25-SKIN
s.
in
layer of skin(CLGSB)
stratum Corneum-strongest, no nucleus
str Lucidum
str GrANulosum-OdlANd bodies(lipid filled), thinnest
str Spinosum-keratinocyte formed, Langerhans cell
str Basale-cell division, melanocyte
SB+SS=Malphigian layer
no.-melanocyte:keratinocyte=1:10
pigment-melanocyte:keratinocyte=1:36
4a
iim
norm skin turnover time=28d(4w)
parakeratosis-nucleus in SC, turnover rate=3-7d, actinic keratoses
hyperkeratosis-↑thickness SC
dyskeratosis-abnorm keratinisation bel SG
bn-Darrier ds, Hailey Hailey ds
malign-Bowen ds
hyperGranulosus-thickening of SG
thickness epidermis:dermis=1:20
papillary:deeper reticular dermis=1:9
S-S bond-skin keratin<nail keratin
Ai
m
Epidermal blister
acq
pemphigus
AI IgG antidesmogleinAb→ desmoglein(DSG) prot→ break desmosome→ cell
become circular→ acantholysis
DSG1 b/n SC&SG-pemph foliaceus-subcorneal blister-seborrheic area
pemph erythematosus
DSG3(+1) b/n SS&SB-pemph vulgaris-suprabasal blister
mucosal-DSG3
cutan-DSG3&1
Paraneoplastic pemphigus-DSG1,3, desmoPlakin
endemic/fogOselvagem/Brazilian pemphigus-desmocOllin
cong
Darrier ds-V shape nicking, Ca-ATPase 2A2 gene defect
Hailey Hailey ds-Ca-ATPase 2C1 gene def, SS, acantholysis+
Epidermolysis bullosa simplex-cong keratin abs, trauma induced
s.
in
epidermolysis bullosa(EB)
EB simplex-intraepidermal(epidermolytic)-keratin4,14, plectin, integrin, desmoplakin
jnal EB-intra lamina lucida(lamina lucidolytic)-laminin332(laminin5)
dystrophic EB-sublamina densa(dermolytic)-type VII collagen
epidermolytic hyperkeratosis-keratin1,10
Eczema
Odland bodies→ intercellular cement→ lost→ intercellular edema,eczema,dermatitis
atopic dermatitis
white dermographism
Rx-steroid, calcineurin inh(tacrolimus)
iim
patch test
D0(patch appli)→ D2(patch remove)→ D4(best)→D7(Ni HSR)
urticaria pigmentosa-disorder of mast cell
4a
eccrine sweat gld duct block-miliaria
Apocrine sweat gld duct block-hidrAdinitis suppurAtive(inverse acne), Fox Fordyce
ds
sebaceous duct block-acne
ECtopic sebaCeous duct-FordyCE spot
ceruminous gld-modif apocrine sweat gld
breast-modif sweat gld
m
stem cell-bulge of hair follicle
acne rosacea-erythema, papulopustule, background erythema&telangiectasia,
central face,bulge cheek,nose,forehead, no comedone
Ai
acne vulgaris
comedone-palmitic acid
stage1-keratin plug pilosebaceous unit-topic keratolytic
stage2-1+papule-topic retinoid+topic abtic
stage3-2+pustule-topic retinoid+oral doxycyccline/azithromycin/minocycline
stag4-3+nodul-oral retinoid(isotr,acitr)
stage5-4+cyst-oral isotretin+intralesion steroid
hormonal acne-cyproterone acetate
s.
