceous
glands, such as the underarms, under
the breasts, inner thighs, groin and
buttocks.
◢ adolescent/adults
231b
485. ERYTHEMA INFECTIOSUM
it is caused by parvovirus B19
mild prodromal symptoms, sore throat,
malaise, low grade fever
facial erythema followed by lacy "fish net"
pattern rash
adult women may develop itching and
arthritis
243b
487. MORBILLIFORM ERUPTIONS-
indistinguishable from viral exanthems
generalized erythematous pruritic
eruption, symmetrical, usually spares face
but may involve palms and sole and
mucous membranes
usually starts 7-10 days after starting drug
TX is to remove drug and treat itching
244b
489. tetracyclines and sulfonamides- cause
eruption of glans penis
=single or multiple red plaques appear
after exposure and reappear in same place
with subsequent exposure
lesions itch and burn, may form bulla and
erode, the desquamation and crust
245b
491. Nits easier to see than lice,
fluorescent under woods lamp
TX- permethrin 1% OTC, rinse out
in 10 minutes or single dose oral
ivermectin 200 micrograms/kg
Nit removal essential but diffictult
246b
500. What is the most common
presentation of eczema?
251a
501. subacute eczema
itchy, red, scailing patches, papules
and plaques
borders may be indistinct, variable
patterns and degree of itch
scratching and repeated exposure
converts to a chronic process
251b
503. acute or chronic hive-like swelling of the
hypodermis (subcutaneous tissue) and
mucosa, caused by increased vascular
permeability
color is usually uniform and it often
involves the lips, palms and soles, limbs
and genitalia
often occurs with urticaria
252b
504. How would I differentiate acne from
rosacea?
253a
510. What is the treatment of bacterial
folliculitis?
256a
511. minimize heat, friction, and occlusion
antibacterial soap
mupirocin (bactroban) TID x 5 days for
limited superficial involvement- treat
nasal passages and finger tips also
oral antistaphylococcal drugs-oxacillin,
dicloxacillin, cefuroxime
256b
515. ✫ normally seen on the sole of the foot, and
occasionally on the palm of the hand
✫ It is characterised by a raised darker area
surrounded by a paler macular (lentiginous) area
that may extend for several centimetres around
the raised area
✫ Lentigo maligna melanoma occurs on the sun-
exposed skin areas (usually the face) of elderly
patients
258b
517. ✿ a very firm, white or violaceous patch of skin on any body
site, but more commonly on the thighs, trunk and upper
arms
✿ commonly in children or young adults.
✿ infection with Borrelia burgdorferi may be the cause ➜
supported by some patients with early morphoea lesions
appear to respond to tetracycline antibiotics
259b
519. a form of factitious disorder➜ patients will
intentionally feign symptoms and signs of disease
to assume the patient role. It is also self-inflicted
skin damage, most commonly from prolonged
scratching, but sometimes by means of sharp
instruments or another agency.history of suicide
or psychiatric disoredr may a clue.
260b
521. phototoxic reaction.The damage
caused is due to the formation of
PYRIMIDINE DIMERS ➜prevent
the enzyme DNA polymerase from
replicating the DNA strand beyond
the site of dimer formation
261b
523. purely cutaneous disorder➜
lymphocytic infiltration,➜ multiple
crops of PRURITIC papules
occurring on the trunk and limbs
Rx ➜ichthyol UV light therapy may
benefit
262b
525. Is tinea when the clinical appearance has been
altered by inappropriate treatment, usually a
TOPICAL STEROID CREAM ➜the original
infection slowly extends➜The steroid cream ↓
inflammation ➜ the condition feels > irritable
when the cream is stopped for a few
days➜steroid cream is promptly used again➜ ≫
steroid applied➜ ≫ extensive the fungal
infection becomes
263b
531. a scalp disorder characterized by the
thinning or shedding of hair resulting from
the early entry of hair in the telogen phase
(the resting phase of the hair follicle).
Emotional or physiological stress may
result in an alteration of the normal hair
cycle and cause the disorder
266b
533. Effluvium can present with similar appearance to
alopecia totalis, with further distinction by
clinical course, microscopic examination of
plucked follicles, or biopsy of the scalp.Histology
➜ telogen hair follicles in the dermis with
minimal inflammation in effluvium, and dense
peribulbar lymphocytic infiltrate in alopecia
totalis.
267b
534. heavy smoker, multiple, small punched-out ulcers
situated on the lower third of both legs. Both dorsalis
paedis and posterior tibial pulses appear absent.
Which diagnosis fits best with this clinical picture?
Flea infestation
Multiple venous ulcers
Vasculitis
Multiple arterial ulcers
Traumatic skin damage
268a
536. A 12-year-old boy has had a gradually progressive plaque on
his buttock for the past 3 years. The plaque is 15 cm in
diameter, annular in shape with crusting and induration at
the periphery and scarring at the centre. Which one of the
following options is the most likely diagnosis?
Tinea corporis
Granuloma annulare
Lupus vulgaris
Borderline leprosy
Cutaneous leishmaniasis
269a