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25-SKIN
layer of skin(CLGSB)
stratum Corneum-strongest, no nucleus
str Lucidum
str GrANulosum-OdlANd bodies(lipid lled), 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
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
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
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
palpable purpura
vasculitis
cutan small vess vasculitis
PAN
emboli
a/c meningococcemia
disseminated gonococcal inf
Rocky mountain spotted fever(R Rickettsiae)
indication of PUVA(MPAVE)
Mycosis fungoides
Psoriasis
Atopic dermatitis
Vitiligo
Eosinophilic folliculitis
disorder of nail
blue black pigmentation-minocycline
dorsal pterygium(extension of prox nailfold nailbed), longitudinal groove,
anonychia, onycholysis-lichen planus
& nail-CKD
Koenen periungual broma-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
REgular-alopecia aREata
Salmon patch(oil drop sign)-psoriasis
V nicking-Darrier ds
ventral/inverse pterygium-scleroderma
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
pseudoKoebner-lichen sclerosis
REverse Koebner-granuloma annulaRE
migration of melanocyte fr neural crest SB-embryogenesis
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)
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-ssured
Strawberry/raspberry-Scarlet fever, TSS, Kawasaki ds
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
bullous pemphigoid(Lever)
maj Ag(230kD)-intracellular
min Ag(180kD)-transmemb
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
skin inf
Strepto pyogenes(CEI)
Cellulitis, Erysepelas, Ecthyma, Impetigo contagiosa(non bullous), vesicle with
honey crust
Staph aureus
carbuncle, furuncle, supercial&deep folliculitis, bullous impetigo, ecthyma, impetigo
contagiosa, no erysepelas
Pseudomonas aeruginosa
echthyma gangrenosum
genital ulcer
painless
NO LNpathy
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)
cong syphilis-sabre wart, prim bullous lesion
hepravirus hominis-chancroid
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
grey-cexime+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
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
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
lichen nitidus
pinpoint papule on dorsum of hand&genitalia
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 smearve, 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)-10bacilli/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 inltration
Ridley Jopling classif(clinical, bacteriological, immunological)
palm&sole
nappes claires-scaly plaque with islands of sparing
nutmeg grater app
Rx-oral retinoid, mtx
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
periungual telangiectasia
LE
systemic sclerosis
dermatomyositis
no. of scabies mite on body=10-15
Norwegian scabies-pt on CT
erythema Gyratum repens
multiple concentric ring, wood Grain pattern, erythema, swelling, trunk, a/w ca lung
pellagra
glove/gauntlet of pellagra, Cassal necklace
Becker nevus-dermal, large hyperpigmented patch, hair,shoulder area, does not
present at birth
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
lichen simplex
hyperpigmented, thick skin, accentuation of skin crease
pompholyx(bubble)
vesicle on hand,nger, deep seated sagograin like lesion
molluscum sebaceum-keratoacanthoma
Sweet synd