in
lIChen planus
hypergranulation, Max Joseph space, basal cell degenerat, mucous involvm,
sawtooth app rete ridges, dyskeratosis, dermoepidermal jn, WICkham striae, itchy
polygon violaceous papular lesion
oral-white, crisscross, lacy reticular
oral ulcerative-premalign
hypertrophic-leg
lichen planus pigmentosus-pigmentation on sunexposed areas
lichen planus pilaris-Ag bulb of hair
Melasma
Rx-KligMan regime-topic retinoid+ topic hydroquinone+ topic steroid
kojic acid cream
iim
palpable purpura
vasculitis
cutan small vess vasculitis
PAN
emboli
a/c meningococcemia
disseminated gonococcal inf
Rocky mountain spotted fever(R Rickettsiae)
4a
indication of PUVA(MPAVE)
Mycosis fungoides
Psoriasis
Atopic dermatitis
Vitiligo
Eosinophilic folliculitis
Ai
m
disorder of nail
blue black pigmentation-minocycline
dorsal pterygium(extension of prox nailfold→ nailbed), longitudinal groove,
anonychia, onycholysis-lichen planus
½&½ nail-CKD
Koenen periungual fibroma-tuberous sclerosis
koilonychia, pale discolourat-Fe def anem
leuconychia-nail matrix dysfn
Mees line-arsenic poisoni
onycholysis-psoriasis, Reiter synd
pitting
Coarse-eCzema
IRregular-psoRIasis
Koebner/isomorphic phenomenon
Little-Lichen planus, Lichen nitidus
Plans-Psoriasis, Pemphigoid
Kan-Kaposi sarcoma, Keratosis follicularis
Make-Molluscum contagiosum
Win-Wart(pseudoisomorphic)
Very-Vitiligo
Descent-DLE
iim
pseudoKoebner-lichen sclerosis
REverse Koebner-granuloma annulaRE
s.
in
REgular-alopecia aREata
Salmon patch(oil drop sign)-psoriasis
V nicking-Darrier ds
ventral/inverse pterygium-scleroderma
migration of melanocyte fr neural crest→SB-embryogenesis
4a
disorder involving loss of melanocyte(Contact WaX Vala Phir)
Contact with monobenzylether of hydroquinone(contact leucoderma)
Waardenburg synd
Xeroderma pigmentosum
Vitiligo
Piebaldism
vitiligo
AI destruct melanocyte-chemical leukoderma(para tertiary butyl phenol)
Ai
m
piebaldism
hypopigmentation disord
absent melanocyte
depigmentation patch on ventral/lat trunk, midextremity, sparing hand&ft
poliosis&white forelock, no deafn
hyperpigmentation
Rx-2-5% hydroquinone
tongue-ds
bald tongue of Sandwith-vitB3 def
black hairy-prolong use atbc
cerebriform-pemphigus vegetans
hairy-lingua nigra
hunter/Moeller-pernicious anem
magenta/beefy red-vitB2 def
scrotal-fissured
Strawberry/raspberry-Scarlet fever, TSS, Kawasaki ds
iim
bullous pemphigoid(Lever)
maj Ag(230kD)-intracellular
min Ag(180kD)-transmemb
s.
in
vesicobullous disorder-immunopathological app
bullous pemphigoid-linear band IgG or C3 in epidermal BM
pemphigus neonatorum
pemphigus vulgaris/foliaceous-cell surface deposit of IgG on keratinocyte
pemphigoid gestationis-linear band of C3 in epidermal BM
dermatitis herpetiformis-granular deposit of IgA in dermal papillae
c/c bullous ds of childhood/linear IgA dermatosis in adult-IgA deposit along
dermoepidermal jn
4a
wood lamp examination
9%NiO+Ba silicate, UV-365nm, black light
blue white/ash leaf-tuberous sclerosis
brilliant green/yellow-tinea capitis
coral pink/red-erythrasma(Corynebacterium minutissimum)
dull Yellow-pitYriasis versicolour
green-scabies burrow
orange-acne
pale blue/green-Pseudomonas inf
Pinkish REd-PorphyREa cutanea tarda
white-vitiligo
Ai
m
skin inf
Strepto pyogenes(CEI)
Cellulitis, Erysepelas, Ecthyma, Impetigo contagiosa(non bullous), vesicle with
honey crust
Staph aureus
carbuncle, furuncle, superficial&deep folliculitis, bullous impetigo, ecthyma, impetigo
contagiosa, no erysepelas
Pseudomonas aeruginosa
echthyma gangrenosum
genital ulcer
painless
NO LNpathy
cong syphilis-sabre wart, prim bullous lesion
hepravirus hominis-chancroid
s.
in
doNOvaNOsis(Calymmatobacterium graNulOmatis)-pseudobubo
LNpathy+
painfulLN
LGV/genital elephantiasis(Chlamydia trachomatis)
painlessLN
hard chancre/syphilis(Treponema pallidum)
painful, multiple lesion, painful LNpathy
presence of vesicle, b/l LNpathy
HSV(recurr)
suppurative LN, u/l LNpathy
chancroid/soft chancre(Hemophilus ducreyi)
4a
iim
Suraksha clinic
STI clinic, NACO(G G White of Britain Reads Yellow Book)
1-Grey-UD, CD, ARD
2-Green-vag discharge
3-White-genit ulcer ds(non HSV)-inj benzathine penicillin+tab azithromycin)
4-Blue-genit ulcer ds(non HSV pt allergic to penicillin)-tab doxycycline+tab
azithromycin
5-Red-genit ulcer ds(HSV)-acyclovir
6-YelLOW-LOWer abd pain
7-Black-inguinal bubo, cx bubo, painful scrotal swelling
m
grey-cefixime+azithromycin-gonococcal, chlamydia-urethritis, cx discharge
green-secnidazole+fluconazole-gardenella, trichoma, candida-vag discharge
red-acyclovir-HSV genital ulcer
white-benzathine penicillin+azithromycim-syphilis, chancroid
Ai
scalp cycle(ACT)
Anagen(84%, growing, black bulb, 3y)→
Catagen(2%, transitional, 3w)→
Telogen(14%, resting, white bulb, 3mth)
alopecia
focal
rash in area of hair loss
yes
severe itching, painful boggy swelling, multiple discharging sinus
tinea capitis
perforation test
iim
s.
in
+-Trichophy tonsurans,T VIolaceum-griseofulVIn, T ruBrum-terBinafine
–-Microsporum canis-griseofulvin
no rash
exclamation mark hair
present
alopecia areata, pitting nail, Rx-minoxidil
absent
h/o tying hairband very tightly, traction alopecia
diffuse
patterned hair loss
yes
frontal hair line
lost
mal pattern baldness
preserved
fem pattern baldness
no
h/o major stress(inf/fever) or change in h(post partum), alopecia after 3-4mth
stress, telogen effluvium(>100hair/d)
h/o irritation or anticancer drug, alopecia within 2-3w after exposure-anagen
effluvium(>1hair/d)
Ai
m
4a
cause of scarring alopecia
Tinea capitis inf, kerion
Staphylococcal folliculitis
Syphilis
Herpes simplex and zoster
Lupus vulgaris
Lichen planus
Lupus erythematosus
Sarcoid
Scleroderma
Basal cell carcinoma
non scarring alopecia(TATA)
Telogen effluvium
Alopecia areata
Trichotillomania
Androgenic type
psoriasis
All-Auspitz sign(plaque psoriasis)
Indian-Isomorphic/Koebner phenomenon
Great-Grattage sign
iim
lichen nitidus
pinpoint papule on dorsum of hand&genitalia
s.
in
Bulky-Barkley movem
Women-Woronoff(PGE2-healing lesion)
Say-Silvery scale
Chal-Corticosteroid withdrawal, Camel foot app
Phoot-Parakeratosis, Pitting(Prox nail matrix)
Man-Munro Microabscess(neutrophil in stratum corneum)
Or-Oncholysis, Oil spot, Oil drop sign(nail bed)
Eat-Extensor surface, Epidermal hyperplasia
Tazaroti-Tazarotene
psoriasis vulgaris-plaque-immunosuppression
guttate psoriasis-Ag-Streptococcus-abtc
erythroderm psoriasis-mtx>acitretin
Venzumbusch(gen pustular) psoriasis-sheet/lake of pus-mtx>acitretin
impetigo herpetiformis-steroid
psoriasis arthritis-mtx
Ai
m
4a
Leprosy
periph n-ulnar n
cranial n-CNVII
Lucio rxn-nonnodular LL
India-BT-pseudopodia, jagged, serrated edge, saTellite lesion
indeterminant-never scaly, never completely anaesthetic, never palpable
PB differentiated fr MB-bacteriological index
PB(TT)-1-5lesion, ≤1n involvem, skin smear–ve, sharp border, palpable ulnar n
MB(LL)-≥6lesion, >1n involvem, skin smear +ve, sLopy border, symmetrical
BB-inverted saucer, punched out, Swiss cheese lesion
intern organ-testis
Bx not taken fr-radial n
intern organ not involved-uterus
Dx-microscopic(skin smear)-10⁴bacilli/g ts, culture-best animal-armadila, MC
animal-footpad MiCe, bacterial index-Dharmendra scale, Ridley scale
Rx-PB-(dapsone100mg/d+rifampicin 600/mth)(Green packet)×6mth(9mth)→f/u
yly-2y
MB-(dapsone 100mg/d+rifampicin 600 mg/mth+clofazimine
50mg/d,300mg/mth)(Redpacket)×12mth(18mt)→f/u yly-5y
Px-morphologic indicat-%of uniform stain bacilli-become 0<6mth
Bacteriologic indicator(Best)-upto 2y
1st bacteria etiolog a/w human ds-M lepra
subepidermal zone Grenz-free of infiltration
Ridley Jopling classif(clinical, bacteriological, immunological)
TT, BT, BB, BL, LL
lepra rxn
1(reversal/downgrading rxn)-T4HSR, BL>BB,BT, exacerbation of skin lesion
2(ENL)-T3HSR, LL>BL, TNFα
Rx-thalidomide(200-300mg/d)
iim
erythema nodosum(TB, pregn, SLE)
red tender nodule on shin never ulcerate
s.
in
TB skin
exogenous-lupus vulgaris-buttock, diascopy-apple jelly nodule, noncaseating
granuloma
enDogenous-child, scrofuloDerma, nonhealing sinus, periorificeal, fr LN
tuberculid
lichen scrofulosorum-involve sweat gld, hair follicle, noncaseating epitheloid
granuloma
papular
nodular-Bazin ds, erythema induratum, calf
neonatal fat necrosis resemble-post steroidal panniculitis
Dowling Degos ds-fine reticular pigmentation with palmar pits
4a
incontinenti pigmenti(Bloch Sulzberger synd)-scarring alopecia, onychodystrophy,
avasc periph retina, retina pigmentary change, ocular involvem<100%
m
scale-visible exfoliation of skin
pityriasis alba
lack of sebaceous secretion bef puberty
cheek, face
scaly hypopigm macule, spontaneous resolution
Rx-w/w
Ai
pityriasis Rosea
HHV6,7
trunk, shoulder
heRald/mother patch, fir/chRistmas tree app, cigaRette paper scale, hanging cuRtain
sign, sparing-palm,sole
Rx-topic steroid, UVB
pityriasis rubra pilaris
unknown etiology
begin on face, scalp→ trunk, dorsum of digit
palmoplanter keratoderma(PRP sandal)-orange, red waxy hyperkeratosis of
palm&sole
nappes claires-scaly plaque with islands of sparing
nutmeg grater app
Rx-oral retinoid, mtx
periungual telangiectasia
LE
systemic sclerosis
dermatomyositis
iim
no. of scabies mite on body=10-15
Norwegian scabies-pt on CT
s.
in
pityriasis versicolor
Malassezia globosa>furfur
trunk, shoulder
pale, brown, pink scaly macule, start around hair follicle& merge with each other
Rx-ketoconazole, itraconazole, miconazole, clotrimazole, selenium sulphide
erythema Gyratum repens
multiple concentric ring, wood Grain pattern, erythema, swelling, trunk, a/w ca lung
4a
pellagra
glove/gauntlet of pellagra, Cassal necklace
Becker nevus-dermal, large hyperpigmented patch, ↑hair,shoulder area, does not
present at birth
m
nevus of Ito-blue nevus along shoulder, supraclavicular, lat brach n dermal
melanocyte trap
nevus of Ota-blue nevus along CNV1,2, blue sclera, hyperpigmented discrete,
spotted, speckled, bluish/slate grey,macule, face,periorbital
Mx-Q switch laser
Ai
lichen simplex
hyperpigmented, thick skin, accentuation of skin crease
pompholyx(bubble)
vesicle on hand,finger, deep seated sagograin like lesion
molluscum sebaceum-keratoacanthoma
Sweet synd
child, multiple tender erythema
neutrophil, histiocyte in dermis
Cock peculiar tm-epithelioma
s.
in
UVA=320-400nm-solar keratosis, ageing, skin ca, photosensitive rxn, Meirowsky
phenom(UVA→ oxidat of melanin→ immed skin pigment darkening)
UVB=280-320nm
UVC=250-280nm
xerotic/asteatotic/winter eczema/eczema craquele/pruritis hiemalis/winter
itch/dessication dermatitis-dry,itchy,cracked skin, red,bumpy,pimple like irritation in
lower limb
Ai
m
4a
iim
Abbreviations
a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune
bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis
E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year
#-fracture
°-degree
THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP
TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE
HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS.