24 Urological Trauma LR

DERMATOVENEROLOGY EXAM Q&A 2012
1) Epidermis – the outer skin layer: enumerate all types of layers, describe all types of layers, Malpighian’s
layer, function of Langhan’s cells, localization and function melanocytes
1. Epidermis layers
a. Germinative layer (stratum basale / stratum germinativum)
- It sonsists of a single layer of prismatic (columnar) cells arranged like a palisade
- Between these cells, there are slit-like spaces called intercellular bridges
- Among the cells of germinative layer localize melanocytes, which produce melanin
- Skin color straightly depends on the amount of melanin
b. Prickle cell layer (stratum spinosum)
- Consists of five to ten rows of cells which are cuboid in the deep parts of the layer but become
flatter gradually as they approach the next layer, the granular layer
- The cells of the prickle-cell layer are marked by the presence of specific tonofibrils in their
cytoplasm
- Special Langhan’s cells are demonstrated in this layer, which carry immunological function
c. Granular layer (stratum granulosum)
- Contains one to two or four rows of cells elongated parallel to the epidermis
- It was considered previously that they were formed of a special substance called keratohyline
- The presence of keratohyline granules is the first visible stage, of the beginning of the process of
keratinization of the epidermal cells
d. Lucid layer (stratum lucidum)
- Composed of elongated cells containing a special protein substance which refracts light strongly
- This substance resembles drops of oil and is celled eleidin
- Besides its main component, eleidin, the stratum lucidum contains glycogen and fatty
substances (lipoids, oleic acid)
e. Horny layer (stratum corneum)
- It is composed of fine, anuclear keratinized elongated cells
- They are firmly attached to one another and are filled with a horny substance (keratin) the
chemical structure of which has still not been finally determined
- It is believed that this is an albunoid substance poor in water and rich in sulphur and contains
fats and polysaccharides
- The outer part of stratum corneum is less compact and occasional lamina separate from the
main bulk, i.e. the process of physiological desquamation occurs
2. Malpighian’s layer
- The epidermal germincative, prickle-cell and granular layers are sometimes embraced under the
name of Malpighian layer
3. Function of Langhan’s cells
- Langhan’s cells are demonstrated in prickle cell layer, which carry immunological function
4. Localization and function of melanocytes
- Melanocytes are localized in germinatice layer
- Its function as pigment formation, melanin
- Skin color straightly depends on the amount of melanin
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2) Urticaria – etiology, classification, clinical forms, clinical picture, treatment
1. Etiology
a. Exogenic
- Physical, thermal, mechanical, chemical agent
- Drugs, antibiotics, sera
- foods
b. Endogenic
- Pathological process in viscera, e.g. GIT, CNS disturbance
c. Autogenic
- Allergen, toxins, toxic substances
- Promote development of immediate-delayed hypersensitivity
2. Classification
a. Acute urticaria – artificial urticaria, acute circumscribed oedema (giant urticaria, angioneurotic
oedema, Quincke’s disease)
b. Chronic recurrent urticaria
c. Stable chronic popular urticaria
d. Solar urticaria
3. Clinical forms
a. Acute urticarial
- Pinkish-red with mat hue in the center
- Pink fringe uneven contours on periphery
- Lesions coalesce into extensive body zones
- Round wheals on trunk, hand, buttocks
- Eruption on the mucous membranes of lips, tongue, nasopharynx
b. Artificial urticaria
- Linear wheals , demonstrating dermatographia, no itching
c. Acute circumscribed oedema
- Oedema on the mucous membrane, face subcutaneous fat (lips, cheeks), or genital
- Hard-elastic white skin
d. Stable chronic papular urticarial
- Papules are reddish-brown on extensor surface of the limbs
e. Solar urticaria
- Eruption on the exposed skin areas, may lead to disorder of respiration and heart; shock
4. Clinical picture
a. Acute urticaria
- Severe itching, abundant lesions of various size elevated above the skin
b. Chronic recurrent urticarial
- Itching, headache, weakness, elevated body temperature and arthralgia
- Nausea, vomiting, diarrhea when edema on the GIT mucosa
5. Treatment
- Salt purgative, dairy products and vegetables, sedatives, hypersensitizing agents (calcium
preparations, sodium hyposulphite infusion, magnesium sulphate injections), and
antihistaminics
- Preparations of bromide and valerian, Nanophyn, Dimedrol, Peritol, Tavegil (Glemastine fumarate),
Diazolin (Mebhydrolin Napadisy-late), Stugeron (Ginnarizine), Alfadryl (Moxastine), Suprastin (chlo-
ropyramine), Diprazine (promethazine hydrochloride), Seduksen (Diazepam), as well as drugs
containing ephedrine and belladonna and their derivatives are used.
- To reduce vascular permeability, calcium chloride, calcium gluconate or calcium lactate are
prescribed simultaneously orally or intramuscularly together with vitamin G and rutin.
- Purgatives, cleansing enema, and in some patients diuretics (furosemid, theobromine and sodium
salicylate) may prove valuable in acute urticaria.
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- Iron preparations, salicylates, vitamins Bla and Be, sodium hyposulphite, Salol and Atophan
(Cinchophen) are recommended in chronic urticaria.
- Severe forms of the disease AGTH and corticos-teroid hormones are given, followed by histaglobin
therapy.
- External therapy is of no essential importance. Aqueous-zinc pastes, ointments with
corticosteroid hormones and baths with a decoction of bur-marigold, chamomile, starch or
bran are prescribed.
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3) Dermis – the true skin, Hypoderm: enumerate all types layers, describe all types layers, describe the
hypoderm, enumerate and describe all types of glands, enumerate and describe all types of hair
1. Layers
a. Papillary layer (stratum papillare)
- Consists of thin bundles of astructural amorphous interstitial substance, collagen fibers and
many fine elastic and argyrophil fibers
b. Reticular layer (stratum reticulare)
- Consists of collagen bundles are more compact and thick and intertwine into a thick network of
loops
- The reticular and particularly the papillary layer of normal skin have a small number of various
cell elements: fibroblasts, histiocytes, lymphocytes, mast and plasma cells, and peculiar pigment
cells
- Hairs, glands (epithelial appendages of the skin), muscles, vessels, nerves and nerve endings are
located in the dermis.
2. Hypoderm
- Hypoderm is the deep part of the skin or the subcutaneous fatty tissue
- Consists of thick bundles of collagen and elastic fibres stretching from the reticular dermal layer
and forming a wide-loop reticulum in which accumulations of large fat cells, lobules of fatty
tissue, are lodged
- The thickness of the hypoderm varies from 2mm till 10cm and more, and in some areas there is
no hypoderm at all (eyelids, prepuce, small pudendal lips, scrotum)
3. Glands
a. Sebaceous glands
- Holocrine glands character which secreting sebum
- Found in all skin areas connected to the hair follicles
- In skin of vermilion border, glans penis, inner surface of prepuce, small pudendal lips, nipples,
and eyelid margins the sebaceous glands open directly to the surface without association with
hair follicles.
- Sebaceous glands of inner surface of prepuce called Tyson’s glands which produce smegma
- On margin of eyelids called maibomian glands
b. Sweat glands
- Simple tubular glands which secrete sweat
i. Eccrine sweat glands
- Found in all skin areas with the exception of the vermilion border, the glans penis, the
inner surface of the prepuce, and the outer surface of the lesser pudendal lips.
- Large numbers in the skin of the palms, and soles
- Located in the deep layer of dermis
ii. Apocrine sweat glands
- Found in the axillae, around the anus, region of the nipples, external female genitals, in the
groin, on the pubis, and around the umbilicus.
- The ducts open into the hair follicles, while their body lies deep in the subcutaneous fat.
- Their activity is linked with the activity of the sex glands and remains underdeveloped
until the period of sexual maturation.
4. Hair
a. Types of hair
i. Long hair
- On the head, beard, moustache, in the axillae, pubis, genitals
ii. Bristly hair
- Eyebrows, eyelashes, the hair in the nose and external acoustic meatus
iii. Downy hair
- on the face, trunk, and limbs
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b. Characteristics of hair
- Hair shaft rising above the skin surface
- Hair root buried in the dermis, consists 3 layers (medulla, cortex, cuticle)
- Hair follicle or sacculus is membranes and connective tissue capsule enclosing the hair root, also
drain the sebaceous glands ducts
- Hair bulb is the lower part of hair root, consists 3 layers (inner root-sheath, Huxley’s layer,
Henle’s layer)
- Hair papilla consists nerve fibres and blood vessels supplying nutrient to the hair
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4) Mycoses – favus: classification, etiology, clinical picture of the scalp, methods of diagnostics, treatment
1. Classification
- Favus of scalp
- Favus of smooth skin
- Favus of the nails
- Visceral favus
2. Etiology
- Anthropophilic fungus Trichophyton (Achorion) shoenleinii
3. Clinical picture of the scalp
a. Favus of scalp
i. Scutular (typical form)
- Ochre-yellow cup-shaped crusts, depression on center, appear on slightly hyperaemic spot
- Involve whole scalp, hairs not break, thin, lusterless, as if dusty, and grey
- Mouse-like or barn-like odour
ii. Squamous or pityroid (atypical form)
- Appearance of congestive-hyperaemic skin areas with copious microlamellar scaling
resembling severe seborrhea
iii. Impetiginous (atypical form)
- Pustule formation in hair follicles orifices
- If not treated, will leave cicatrical atrophy on scalp
b. Favus of smooth skin
- Scutular form of skin favus growth may coalesce
- Atypical varieties marked by formation of erythematous scaling foci, grow along the periphery
and coalesce (pityroid form) or forming superficial follicular pustules resembling ostial folliculitis
(impetiginous form)
- Leave no cicatrical atrophy on smooth skin
c. Favus of the nails
- Typical favus of the nails
- Brown or dirty-grey spot or yellow bands first in center of nail, spread over gradually
- Finger-nails mostly affected, destructive nails changes are less pronounced
d. Visceral favus
- In tuberculosis patients
- In cases with favus of lung, GIT, meninges, meningoencephalitis , lymphadenitis (neck, occipital ,
parotid lymph nodes)
4. Methods of diagnostics
- Typical scutular form diagnosed based on the appearance and character affection of the hairs
- Atypical form diagnosed based on the appearance of hair (e.g. lusterless, thin, not broken)
- Distinction from squamous form, will be seborrhoeic eczema marked by bright color of foci,
which are edematous and presence serous crusts
- Distinction from impetiginous form, in impetigo vulgaris and ostial folliculitis, the foci are
surrounded by acute inflammatory, edematous corona
- Based on result of microscopy and cultural examination of sputum, faeces, cerebrospinal fluid
and lymph nodes aspiration
5. Treatment
- External treatment by 2-5% iodine tincture in the morning, and 10%sulphur and 3% salicylate
ointment or 10-15% sulphurtar ointment in the evening.
- Antibiotic griseofulvin (will causes vitamin B complex hypovitaminosis) daily dose of 21-22
mg/kg with polyvitamins of B complex
- X-rays exposure to the scalp
- 4% epilin plaster when griseofulvin contraindicated
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5) Function and anatomy of the skin: enumerate all types of function, describe all types of function, blood
system of the skin, lymphatic system of the skin, neuro-receptor apparatus of the skin
1. Functions of skin
a. Immunological function
b. Metabolic function
- Involve in metabolism of water, minerals (sodium, potassium etc), fats, proteins (collagen,
albumin, globulin, keratin ammonia, pigment), and carbohydrates.
- Also metabolism of hormones, enzymes, vitamins (C, B1,2,3,5,8,12, A, D, E) and trace elements
c. Respiratory and resorption function
- Little part of respiration (oxygen and carbon dioxide exchange) involve through skin
- Substances easily dissolved in fats and lipids are readily resorbed through skin
d. Secretory and excretory function
- Sweat (eccrine and apocrine) and sebaceous glands responsible for this
- Excretes some metabolites or toxic substances and drugs (e.g. sugar in DM patient, some drugs)
e. Thermoregulation function
- Heat production result from metabolism which belong to chemical thermoregulation
- Physical thermoregulation is heat emission which include heat radiation, heat conduction, and
evaporation of sweat from skin surface
f. Receptory function
- Pain which perceived by free nerve ending
- Itch sensation
- Tactile which include sense of touch , pressure, and vibration
- Temperature sensitivity include sense of heat and cold
g. Protective function
- Resistant to mechanical effects (friction, compression etc)
- Poor heat conductor prevent from drying
- Melanin protects skin from damaging sun rays effect
- Skin acidity (pH5-6) prevent penetration of microbes
- Sterilizing properties / bactericidal properties of sweat and sebum
2. Blood system of skin
- Deep arterial plexus gives off large arterial vessels reaching the subpapillary layer forming
superficial subpapillary arterial plexus, in turn gives off small arterial branches.
- Capillaries from small arterial branches form loops that continue with venous capillaries loops
- Venous capillaries come together forming superficial subpapillary venous plexus, then drain into
subcutaneous veins
3. Lymphatic system of skin
- Superficial network arises in the papillary layer as blind rounded dilated capillaries with
numerous anastomoses in between
- Deep network in the lower part of the dermis and has valves, forming lymphatic plexus
continuous with lymph trunks
4. Neuro-receptor of skin
a. Vater Pacini corpuscles – the receptors of the sense of deep pressure and proprioceptive
sensations, usually located in the subcutaneous fatty tissue
b. Free nervous endings – nonspecific receptors
c. Meissner’s corpuscles – are situated in the papillae receptors for the sensation of tactile
sensation
d. Krause’s bulbs – the receptors for the sensation of cold situated in and under the papillae
e. Ruffini’s bodies – receptors for the sensation of warmth located much deeper, in the deep parts
of the dermis and in the upper parts of the subcutaneous fat
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6) Lichen rubber planus: etiology theory, describe the typical clinical picture, describe Kebner’s
phenomenon and Wikhem’s net, clinical forms, treatment
1. Etiology theory
- Unknown etiology
- Viral theory,
- Neurogenic theory,
- Hormonal theory,
- toxico-allergic theory,
- metabolic disorder theory,
- endocrine disorder theory,
- genetic (hereditary) theory
2. Typical clinical picture
- Monomorphic, flat papules erruptino
- Papules has polygonal form, pinkish-violet or crimson-red color
- Shiny surface, wax-like gleam
- Depression in the center of papules
- Lesion diameter 2-3 mm
- Papules may coalesce form small plague with small scales
- Localized at upper extremities flexor, lower extremities extensor surface, axillar, trunk, inguinal
fold
- Wickham’s striae and Koebner’s phenomenon
i. LRP of mucous membranes
- The lesions on the buccal mucosa are represented by greyish-opal punctate papules
grouped in rings, networks and lacework
- Flat whitish-opal plagues with clearly boundaries resembling the foci of leukoplakia form on
the surface of the tongue
- Small violet plagues with slight scaling and a greyish white network on the surface appear on
the vermillion border of the lip
ii. LRP of nails
- Longitudinal tracings, sometimes ridge-like
- Hyperaemic of the nail bed with opaque foci on the nail plates
3. Kebner’s phenomenon
- The typical lesions that are arranged at the sites of excoriations
4. Wikhem’s net
- Small whitish dots and lines intertwinning like a cobweb seen through the horny layer
5. Treatment
a. Systemic therapy
- Remove the pathogenic factors
- Antibiotic therapy – tetracyclin, chlortetracycline, hydrochloride or oleandomycin,
ecmonovocillin
- Hyposensitive agents – IV infusion of calcium chloride of sodium hyposulphate solutions
- Sedative – bromine preparations, valerian
- Vitamin C, rutin, nicotinic acid and injection of vitamin B1, 6, 12
- Glucocorticoids in hard cases
- Antihistaminic agents injection – mebhydrolin, napadisylate, chloropyramine, clemastin
fumarate, promethazine hydrochloride, diphenylhydramine hydrochloride
b. External therapy
- Ointments or creams with corticosteroids – locasalen, locacorten, flucinar, celestoderm, elocom,
belosalic, diprosalic
- 2-5% resorcini solution
- 1% mentoli solution with 1% chlolarhidraty
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c. Physiotherapy
- Hypnotic sleep, electric therapy
- UV irradiation
- PUVA therapy
- Diathermy of the cervical sympathetic ganglia
- Inductothermy of the lumbar region combined with oral medication with methyldopa or
raunatin
- Balneal therapy
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7) Morphological lesions of the skin: classification of all morphological lesions, enumerate primary
infiltrative morphological, describe primary infiltrative morphological, evolution of nodus, evolution of
papula
1. Classification
a. Primary
i. Infiltrative – spot, papule tuber, nodule
ii. Exudative – vesicle, bulla, pustule, wheat
iii. Cavitary – vesicle, bulla, pustule
iv. Non cavitary – spot, papule, tuber, nodus, wheat
b. Secondary
- Erosion, ulcer, squama, crust, scar
- Fissura, excoriation, spot, vegetation, lichenization
2. Primary infiltrative morphological
a. Spot
- Is a circumscribed alteration in the color of the skin or mucous membrane. It is not elevated on
the skin
- According to the cause of formation
i. Vascular – roseola, erythema, erythrodermia
ii. Hemorrhagic – petechial, purpura, vibrces, ecchymoses, hematoma
iii. Dischromic – depigmentation, hyperpigmentation
b. Papule
- Is a solid, more or less hard lesion, elevated. Size is until 5mm
- According to localization – epidermal, dermal and epidermodermal
- According to form – semispherical, acuminated, flat, polygonal, oval, round
c. Tuber
- Infiltrative solid skin elevation of a non-acute inflammatory character
- Occur on restricted areas of skin as a rule, either in groups or they coalesce forming a compact
infiltration
- The inflammatory cellular infiltration in tubercles spreads not only in the papillary but mainly in
the reticular layer of dermis
- Histologically, it is an infectious granuloma which either ulcerates with the eventual formation
of scar or resorbs leaving cicatricial atrophy
d. Nodule
- Is primary infiltrative morphological lesion without acute inflammation
- It is large (size of pea to walnut or larger) and is situated in the subcutaneous fat
- The nodules ulcerate and eventually cicatrize. Consistency is soft to firm elastic
3. Evolution of nodus
- Nodule → ulcer → crust → squama → scar
4. Evolution of papula
- Papule → squama → pigmentation
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8) Pyodermas: etiology, classification of pyodermas, pityriasis simplex, tourniole, treatment
1. Etiology
- Staphylococcus - Escherichia coli
- Streptococcus - Pneumococcus
- Blue-pus bacillus - Gonococcus
- Proteus vulgaris - Fungi
2. Classification of pyodermas
a. According etiology factor
- Staphylococcus
- Streptococcus
- Mixed
b. According depth of localization of process
- Superficial – ostial folliculitis, sycosis
- Deep – deep folliculitis, furuncle, carbuncle, hidradenitis
c. According to the character of their course
- Acute
- Chronic
d. Primary – various independent nosological forms
Secondary – complication of other dermatoses
3. Pityriasis simplex
- Atypical pyoderma, no pustule
- Localize on skin around mouth, cheeks, mower jaw, trunk and limbs skin
- Common in children and women
- It is round, or oval spot, strictly circumscribed whitish or pink foci, covered with small scales
abundantly
- Resolve without problem, desquamation of spots
- May cured by sunrays (use keratolytic solution to remove scales, let the sun penetrate inside
skin)
- Serous secretion
4. Tourniole
- Impetigo of nail folds
- Pain
- Around finger nails, under nail plate
- Develop in wound of finger and nail, after injury
- Phlyctena form around finger nail, first serous secretion, then cloudy purulent
- Affected phalange swells, then erosion forms like horseshoe
- Loss of nail plate in the end
5. Treatment
a. Systemic
- High-calorie diet
- Vitamin A, B, C, E
- Autovaccines
- Antibiotics (depend local or generalize type of microbes)
- Stimulation therapy (autohaemotherapy, lactotherapy, pyrogen)
- Systemic hormone
b. External
- Painted twice daily aniline solution (brilliant green etc)
- 1-2% alcohol boric or salicylic solution
- Ointment, creams containing antibiotics and steroid hormones
c. Physiotherapy
- UV irradiation (erythema doses)
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exudative morphological lesions, describe primary exudative morphological lesions, evolution of
vesicular, evolution of pustule
1. Classification
a. Primary
b. Secondary
2. Primary exudative morphological lesions
a. Vesicle
- Is primary lesion of an exudative character, it has a fluid containing cavity and is slightly elevated
- Size until 5mm
- They can be unicamerate or multicamerate
- According to contents, they can be serous or hemorrhagic
b. Bulla
- It is a cavitary lesion with size more than 5mm, consists of a covering, a cavitary with serous
contents and a floor
- According to localization in skin – subcorneal, intraepidermal, subepidermal
- Contents can be either serous or hemorrhagic
c. Pustule
- It is an exudative cavitary lesion containing pus
- May be superficial or deep
d. Wheat
- Is an exudative non-cavitary lesion which form as a result of circumscribed acute- inflammatory
edema of the papillary skin layer
- It is rather hard cushion-like elevation spherical or less frequently oval in shape, which is
attended with strong itching
- It usually disappears rapidly (minutes to hours) leaving no trace
3. Evolution of vesicular
- Vesicular → erosion → crust → squama → pigmentation
4. Evolution of pustule
- Superficial pustule → erosion → crust → squama → pigmentation
- Deep pustule → ulcer → crust → squama → scar
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10) Mycoses: classification of epidermophytosis, etiology eipdermophytosis of the folds, clinical picture
epidermophytosis of the folds, methods of diagnostics epidermophytosis of the folds, treatment
epidermophytosis of the folds
1. Classification of epidermophytosis
a. Epidermophytosis of large skin fold (Tinea inguinalis)
b. Epidermophytosis of feet (Tinea pedis)
- Latent form
- Squamous form
- Squamous-hypertrophic form
- Intertriginous form
- Dyshidrotic form
c. Epidermophytosis of ring worm of nail (Tinea unguim)
2. Etiology of epidermophytosis of the folds
- Epidermophyton inguinale sabouraud (E. floccosum)
3. Clinical picture of epidermophytosis of the folds
- Lesions localized in femoro-scrotal folds, medial thigh, pubis, axillae
- Red-inflammatory, scaling spots lentil size appear first
- Peripheral growth gives large oval foci, hyperemic, macerated surface, edematous edge,
sometimes covered with vesicles, crusts, and scales
- Foci coalesce to form extensive palm size geographic outlines, while center is depressed
- Border of desquamating on edges
- Mild itching, but intense during exacerbation period (hot season and excessive sweating)
- Similar as in eczema, so it was called eczema marginatum disease
4. Methods of diagnostics of epidermophytosis of the folds
- Base on typical clinical picture, localization of process, acute onset, chronic course, and
detection of threads of septate mycelium on microscope
- Best material for examination is the desquamating epidermis taken from the periphery of the
lesion
5. Treatment of epidermophytosis of the folds
a. In acute period with eczematization sign – cold lotion with 3% boric acid solution or 0.25% silver
nitrate solution
No eczematization sign – 1-2% iodine tincture
b. 3-5% sulphur-tar or boric acid-tar ointment
c. Fungicidal agents – nitrofungin, mycoseptin, amycazole, undecin, zincundan ointments, 2-5%
Castellani’s paint, Wilkinson”s ointment half-and-half with naphthalan, and Octathione
ointment
d. Hyposensitizatino therapy – orally 10% calcium chloride solution, 0.5 g of sodium thiosulphate
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11) Morphological lesions of the skin: classification of morphological lesions, enumerate secondary
morphological lesions, describe secondary morphological lesions, definition of mono- and polymorphic
eruption, definition of true and false polymorphism
1. Classification
a. Primary
b. Secondary
2. Secondary morphological lesions
a. Errosion
- Superficial morphological lesion within epidermis only
- Appear after rupture of vesicles, bullae, and pustule and are of the same shape and size as
primary lesions in whose place they had formed
- Usually pink or red and have a moist, weeping surface
- Heal without leaving scars
b. Ulcers
- Skin defect with involvement of epidermis, dermis, and sometimes the deeper lying tissues
- Develop from tubercles, nodules, and after rupture of deep pustule
- Can be spherical, oval or an irregular shape. Color can vary from bright-red to cyanotic
congestive
- Heals always leaving a scar fromo the character of which the previous pathological process may
be determined
c. Squama
- Pathologically detached horny laminae
- According to size, can be furfuraceous (small and fine) and lamellar (large)
- Color may be white, grey, yellowish or brownish
d. Crust
- Forms when a serous exudate, pus or blood dries on skin
- According to contents, can be – serous, purulent, hemorrhagic, and mixed
- According to color, can be –
Transparent or yellowish in serous secretion
Yellow or greenish-yellow in a purulent secretion
Red or brownish in a hemorrhagic secretion
e. Spot
- Develops in process if evolutionary of primary morphological lesions
- Dischromic spot – depigmentatic, hyperpigmentatic
f. Scar
- Forms in place of deep defects in the skin which had been replaced by coarse, fibrous
connective tissue
- Can be divided into – atrophic, hypertrophic, primatrophic, keloid
g. Fissure
i. Superficial (epidermis only)
- Does not penetrate beyond the epidermis and heals without trace
ii. Deep (epidermis and dermis)
- Forms in epidermis and dermis, sometimes with involvement of the deeper tissues, and
leaves a scar after healing
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h. Excoriation
- Skin defect result from scratches or some other traumatic damage
- If only epidermis and dermis involved, then no scar. If deeper, scar formed
- It is objective sign of excruciating itching
i. Vegetation
- Form in region of a persistent inflammatory process as the result of intensified proliferation of
the epidermal prickle cell layer
- Have appearance of villi, dermal papillae which lead them an uneven nodular character
resembling a cock’s comb
- Color can differ based on the presence of discharged from bleeding or secondary infectious from
grey to red or yellow. Can be hard or tender
j. Lichenization
- Is thickening and hardening of the skin marked by exaggeration of its normal pattern,
hyperpigmentation, dryness, roughness, and shagreen-like appearance
- Can be primary (due to long term irritation of the skin) or secondary (in confluence of papullary
lesions)
3. Definition of monomorphic eruption
- Single type of primary morphological lesions
4. Definition of polymorphic eruption
- Subdivided into true and false polymorphism
5. Definition of true polymorphism
- Consists of several types of primary morphological lesions
6. Definition of false polymorphism
- Primary and few secondary morphological lesions found at the same time
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12) Mycoses: etiology, classification of rubromycosis, clinical picture of the nails rubromycosis, clinical
picture of the feet rubromycosis, methods of diagnostics, treatment
1. Etiology of rubromycosis
- Trichophyton purpureum or rubrum
2. Classification of rubromycosis
- Rubromycosis of feet – squamo-hypertrophic, intertriginous, dyshidrotic
- Rubromycosis of feet and hands
- Rubromycosis of nail plates – normotrophic, hypertrophic, atrophic
- Generalized rubromycosis
3. Clinical picture of nails rubromycosis
- Often affects all the fingers and toes nails and begins from distal and side parts of nails
- Sometimes, it is an isolated affection of the nails, in others it is combined with affection of the
skin on the feet and hands or with generalized rubromycosis
- In normotrophic type, thickness of nail plate is normal, lesion occurs on the free edge or sides of
the nail as white or yellowish bands
- Hypertrophic type is marked by the thickening of the nail plate which crumbles and breaks easily
- Atrophic type, the nail plate is thinned out, its greater part is destroyed, only part next to the
nail wall remains
- Sometimes nail plate separated from nail bed ad onycholysis
4. Clinical picture of feet rubromycosis
- Lesions appear first in the interdigital folds and extends to skin of soles, sides and dorsal surface
of feet and toes
- Skin becomes infiltrated, dry, and diffusely hyperemic with furfuraceous scaling
- In children, is often attended with exudative phenomena
- Soon or later will involve the nail plate
- Sometimes begin with nail plates and spread to skin of feet
- By microscopy examination – collect skin fold scraping at nail free margin, fufuraeous scales, and
keratotic masses of nail plates
- Cultural diagnosis
- By clinical pictures
6. Treatment
- Keratolytic ointment then 5% salicylic petrolatum under compress dress
- Keratolytic vanish then hot hand or foot bath with potassium permanganate or sodium
hydrocarbonate
- Iodine tincture with 10-15% sulphur ointment and 2-3% tar
- Acid powder – boric acid and tannin acid powder 3g of each, and zinc oxide and talc 15g of each
- Castellani’s paint, nitrofungin, 2% iodine tincture, fungicidal ointment with antifungal antibiotic
griseofulvin
- Vitamin A, E
- Pyrogenic agents injection (pyrogenal, prodigiosan), aloe, autohaemotherapy
- Keratolytic plaster, potassium iodide ointment , 15% resorcin-lactic-salicylic ointment, 5%
salicylic ointment, fungicidal agents
Page 16 of 67
13) Anatomy of the skin: blood systems of the skin, lymphatic systems of the skin, neuro-receptor
apparatus of the skin, types of hair, describe hair follicles, structure of nails
1. Blood systems of the skin

- Deep arterial plexus gives off large arterial vessels reaching the subpapillary layer forming
superficial subpapillary arterial plexus, in turn gives off small arterial branches.
- Capillaries from small arterial branches form loops that continue with venous capillaries loops
- Venous capillaries come together forming superficial subpapillary venous plexus, then drain into
subcutaneous veins
2. Lymphatic systems of the skin
- Superficial network arises in the papillary layer as blind rounded dilated capillaries with
numerous anastomoses in between
- Deep network in the lower part of the dermis and has valves, forming lymphatic plexus
continuous with lymph trunks
3. Neuro-receptor apparatus of the skin
a. Vater Pacini corpuscles – the receptors of the sense of deep pressure and proprioceptive
sensations, usually located in the subcutaneous fatty tissue
b. Free nervous endings – nonspecific receptors
c. Meissner’s corpuscles – are situated in the papillae receptors for the sensation of tactile
sensation
d. Krause’s bulbs – the receptors for the sensation of cold situated in and under the papillae
e. Ruffini’s bodies – receptors for the sensation of warmth located much deeper, in the deep parts
of the dermis and in the upper parts of the subcutaneous fat
4. Types of hair
a. Long hair
- On the head, beard, moustache, in the axillae, pubis, genitals
b. Bristly hair
- Eyebrows, eyelashes, the hair in the nose and external acoustic meatus
c. Downy hair
- on the face, trunk, and limbs
5. Hair follicles
- Hair follicle or sacculus is the membranes and a connective tissue capsule enclose the hair root
- It is cylindrical shape, terminates on the skin surface as infundibulum of follicle which passes the
hair shaft
- Sebaceous glands ducts connect to follicle on boundary between upper and middle third
- Hair follicle wall lined with epithelium
- It contains fine elastic and argyrophil fibres which form the basement membrane on the
boundary with outer root sheath
6. Structure of nails
- Is a horny plate on the dorsal surface of the distal phalanx of the fingers and toes (nail bed)
- Proximal end and sides of nail plates covered by nail fold (skin fold)
- Nail has a body (corpus unguis), a root (radix unguis) and a distal free margin (margo liber)
- Proximal nail fold forms a thin horny plate of epidermis, the nail cuticle (eponychium)
- Nail bed covered by nail root called matrix (matrix unguis), where the nail grows
- Distal of the matrix is a whitish area called lynula, it is noticeable on thumb and big toe
- Nail plate is hard compact horny masses, smooth outer surface, but rough in inner surface
- Nail plate moves along nail bed and is completely renewed in 90 to 115 days
Page 17 of 67
14) Mycoses: full classification of mycoses, pityriasis versicolor etiology, clinical picture, methods of
diagnostics, treatment
1. Classification of mycoses
a. Keratomycoses – pityriasis versicolor, erythrasma, trichosporosis nodosa, trichomycosis axillaris
b. Dermatomycoses – epidermophytosis, rubromyocosis, trichophytosis, microsporosis, favus
c. Candidiasis – of skin, mucous membranes, viscera
d. Pseudomycoses
e. Deep (systemic) mycosis
2. Pityriasis versicolor etiology
- Pityrosporum orbiculare
3. Clinical picture
- Chronic - long duration (months and years)
- Sometimes mild itching
- Chest, back, neck, hairy head part, abdomen, trunk sides, lateral surface of the arms
- Yellowish-brownish-pink spots, not elevated above skin, no inflammatory phenomenon, scaling
presence in the foci. Foci will grow in size and pathological area appear
- Color of spot becomes dark brown or café with milk
- Scales detected by scratching of skin (Besnier’s sign)
- Secondary or pseudoleucoderma – forms after sunlight and treatment of pityriasis versicolor
- Clinical picture
- Besnier’s sign
- Baltser’s iodine test – skin painted by 5% iodine tincture, affected area stained more intensively
- Wood’s glass – foci of affection detected by mercury vapour lamp pass through glass
impregnated nickel oxide. In dark room, dark brown or reddish-yellow fluorescence of the spot
- Microscopy of scales
5. Treatment
a. Systemic
- Antifungal drugs (diflucan, diflason, ketokanasol, intrakanasol)
b. External
- Keratolytic ointment and solution – salicylic 5% or resorcinol 3-5%, alcohol and sulphuric 10-20%
or salicylic 3-5%
- Officinal cream and ointment – candid, cotrimasol
c. Physiotherapy
- UV radiation
Page 18 of 67
15) Psoriasis: etiology theory, clinical forms, describe stages, enumerate periods, treatment
1. Etiology theory
- Virus origin
- Genetic (hereditary) theory
- Neurogenic theory
- Metabolic disorder theory
- Infectious-allergic theory
- Endocrine disorder theory
2. Clinical forms
- Monomorphic, popular eruption (the epidermoderma) psoriasis papule is pink of various
intensity, the fresh lesions are brighter (even red), while the older ones are blacker
- At first the papules have a regular round contour and a diameter of 1-2mm
- With advancement of the process, the psoriatic papules spread to the periphery, grow in size and
form plaque often large in size and of fantastic shapes. Quite often the patients may
simultaneously have popular lesions of various size and psoriatic plaques
- The silver-white scales (the silver color is due to the presence of air bubbles) cover the surface of
papule which scrape off easily
- On fresh papules the scales are found in the center leaving a narrow bright band on the
periphery. Later the scaling intensifies and occupied the entire surface of the lesions
- Symmetrical eruption, mainly localized in the extensor surfaces of the limbs
- Psoriatic rush may occur in any area of skin (genital organs, mucous membranes, ear region) and
joints
- Presence of psoriasis triad and Koebner’s phenomenon in progressice and sometimes in
stationary stage
- Psoriatic triad
i. Steering-spot phenomenon – abundant desquamation of silver white scales
ii. Terminal or psoriatic film phenomenon – appearance of moist shiny surface after removal of
the scales
iii. Drop hemorrhages – appearing with continues scratching and may cold the pin-point bleeding
(Auspitz’ sign) or ‘blood dew’ (Polotebnov) phenomenon
- Koebner’s phenomenon or isomorphic reaction of skin consists in the development of new
psoriatic eruptions on skin areas exacerbation of which is induced by mechanical and chemical
agents (scratches, injections, cuts, friction, irradiation, burns).
7-9 days elapse between the trauma of the skin and the development of the isomorphic reaction,
through cases have been encountered in which the reaction occurs earlier (3 days) or much later
(21 days)
3. Stages
a. Progressive stage
- Appearance of new papules
- Peripheral growth of the old lesions
- The presence of inflammatory ring around the papules (growth ring, Pilnov’s sign)
- Positive psoriatic triad is presence
- Positive Koebner’s phenomenon
- Formation of new plaque due to coalescence of papules or growth of new plaque
b. Stationary stage
- New lesions not appear
- No peripheral growth ring
- Negative or positive Koebner’s phenomenon
- Positive or negative Psoriatic triad
c. Regressive stage
- Psoriatic lesions become flat and pale
Page 19 of 67
- Scaling reduces or ceases
- Pseudoatrophic ring around of papules (Voronov’s sign)
- Resolution of lesions occurs beginning with the peripheral, or central part, or like a drop of oil
- Terminates with the formation of depigmented (much less frequently hyperpigmented) spots
4. Periods
- Manisfestation
- Latent
- Recurrent
5. Treatment
a. Systemic therapy
- Cystostatic drugs and immunodepresent (metatrexsat, cyclosporine A)
- Aromatic retinoids (tigason, roaccutane)
- Vitamin and co-ferments, ferments (A,C,E,B1, 2, 6, 12, 16, nicotinic and folic acids)
- Immunosuppresant (pyrogonal, derinat, licopoid)
- Sedative drugs (extractus valeriance, persen)
- Angiotrophic drugs (trental, cavinton)
- Antihistamines drugs (klavidol, suprastin)
- Hyposensitives agents (IV infusion of calcium chloride, calcium gluconate or sodium
hyposulphate solutions)
- Glucocorticosteroids therapy and microelements (triamcinolone, prednisolone or
methylprednisolone)
- NSAID (indomethacin, ortophen)
b. External therapy
i. Progressive stage
- Non-irritating ointment with 2% salicylic acid or 2% sulphur, 5%naphthalan, unna’s cream
ii. Stationary and regressive stage
- Ichthammol-naphthalan, sulphurictar ointments in increasing doses
- Ointment, creams with corticosteroids (Locasalen, Locacorten, Flucinar, Celestoderm,
Elocom, Belosalic, Diprosalic) are indicated in all stages of the process
c. Physiotherapy
- Used in stationary stage
- UV rays (not in progressive stage), indirect diathermia
- Photochemotherapy (PUVA therapy) recently been applied successfully in psoriasis. The method
is based on the combination of oral photosensitizing agents (8-methoxypsoralen syn.
Methoxsalen, beroxanum, psoralen, amyfurin) and irradiation with UV rays of a wavelength of
320-400nm
- Treatment at spa and health resorts and balneal therapy (sulphureted hydrogen, radon, and
natural brine baths) are indicated
Page 20 of 67
16) Pyodermas: etiology, classification of pyodermas, ostial folliculitis clinical picture, sycosis clinical picture,
treatment of pyodermas
1. Etiology
- Staphylococcus
- Streptococcus
- Mixed
- Acute
- Chronic
3. Ostial folliculitis clinical picture
- Sensation of pain
- Absent of common symptom
- Acute current
- Localization – face, scalp, neck, forearm
- Follicular pustule, size of pin head, in center of hair follicle, surrounded by hyperemia band of
acute inflammation
- After few days, pustule dry up, crust forms surrounding inflammation, subside, no trace or light
pigmentation in the end
4. Sycosis clinical picture
- Low pain sensation, mild itching
- Generalize symptoms, sometime fever
- Chronic current
- Localization – moustache and beard, less frequently in nose wing inside, eyebrow, scalps and
pubis, axilla
- Few lesions of ostial folliculitis appear at certain skin area, tends to spread larger area
- Top of pustule open, pus dried up into dirty yellow crust, stick to the hairs
- Hair shaft removed from focus has a gelatin-like muff around its root
5. Treatment of pyodermas
a. Systemic
- High-calorie diet
- Autovaccines
- Antibiotics (depend local or generalize type of microbes)
- Systemic hormone
b. External
c. Physiotherapy – UV irradiation (erythema doses)
Page 21 of 67
17) Virus dermatoses: classification of virus dermatoses, etiology warts, factor risk of affection, clinical
picture, methods of diagnostic, treatment
1. Classification of virus dermatoses

- Herpes
- Warts (verrucae)
- Molluscum contagiosum
- Condyloma acuminatum
2. Etiology of warts
- Filterable dermatotrophic virus
a. Common warts (verruca vulgaris) – human papilloma virus (HPV-2, -3), Molitor verrucae virus
b. Plane juvenile warts (verrucae planae juveniles) – HPV-2
c. Plantar warts (verrucae plantares) – HPV-1, -2, -4
3. Risk factor of affection
- Skin traumas and dryness
- Reduced pH of skin water-lipid mantle
- Vegetoneurosis with acrocyanosis or hyperhidrosis
- Decrease of local immunity protective function
4. Clinical picture
a. Common warts (verruca vulgaris)
- Localization – on the hands, fingers, under the nail, feet, face (less frequently)
- Clearly sirsumscribed, no inflammation, semispherical, hard, painless papules, which are
elevated above skin
- Lesions have color of normal skin or grey or brown tinge
- Surface of papules is granular and rough, sometimes with nodular structures
- The size varies from 1mm to 10mm, may form large conglomerates
- The number of warts ranges from solitary lesions to several dozens
b. Plane juvenile warts (verrucae planae juveniles)
- Prevail among children and adolescents
- Localized at back of hands, face, neck, forearms, chest
- Flat, slightly elevated papules have polygonal or rounded form, smooth surface and vary in size
from 1-3mm
- Lesions have color of normal skin, yellowish-pink or yellowish-brown color
c. Plantar warts (verrucae plantares)
- A variety of common warts
- Localized on the soles
- Pain
- Round or oval, had consistency, yellowish-brown, hyperkeratotic surface and resemble corns
- Few in numbers
d. Seborrhoicus warts
- Seen in senile patient, and is believed it changed keratinization in epidermis due to aging
- Mild itching sometimes
- Localized on the skin of trunk, back, chest, abdomen, sebaceous areas
- Round, oval papules, form several to 3-4 mm above the skin
- Round surface is sometimes covered with fat sebaceous scales
- Color from yellowish to dark brown
5. Methods of diagnostic
6. Treatment
a. Systemic treatment
- Immunomodulation therapy (cycloferon, derinat, panavir, immunomax)
b. Local treatment
Page 22 of 67
- Diathermocoagulation
- Electro destruction
- Cryotherapy
- Curettage
- 20% podophyllin solution
- Strong solution of potassium permanganate, trichloro-acetic acid
- Gel ‘panavir’
- ‘intim spray’
Page 23 of 67
18) Pyodermas: etiology, classification of pyoderma, clinical picture of hidradenitis, clinical picture of
angulus infectious, treatment
1. Etiology
- Staphylococcus
- Streptococcus
- Mixed
- Acute
- Chronic
3. Clinical picture of hidradenitis
- Purulent inflammation of apocrine sweat gland
- Mild itching and pain
- Sometimes fever
- Localized on axillar, inguinal fold, less in nipple, scrotum, anus, large pudendal lips
- Solitary small hard mound-like nodes palpated in thickness of dermis or hypoderm
- Nodes grow rapidly in size, adhere to the skin, become pear-shaped and protrude like nipples
and resemble ‘bitch’s udder’
- The skin turns bluish-red, swelling
- The isolated nodes often coalesce, soften, and fluctuation appears after which they open
spontaneously and thick pus with an admixture of blood is discharged
- Ulcers heal in a few days lives deep scar
4. Clinical picture of angulus infectious
- Itching, salivation, and pain during eating
- Localized in one or both angles of the mouth
- Is a condition marked by a rapidly rupturing phlyctena
- Flabby vesicles form at first in the angles of the mouth, which rupture and expose superficial
linear slit-like fissures
- The formed honey-yellow crusts drop off because of maceration
5. Treatment
a. Systemic
- High-calorie diet
- Autovaccines, antibiotics (depend local or generalize type of microbes)
- Systemic hormone
b. External
Page 24 of 67
19) Dermatozoonoses: etiology of scabies, ways of transmission, clinical picture, methods of diagnostics,
treatment
1. Etiology of scabies
- Sarcoptes scabies var hominis or Acarus scabiei mite
2. Ways of transmission
- Direct contact with sick individual
- Shared bed clothes, underwear or through toys of sick child
3. Clinical picture
- Itching at evening and night
- Localized at interdigital webs, sides of fingers, flexor surface of wrist, extensor surface of
forearm, elbow, anterolateral surface of trunk, around areolar, umbilical ring, buttocks, thighs,
penis region
- Small vesicle forms at site the mite had penetrated
- Adult (never face and neck) and children
- Pin-point papulo-vesicular eruptions, burrows (grey dash lines) and excoriations from scratching
- Dry crusts and scales cover papulo-vesicular lesion (Gorchakov-Ardy sign) on extensor surface of
elbow
- Clinical picture
- Gorchakov-Ardy’s sign
- Microscopy (mites or products e.g. eggs, excrements seen on slide)
- Anamnesis
5. Treatment
- If intensive itching, can apply antihistamine
- Emulsion of benzyl benzoate (3 days repeat, not shower)
- Sulphur ointment
- Hyposensitizing and antihistamines
- Aerosol ‘spregal’ twice a day (one day treatment)
Page 25 of 67
20) Mycoses: classification of mycoses, etiology, ways of affection of microsporosis, clinical picture of scalp
microsporosis, methods of diagnostics, treatment
d. Pseudomycoses
2. Etiology of microsporosis
- Anthropophilic fungi – Microsporum ferrugineum, M. audouini
- Zooanthropophilic fungi – M.lanosum
3. Ways of affection of microsporosis
- Anthropophilic – direct contact with sick person or through contaminated clothes and articles
- Zooanthropophilic – through sick person or from sick kittens, cats, dogs
4. Clinical picture of scalp microsporosis
a. Anthropophilic
- Smooth skin, scalp
- Many very small foci, irregular outlines, unclear boundaries
- Foci tends to coalesce and form one large focus, polycyclic edges, moderate scaling, cyanotic-
pink
- Regular well pronounced follicular hyperkeratosis in affected on scalp foci
- Affected hair break off 5-8mm from skin, whitish muff at base of hair shaft. All hairs affected in
focus
- Smooth skin foci are well outlined and produce quaint figures and iris form, no scalp involve, but
affect downy hair
b. Zooanthropophilic
- Solitary large foci with strict round or oval outlines
- Well contoured boundaries covered with grey asbestos-like scales
- All hairs affected in focus, they break off at a length of 5-8mmm from skin
- Small whitish muff (fungal spores)at base of hair shaft
- Mild inflammation in the foci, skin is pink or hyperemia and infiltration. Acutely will forms
pustules and purulent crusts, general disorder (increase temperature), involve regional lymph
nodes, and secondary allergic eruption, microsporids
- Erythematous foci with round contour and greyish scales form on smooth skin. Slightly elevated
edges on solitary vesicles or serous crusts and scales involve downy hairs on face, neck, limbs
- Infected hair irradiated with short UV rays through Wood’s glass in the dark, will produce bright-
green luminescence (antropophilic), and pale-green whitish luminescence (zooanthropophilic)
6. Treatment
- X-rays exposure to scalp
- Di-iodolein for children with microsporosis of scalp
Page 26 of 67
21) Dermatozoonoses: etiology pediculosis, kind of lice, ways of affection, clinical picture, methods of
diagnostics, treatment
1. Etiology pediculosis
- Lice – pediculus capitis, pediculus corporis, phthirus pubis
2. Kind of lice
- Head louse (pediculus capitis)
- Body louse (pediculus corporis)
- Pubic louse (phthirus pubis)
3. Ways of affection
a. Head louse – direct or indirect (through hat, comb) contact
b. Body louse – present in fold of underwear or clothing
c. Pubic louse – during sexual intercourse or sharing bed
4. Clinical picture
a. Head louse
- Found on scalp, eyebrows, beard, moustache
- Their saliva enzymes induce itching, scratching causes pyococci penetrate the skin forming
pyoderma lesions
- Nits have greyish-white color seen with naked eye which attached to the hairs
- Neglected cases, patient’s head covered with crusts, hairs stick together, lymph nodes enlarged
b. Body louse
- Nits deposited in seams and fold of clothing and on long downy hair
- The bites induce itching, result in excoriations on skin, complicated by pyoderma
- Localized on neck, shoulder blades, back
- Brown pigmentation
- In chronic case of many years, leads to skin dryness, scaling, thickening with dirty-grey
pigmentations and small scars
c. Pubic louse
- Localized on pubis, genitals, around anus, and may spread to others hairs areas (chest, axilla,
eyebrows, abdomen)
- Itching, round, hemorrhagic spots, size of pea and light-blue to light-grey
6. Treatment
a. Head louse
- Smear hairs with kerosene with vegetable oil overnight. Comb covered with wisps of cotton
moistened in vinegar used to comb hairs to remove nits
- 10% water-soap emulsion of benzyl benzoate, naphthalin, 20% water-soap emulsion of benzyl
benzoate with anaesthesin, petrolatum
- 2-5% mercurial ointment or Castellani’s paint if complicated by pyoderma
b. Body louse
- Shower with soap, disinfection of underwear, clothing, and bed-clothes
c. Pubic louse
- Shaved, blue ointment or white precipitate ointment
- Vinegar sublime, 20% benzyl benzoate or soap-solvent emulsion (10% to soak underwear and
bed clothes, 20% to disinfect rooms, 50% to treat hairy skin areas)
Page 27 of 67
22) Mycoses: etiology, ways of affection, classification of trichophytosis, clinical picture (superficial of the
smooth skin, infiltrative-suppurative of the scalp), methods of diagnostics, treatment
1. Etiology of trichophytosis
- Anthropophilic – Trichophyton endotkrix (T.violaceum, T.tonsurans)
- Zooanthropophilic – T.ectotkrix (T.mentagrophytes a variant of T.gypseum, T.verrucosum)
- Anthropophilic – direct or indirect (combs, hats) contact
- Zooanthropophilic – through sick person, contaminated articles, sick animal’s hairs or scales
3. Classification of trichophytosis
- Superficial trichophytosis
- Chronic trichophytosis
- Infiltrative-suppurative trichophytosis
- Zoophilic trichophytosis
4. Clinical picture of superficial of smooth skin
- On face, neck, forearms, trunk
- Clear circumscribe foci, elevated above skin
- Round, small ridge of macular or papular character on periphery, which small vesicles and crusts
my formed
- Center of focus is paler and peels
- Foci merge and form quaint pattern
- Mild itching
5. Clinical picture of infiltrative-suppurative of scalp
- Large solitary foci
- Sharply circumscribed, hyperemic, infiltrated and covered by purulent, succulent crusts
- Pus discharged from each follicle separately called follicular abscess or kerion Celci (Celsus’
honeycomb
7. Treatment
- X-rays exposure to scalp
- Infiltrative-suppurative of scalp – wet dressing (10% ichthammol, 2% boric acid, 0.1%
ethoxydiaminoacridine lactate, nitrofurazone solution, Gourlard’s water), hair removal by eyelid
forceps, 10-15% sulphur-tar Wilkinson’s ointment
Page 28 of 67
23) Pyodermas: etiology, classification of pyodermas, clinical picture furuncle, clinical picture carbuncle,
treatment
1. Etiology
- Staphylococcus
- Streptococcus
- Mixed
- Acute
- Chronic
3. Clinical picture of furuncle
- Acute staphylococcal pyonecrotic inflammation of hair follicle and surrounding connective tissue
- Pain
- Sometimes fever and headache
- Deep pustule, painful nodose infiltrate red color diameter 3-5cm
- Fluctuation
- Necrotic core formed after few days, discharge blood and pus content
- Core resolving with a scar
- 2 weeks evolution
4. Clinical picture of carbuncle
- Diffuse pyonecrotic inflammation of deep dermis and hypoderm involving neighbouring follicles
- Acute pain
- High fever, pain at tearing, pulling character, chill, indisposition
- Localized on back of head, back and loins
- Hard nodules coalesce into single infiltrate and grow the size of child palm
- Semispherical surface, tense skin, cyanotic center
- Pustule on top of infiltrate, and fluctuation after 8-23 days
- Green necrotic masses with admixture of blood discharged from pustule opening
- Then, form ulcer and leaves deep scar
5. Treatment
a. Systemic
- High-calorie diet
- Autovaccines, antibiotics (depend local or generalize type of microbes)
- Systemic hormone
b. External
Page 29 of 67
24) Virus dermatoses: classification of virus dermatoses, herpes simplex etiology, factor risk of affection,
clinical picture, methods of diagnostic, treatment

- Herpes
- Warts (verrucae)
2. Herpes simplex etiology
- Filterable virus
- Herpes simplex virus (HSV) – 1, HSV – 2
- Herpes simplex zasterifonnis
- Herpes simplex ulcerosa
3. Risk factor of affection
- Stress reaction to cooling, infectious diseases, overstrain, neuro-psychic and physical traumas
- Disorder of GIT, pneumonia, toxicosis, insolation, dysmenorrhea, febrile diseases (herpes febrilis)
4. Clinical pictures
- Sensation of itching, pain, chill, restlessness, burning, poor appetite, insomnia
- Localized on lips, cheeks, wings of nose, oral mucosa, cornea, genitals
- Grouped vesicles eruption, on hyperemic area with a clear and cloudy content
- Vesicles turn to the erosions with polycyclic edges or dry into crusts which leave no scars when
they drop off
- Vesicles on oral mucosa have painful erosions with hyperemic swollen edges (aphthous
stomatitis)
5. Methods of diagnostic
- Clinical pictures
- Serological tests – RIF (reaction immunofluorescence), IFA (immunofermentative analysis)
- DNA test – PCR, electronic microscopy
6. Treatment
a. Systemic
- Antiviral drugs (acyclovir, famcyclovir, Valtrex)
- Vitamin A, C
- Gamma globulin injections
- Autohaemotherapy
- Pyrogenal
b. Local
- 1-2-3% ‘oxolin’ ointment
- 30-50% interferon ointment
- Sulphur-carbolic paste
- 1-4% silver nitrate solution
- Aniline solution (brilliant green, fucarcini)
- Antiviral creams and ointment (acyclovir)
Page 30 of 67
25) Mycoses: classification of mycoses, clinical picture epidermophytosis of the nails, clinical picture
epidermophytosis of the feet, methods of diagnostics, treatment
d. Pseudomycoses
2. Clinical picture epidermophytosis of nails
- Nail plates of the big and little toes are affected mostly
- Finger nails never involved
- Initial changes form on the free margin of the nail plate as yellow spots and bands
- Whole plate thickens and turn yellow or ochre-yellow, crumbles and breaks easily, horny
material accumulates under it (subungual hyperkeratosis)
- Some cases, plate becomes thin and separated from the nail bed (onycholysis)
3. Clinical picture epidermpphytosis of the feet
a. Latent form
- Slight itching (temporary)
- Scanty desquamation in interdigital regions of feet and soles
b. Squamous form
- Slight itching
- Spot in arches of feet
- Scaling restricted to small areas or may extend to large surface
- Exarcerbation of process, squamous form change to dyshidrotic form and vice versa
c. Intertriginous form
- Itching various intensity, pain (sometime) when erosion
- In interdigital folds (4th and little toes) less between 3rd-4th toes, may spread to other interdigital
fold and to flexor surface of toes and dorsal surface of foot
- Cracks surrounded by periphery by whitish separate horny layer of epidermis form in interdigital
folds
- Weeping surface
d. Dyshidrotic form
- Itching and pain
- On arch of foot, lateral and medial surface of foot is unilateral localization of the process
- Group vesicles resemble soft boiled sago grains, hard top, size ranges from pin head to small pea
- Vesicles coalesce and form multilocular bullae in eroded surface with ridge of macerated
epidermis on periphery form
- Protracted torpid course of this form, recurrences, exacerbation in spring and summer
- Microscopy diagnosis
- Cultural diagnosis
- Positive in skin test with intracutaneous injection of epidermophytin
5. Treatment
- Acute process – fungicidal and disinfectant agents, hyposensitization (calcium preparations,
antihistaminics, vitamins, autohaemotherapy), topical anti-inflammatory
- Acute dyshidrotic – hyposensitization (calcium chloride, sodium hyposulphate infusion),
corticosteroid (prednisolone, triamcinolone)
- Sulphonamide
- Desquamative and fungicidal agents – 3-5% sulphur-tar or salicylic-tar pastes
- Nitrofungin, fungicidal ointments, Castel-lani’s paint
- Dimazole, dequalinium powders
Page 31 of 67
26) 33) Virus dermatoses: classification of virus dermatoses, etiology herpes zoster, ways and risk of
affection, clinical picture, methods of diagnostic, treatment

- Herpes
- Warts (verrucae)
2. Etiology of herpes zoster
- Neutrophic filterable virus, strongiloplasma zonae
3. Ways and risk of affection
- Ways of affection is by direct contact with sick person
- Risk of affection – infectious diseases, toxicosis, metabolic disorders, blood diseases, neuro-
psychotic overstress, cooling, and physical trauma
4. Clinical picture
- Localization depends on nervous (trunk, face, hand, neck etc)
- Prodromal period – attack of pain along the distribution of the nerves, burning, hyperemia of
the involved areas, general weakness, chill, and headache
- Unilateral process corresponding to the segmental distribution of one or more nerves
- Grouped vesicles eruption are tense, filled with clear serous content on a hyperemic skin area
- Vesicles can coalesce and form foci of affection with finely scalloped edges, sometimes form
bullae. The vesicles turns to the erosions or dry into crusts
- Stable neuralgia and muscular pareses may remain at the site of the affection after the acute
skin manifestations disappear
- Clinical picture
- Stamp-smear
- Bacteriologic experiment
- Electronic microscopy
- IFA, PCR
6. Treatment
a. Systemic
- Antiviral drugs – acyclovir
- Vitamin A, C, B1, 5, 12
- Gamma globulin injection
- Autohemotherapy
- Pyrogonal
- Analgetic drugs – baralgin, pentalgin
b. Local
- 1-2-3% oxolinum
- 30-50% interferon ointment
- Sulphur-carbolic paste
- 1-4% silver nitrate solution
- Aniline solution (brilliant green, fucarcini)
- Antiviral cream and ointment
c. Physiotherapy
- UV rays irradiation, ultrasonic, indirect diathermy of cervical sympathetic ganglia, diadynamic
current, procaine hydrochloride electrophoresis, circular procaine blockade, 50% interferon
ointment phonophoresis
Page 32 of 67
27) Virus dermatoses: classification of virus dermatoses, etiology of molluscum contagiosum, ways and risk
of affection, clinical picture, methods of diagnostics, treatment

- Herpes
- Warts (verrucae)
2. Etiology of molluscum contagiosum
- Largest filterable virus Molitor hominis
- Transmitted by direct contact with sick person, carrier, contaminated objects, sexual intercourse
- Risk of affection when lesions present
4. Clinical picture
- In children, localized on face, neck, chest, back of hands
- In adults, on external genitals, pubis, and abdomen
- No subjective sensations
- Nodule has semispherical form with a crateriform depression in the center and a caseous-like
content and has size of a pea and the color of normal skin or pearly-grey (mother of pearl)
- The nodules may be solitary or may occur in dozens (disseminated lesions)
- Sometimes lesions can coalesce and form Molluscum giganteum
- Clinical picture
- Microscopy – reveals degenerative shiny oval epithelial cells with large protoplasmic inclusions
(molluscous bodies)
6. Treatment
- Curettage
- Freezing with liquid nitrogen (cryotherapy or cryodestruction)
- Solution of iodine (for adult person – 5%, for children – 2.5%)
- Antiviral ointment – 2% of ‘oxolinum’, gel ‘panavir’
Page 33 of 67
28) Eczema: etiologic theories, classification, clinical forms, clinical picture of true eczema, treatment
1. Etiologic theories
- Neurogenic theory
- Endocrine theory
- Allergic theory
- Hereditary factors
- Metabolic theory
- Exogenic factors (chemical, biological agent, bacterial allergens, physical factors, drugs, foods)
2. Classification
- Acute (eczema acutum)
- Subacute (eczema subacutum)
- Chronic (eczema chronicum)
3. Clinical forms
- True – idiopathic, dyshidrotic
- Microbial – varicose, mycotic, paratraumatic, nummular, sycosiform, eczema of nipples & areola
- Seborrhoeic
- Infantile
- Occupational
4. Clinical pictures of true eczema
a. Idiopathic eczema
- Clear cut polymorphism and variegated eruptions (erythematous spots, micro vesicles, papules,
pustules, erosions, and numerous scratches)
- True and false (evolutional) polymorphism, i.e. the simultaneous presence on the affected areas
of vesicles, erythema, exudative papules, small erosions with drop oozing, scales, crusts, and
other lesions, the interrupted character of the affection foci
- The alternation of the affected skin areas with healthy areas ('archipelago' pattern)
- Formation of serous 'wells' somewhat resembling the surface of boiling water
- Border is not clear
- Process is symmetrical
- Itching sensation of various intensity
b. Dyshidrotic
- The formation of small, the size of a pin head, and hard to the touch vesicles on the sides of the
fingers and toes and sometimes on the palms and soles on the hyperemic area
- Large multicameres bullaes are encounter less frequently
- The vesicles may rupture and turn into excoriations or they dry up and form flat yellowish crusts
- Lying in the epidermis, the vesicles are seen through it and resemble boiled rice
- Severe itching, burn sensation
5. Treatment
a. Systemic
- Hypoallergic diet
- Removing the causes of the diseases
- Sedative medicine – extractus valeriane, persen, novo-passte and etc.
- Antihistamines – suprastin, klaridol, klaritin, arius and etc.
- Desensibilization medicine - (intravenous infusion of calcium chloride, calcium gluconate or
sodium hyposulphate solutions)
- Enterosorbents – enteros gel, polifepan and etc
- Corticosteroid therapy
- Vitamin and microelements – B2, 15, 6, sulfur
- Antibiotics
- Antifungal drugs
Page 34 of 67
b. External
- Application – sol. ac. boric 2%, sol. 0.25 per cent silver nitrate, 0.5 per cent resorcinol, 0.25 per
cent amidopyrin, sol. rivanoli 1:1000 etc
- Shake solution – (oily, watery, hydro-alcoholy) which are added 1-2 per cent of anaesthesin and
naphthalan which intensify the antipruritic effect
- Corticosteroid ointments – 0.5 per cent prednisolone, 0.25 per cent Depersolone, Locacorten,
Flucinar, Ftorokort, Ultralan, Celestoderm etc
- Keratoplastic agents – ointments containing 5-10-20 per cent naphthalan, 1-2 per cent tar which
resolve the infiltrate, 2-5 per cent sulphur, 2-3-5 per cent ichthammol, etc.
- Aniline solution – Castellani's, brilliant grin
- Aerosol – oxycort, polcortolon etc
Page 35 of 67
29) Dermatitis: classification, types of irritants, ways of penetration of allergen, clinical picture of
toxicodermis, treatment
1. Classification
a. Simple contact or artificial dermatitis
Allergic dermatitis – allergic dermatitis, toxicodermia
b. Acute dermatitis
Chronic dermatitis
2. Types of irritants
a. Physical irritants
- High and low temperatures (burns, frostbite, chilblains)
- Ultraviolet rays (solar dermatitis)
- X-ray and radioactive radiation
- Mechanical (pressure, friction)
- Electricity
b. Chemical irritants
- Alkalis and acids, salts of same acids
- Synthetic texture
- Disinfectants
- Colors, lacquer, solvents
- Ni, Cr
c. Biological factors irritants
- Several plants (such as white dictamnine, cow parsnip, primrose, crowfoot plants of the cashew
family and some species of redwood)
- Insects, caterpillars etc
d. Medical irritants
- Non steroid antiinflammationary medicines
- Group of antibiotics medicines
- Salicylic, boric, lactatic acids, resorcini, sulfufuris, iodine
3. Ways of penetration of allergen
- Allergen penetrate to organism through the skin
4. Clinical picture of toxicodermis
a. Diffuse toxicodermia
- Often found on the skin, lips and mucous membranes
- Polymorphic eruptions (papules, wheal, erythema, spots, papulo - vesicales)
- Diffuse erythematous foci or erythrodermia develop are rarer
- General symptoms – disorders of the nervous system (insomnia etc.), elevated body
temperature, transient arthralgia, CVS (development of the haemorrhagic component), liver and
kidneys (drug disease)
- Sensation of itching and sometimes burning sensation
b. Fixed or local toxicodermia
- Localized as a rule on the mucous membrane of oral cavity and on the genital organs
- Polymorphic eruptions (erythema, spots, vesicles, bullas)
- Sensation of itching and sometimes burning sensation
5. Treatment
a. Systemic
- Removing the causes or discontinuing the drug which had caused the disease
- Diet
- Hyposensitization therapy
- Antihistaminis
- Vitamin C, P, В complex
- Ca
Page 36 of 67
- Diuretics
- Enterosorbents
- Antipyretics
- Hormones therapy (prednisolon, dexometason etc.)
b. External
- Should get the anti-inflammatory effect and relieve itching and burning
- Shake solutions (lotions) with menthol, anesthesin etc.
- Hormonal cream (celestoderm, beloderm, elocom etc.)
- Lotions for application
- Aniline solutions on erosions
Page 37 of 67
30) Bullous dermatoses: etiologic theories, classification, clinical types of acantolitic pemphigus, clinical
features of clinical types, treatment
- Immunological theory - Neurogenic theory
- Infectious theory - Endocrine theory
- Viral theory - Enzymatic theory
- Metabolic theory - Toxic theory
2. Classification
a. Dermatitis herpetiformis or Duhring’s disease
b. True pemphigus (pemphigus vere)
- Pemphigus vulgaris
- Pemphigus vegetans
- Pemphigus foliaceus
- Pemphigus seborrhoicus
c. Pemphigus non-acantholyticus or cicatricial pemphigoid
3. Clinical types of acantolitic pemphigus
- Pemphigoid bullosa
- Benign mucosal pemphigoid (pemphigoid benigus mucosae)
4. Clinical features of clinical types
a. Pemphigoid bullosa
- Large tense bullae, no itching, filled with a serous, rarely by purulent or haemorrhagic content
- Localized on the flexor surfaces of the limbs, region of the navel, inguinofemoral areas, axillae
- Periphery of the foci is hyperaemic and oedematous
- The mucous membranes of the mouth and genitals sometimes involved
- Involvement of the conjunctiva may causing loss of vision
- Bullous eruptions resemble pemphigus vulgaris
- The bullae are localized on the borderline between the dermis and the epidermis
- In immunofluorescence, a greenish fluorescence in response to anti-IgG is seen as a thin line
along the basal membrane lining the floor of the bulla
- Heal spontaneously
- Tendency of the bullae to form groups, and recurrences of bullae at the sites of old eruptions.
- Prevails among elderly people.
b. Benign mucosal pemphigoid (pemphigoid benigus mucosae)
- Initial manifestations on the eye conjunctiva.
- Sites of regressing bullae followed by xerosis and opacification and ulceration of the cornea
- Mucous membranes of the mouth, oesophagus, upper respiratory tract and genitals involved in
the process with the formation of bullae, erosions, and destructive adhesive cicatricial changes
- The vesicular and bullous lesions are arranged on a hyperaemic base
- Recurrent bullae forming only on the oral mucosa. Chronic course with no cicatrization
- The bullae form under the epithelium, but they do not contain acantholytic cells
- The dermatosis is very resistant to any therapy, and in rapid epithelization of the erosions, the
bullae is attended with tenderness and burning sensation
5. Treatment
a. Pemphigoid bullosa
- Corticosteroids (prednisolone, methylprednisolone) during exacerbation
- Antibiotics, vitamins B complex, ascorutin, and potassium preparations
- Ointments (Hyoxisone, Dermatol, Lorinden-C) and aniline dyes
b. Benign mucosal pemphigoid (pemphigoid benigus mucosae)
- Prednisolone 0.5%, hydrocortisone 1.0-2.5%
- Ointment, irrigation with aerosoles containing steroid hormones
Page 38 of 67
31) Eczema: etiologic theories, classification according to the clinical forms, clinical picture of microbial
eczema, clinical picture of seborrhoeic eczema, treatment
- Neurogenic theory
- Endocrine theory
- Allergic theory
- Hereditary factors
- Metabolic theory
- Exogenic factors (chemical, biological agent, bacterial allergens, physical factors, drugs, foods)
2. Classification according to the clinical forms
- True – idiopathic, dyshidrotic
- Microbial – varicose, mycotic, paratraumatic, nummular, sycosiform, eczema of nipples & areola
- Seborrhoeic
- Infantile
- Occupational
3. Clinical pictures of microbial eczema
- Monovalent sensebilisation to infectionic agent
- Localization as a rule on the limbs
- Asymmetrical process, clear border
- Around or scalloped edges
- The eruption is covered with purulent crusts
- Eroded surface is seen after removing the crusts
4. Clinical pictures of seborrhoeic eczema
- Localized on the scalp, face, chest and between the shoulder blades
- Vesiculation and weeping are very rare
- Rounded yellowish-pink erythematous spots covered with greasy yellowish scales
- Copious stratified yellowish crusts and scales form on the scalp, hairs on the affected areas are
shiny and sometimes stuck together in bundles
- Seropurulent exudation in the fold behind the ears
- In some cases is severe itching
5. Treatment
a. Systemic
- Hypoallergic diet, removing the causes of the diseases
- Desensibilization medicine - (intravenous infusion of calcium chloride, calcium gluconate or
- Corticosteroid therapy, vitamin and microelements – B2, 15, 6, sulfur
- Antibiotics, antifungal drugs
b. External
- Application – sol. ac. boric 2%, sol. 0.25 per cent silver nitrate, 0.5 per cent resorcinol, 0.25 per
cent amidopyrin, sol. rivanoli 1:1000 etc
- Shake solution – (oily, watery, hydro-alcoholy) which are added 1-2 per cent of anaesthesin and
naphthalan which intensify the antipruritic effect
- Corticosteroid ointments – 0.5 per cent prednisolone, 0.25 per cent Depersolone, Locacorten,
Flucinar, Ftorokort, Ultralan, Celestoderm etc
- Keratoplastic agents – ointments containing 5-10-20 per cent naphthalan, 1-2 per cent tar which
resolve the infiltrate, 2-5 per cent sulphur, 2-3-5 per cent ichthammol, etc.
- Aniline solution – Castellani's, brilliant grin
- Aerosol – oxycort, polcortolon etc
Page 39 of 67
32) Dermatitis: classification, types of irritants, clinical picture of simple contact dermatitis, clinical picture
of allergic contact dermatitis, treatment
1. Classification
a. Simple contact or artificial dermatitis
Allergic dermatitis – allergic dermatitis, toxicodermia
b. Acute dermatitis
Chronic dermatitis
2. Types of irritants
a. Physical irritants
- High and low temperatures (burns, frostbite, chilblains)
- Ultraviolet rays (solar dermatitis)
- X-ray and radioactive radiation
- Mechanical (pressure, friction)
- Electricity
b. Chemical irritants
- Alkalis and acids, salts of same acids
- Synthetic texture
- Disinfectants
- Colors, lacquer, solvents
- Ni, Cr
c. Biological factors irritants
- Several plants (such as white dictamnine, cow parsnip, primrose, crowfoot plants of the cashew
family and some species of redwood)
- Insects, caterpillars etc
d. Medical irritants
- Non steroid antiinflammationary medicines
- Group of antibiotics medicines
- Salicylic, boric, lactatic acids, resorcini, sulfufuris, iodine
3. Clinical picture of simple contact dermatitis
- Exclusive occurrence at the site of action of the unconditional irritating factor
- Simple contact dermatitis is usually acute and occurs soon after exposure to the irritant
- Absence of sensitization
- Absence of incubation period
- Subjectively: sensation of pain and burn
- Objectively: from erythema and bullas to necrosis, asymmetrical process, the border is clear
- Absence of tendency towards dissemination or peripheral growth
- Dermatitis resolves (even without any active treatment) one or two weeks after the action of
the irritant ceases
4. Clinical picture of allergic contact dermatitis
- Occurs in patients with heightened sensitivity to a definite substance, the allergen
- Increased sensitivity develops in repeated contact with the allergen, which results in
monovalent sensitization of the body
- Has incubation period
- Rush is localized on areas, which had been exposed to the allergen, but in some patients the
process tends to spread to the covered skin areas
- Objectively: asymmetrical process, the border is not clear, polimorphic eruption (erythema,
swelling, papules and vesicular lesions)
- Positive skin allergic tests (application test, intracutaneus test, scarification test)
- Repeated contact with allergen facilitates the transformation of allergic dermatitis to eczema
5. Treatment
a. Simple contact dermatitis
Page 40 of 67
- Remove of irritant
- The condition of the patient's organism
- The attendant secondary infection
- Particularly by the size of the pathologic area
i. Systemic
- Desensebilsation medicine - (intravenous infusion of calcium chloride, calcium gluconate or
ii. External
- On mild hyperaemia can using powders and corticosteroid ointments, on hyperaemia and
swelling solution for application or aqueous shake solutions, corticosteroid ointment,
saerosol “Pantenol”, “Alosolum”, losions “Pantenol”, “Bepanten” and etc.
- On erosions area can using Castellani's paint or aqueous alcohol solutions of aniline dyes
which also cause a favourable effect in concomitant secondary infection
- Chronic dermatitides - are treated by corticosteroid and then with keratoplastic (containing
naphthalan, tar) ointments
- Corticosteroid ointments with antibiotics - Lorinden C, Dermosolone, HyoxiSone, Belogent
and etc
b. Allergic contact dermatitis
- Remove of irritant, allergen
- The condition of the patient's organism
- The attendant secondary infection
- Particularly by the size of the pathologic area
i. Systemic
- Hyposensitization treatment
- Sedatives
- Antihistamines
- Steroid hormones
- Vitamins
ii. External
- Anti-inflammatory treatment depends on the morphological features of the eruption
- The management of patients with allergic dermatitis is therefore planned on the same
principles as the treatment of eczema patients, but before all else the effect of the
stimulating and sensitizing factors is removed
33) 26) Virus dermatoses: classification of virus dermatoses, etiology herpes zoster, ways and risk of
affection, clinical picture , methods of diagnostics, treatment
Page 41 of 67
exudative morphological lesions, describe primary exudative morphological lesions, evolution of bulla,
evolution of wheal
1. Classification
a. Primary
b. Secondary
2. Primary exudative morphological lesions
a. Vesicle
- Is primary lesion of an exudative character, it has a fluid containing cavity and is slightly elevated
- Size until 5mm
- They can be unicamerate or multicamerate
- According to contents, they can be serous or hemorrhagic
b. Bulla
- It is a cavitary lesion with size more than 5mm, consists of a covering, a cavitary with serous
contents and a floor
- According to localization in skin – subcorneal, intraepidermal, subepidermal
- Contents can be either serous or hemorrhagic
c. Pustule
- It is an exudative cavitary lesion containing pus
- May be superficial or deep
d. Wheat
- Is an exudative non-cavitary lesion which form as a result of circumscribed acute- inflammatory
edema of the papillary skin layer
- It is rather hard cushion-like elevation spherical or less frequently oval in shape, which is
attended with strong itching
- It usually disappears rapidly (minutes to hours) leaving no trace
3. Evolution of bulla
- Bulla → erosion → crust → squama → pigmentation
4. Evolution of wheat
- Disappear rapidly without any traces or may become squama
Page 42 of 67
35) Virus dermatoses: classification of virus dermatoses, etiology of condiloma acuminatum, ways and risk
of affection, clinical picture, treatment

- Herpes
- Warts (verrucae)
2. Etiology of condiloma acuminatum
- Human papilloma virus (HPV – 6, HPV – 11)
- Transmitted during sexual intercourse
- Risk in individual with poor hygienic habits
4. Clinical picture
- Localized on genitals, perianal region, mucous membrane of urethra, oral and rectum
- Small, soft, pink filliform, slightly elevated lesions with smooth surface
- They coalesce resemble a cauliflower or raspberries
- These growth may macerate and ulcerate
- Some lesions have a pedicle (a narrow base)
- Secretion with an offending odour often accumulates between the condylomata
5. Treatment
a. Systemic treatment
- Immunomodulation therapy (cycloferon, derinat, panavir, immunomax)
b. Local treatment
- Diathermocoagulation
- Electro destruction
- Cryotherapy
- Curettage
- 20% podophyllin solution
- Strong solution of potassium permanganate, trichloro-acetic acid
- Gel ‘panavir’
- ‘intim spray’
Page 43 of 67
36) Bullous dermatoses: classification of bullous dermatoses, etiologic theories of Duhring’s disease, clinical
features, methods of diagnosis, treatment
1. Classification of bullous dermatoses

a. Dermatitis herpetiformis or Duhring’s disease
b. True pemphigus (pemphigus vere)
- Pemphigus vulgaris
- Pemphigus vegetans
- Pemphigus foliaceus
- Pemphigus seborrhoicus
c. Pemphigus non-acantholyticus or cicatricial pemphigoid
2. Etiologic theories of Duhring’s disease
- Chronic recurrent allergotoxic dermatosis
- Endocrine disorders, lymphogranulomatosis, leukosis, blastoma, hormonal shifts (pregnancy,
menopause), toxemia, vaccination, nervous and physical overstrain
- Viral theory
3. Clinical features
- Between age of 25-55
- Pleomorphic eruption, itching, excoriations, burning and pain
- Vesicles, bullae, papules and pustules appear simultaneously, wheals form earlier on limited
erythematous areas
- Secondary lesions, erosions, scales and crusts
- The eruptions are grouped (herpetiform) symmetrical arrangement
- Erythematous, maculopapular and urticarial lesions appear on the skin of the trunk, extensor
surfaces of the limbs and buttocks
- Pale yellow translucent vesicles 5-10 mm in diameter, coalesce, rupture, dry up and form crusts
- Contents of the vesicles, pustules and bullae may be haemorrhagic
4. Methods of diagnosis
- Clinical pictures
- Blood is marked by eosinophilia
- Large number of eosinophils also discovered in the bulla contents
- Granular deposits of immunoglobulin (IgA) are demon¬strated in the zone of the basal
membrane by means of the direct immunofluorescence test
5. Treatment
- Steroid therapy (prednisolone, triamcinolone)
- Cytostatics (immunosuppressants) – methotrexate, prospidium chloride
- Anabolic hormones (Metandienone, Nerobolil), preparations of calcium and potassium, agents
stimulating phagocytosis (pentoxyl, methyluracil) and vitamins (ascorbic acid, folic acid),
antibiotics
- Symptomatic therapy – blood transfusions, injection of gamma-globulin, antianaemin,
autohaemo-therapy
- Diet include high-calory pro¬teins, calcium and vitamins
- Frequent warm baths with disinfectant solutions (potassium permanganate), application of
disinfectant agents (Castellani's paint). Wash mouth every meal (with calendula solution)
- Affected skin areas smeared with corticosteroid ointments (Locacorten, Flucinar), irrigated with
aerosoles containing corticosteroid and antibacterial agents (Oxycyclosole)
Page 44 of 67
37) Syphilis: the etiology of syphilis, characterize of T.pallidum (movements, structure, kind of saprophytic
spirochaeta), environment resistance, ways of transmission, conditions of affection
1. Etiology of syphilis
- Treponema pallidum
2. Character of T.pallidum
- Great motility, with several types of movements – back and forth (sometimes this is a thrust-
like, swinging movement); pendulum-like, bending, contractile (wave-like, spasmodic) and
around its own axis (rotary)
- 8 to 14 uniform spirals
- It is covered with a triple-layered coat, fibrils found under the layers.
- Next, the cytoplasmic membrane compose three layers covering the cytoplasm
- Fibrils attaches itself to blepharoblasts
- Ribosomes, nuclear vacuole and mesosomes contain inside cytoplasm
- Kind of saprophytic spirochaete – Spirocheta dentium, buccalis, refringens, balanitidis
3. Environment resistance
- External environment outside the body it dies rapidly. Drying kills it. Heating to 60°C destroys it
within 15 minutes and at 100°C instantly.
- Various disinfectants (0.5 per cent phenol solution) produce rapid effect
- More resistant to low temperatures
- In a moist discharge, treponema lives for up to 12 hours and longer
- Through injured skin or mucous membranes
- Sexual
- Household
- Through blood transfusion
- Diaplacental
5. Condition of affection
- Presence of the pathogenic Treponema Pallidum
- Presence of the contact
Page 45 of 67
38) Syphilis: full classification, conditions and ways of transmission, enumerate and describe atypical
chancres, clinical types of hard chancre, kind of saprophytic spirochaeta
1. Classification
a. Primary, seronegative syphilis—syphilis I seronegative
b. Primary, seropositive syphilis—syphilis I seropositive
c. Primary latent syphilis—syphilis I latens.
d. Secondary fresh syphilis—syphilis II recens.
e. Secondary recurrent syphilis—syphilis II recidiva.
f. Secondary latent syphilis—syphilis II latens.
g. Tertiary active syphilis—syphilis III active.
h. Tertiary latent syphilis—syphilis III latens.
i. Latent syphilis—syphilis latens:
- Early latent syphilis—syphilis latens praecox;
- Late latent syphilis—syphilis latens tarda.
j. Early congenital syphilis—syphilis congenita praecox: con¬genital syphilis of infants (under 1
year of age) and very young
k. Late congenital syphilis—syphilis congenita tarda.
l. Later congenital syphilis—syphilis congenita latens.
m. Visceral syphilis (with indication of the involved organ).
n. Syphilis of the nervous system.
o. Tabes dorsalis.
p. General paresis—paralysis progressive.
2. Conditions of transmission
- Sexual
- Household
- Diaplacental
4. Atypical chancres
a. Chancre-amygdalitis
- Enlargement, hardening of tonsil without erosion or ulcer otherwise is called primary syphiloma
- No marked inflammation around tonsil, temperature reaction or painful swallowing
- Tonsil sharply demarcated
- Large number of treponemas found on the surface of the tonsil
- Regional scleradenitis on the neck at the mandibular angle, lymph nodes enlarged, mobile,
dense, elastic consistency, not fused with the surrounding tissues, painless
b. Chancre-panaritium
- Found on the fingers
- Club-shaped swelling, sharp tenderness of the distal phalange
- No acute inflammatory erythema, presence of regional (cubital lymph nodes) scleradenitis
c. Indurative swelling
- Found in the region of labia majora, scrotum or prepuce
- Indurateive swelling
- Regional scleradenitis
5. Clinical types of hard chancre
- Erosive
- Ulcerous
- Herpetiformis
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- Petechial
- Chancre-print
- Crustous
- Burnous
- Diphteroid
6. Kind of saprophytic spirochaeta
- Spirocheta dentium, buccalis, refringens, balanitidis
Page 47 of 67
39) Gonorrhea: etiology, classification, environment resistance, condition and routes of infection, methods
of diagnosis and provocation, treatment
1. Etiology
- Neisser's gonococcus (Neisseria gonorrhoeae)
2. Classification
a. Fresh gonorrhoea
- Acute
- Sub-acute
- Torpid
b. Chronic gonorrhoea
c. Latent gonorrhoea
- Gonococci grow on artificial nutrient media in the presence of human protein at a body
temperature of 37°C. Some strains of the gonococci produce penicillinase, which explains their
relative resistance to penicillin and its derivatives
- Gonococci are strictly human parasites. Outside the human body they perish rapidly; heating
above 56°C, antiseptics, dessication, and direct solar rays destroy them. In pus the gonococci
retain their viability and pathogenicity only until the pathological substrate dries (from 30
minutes to 4-5 hours)
4. Condition of infection
- Urethritis in male
- Hygienic rules in direct contact with sick person or through contaminated objects
5. Routes of infection
- Sexual route
- Through labor or parturition
- rare cases through contaminated sponges, diapers or chamber-pots (usually in very young girls)
6. Methods of diagnosis
- Identified in the smears or cultures by microscopy or bacterioscopy
- Serological tests (the Bordet-Gengou phenomenon, test for gonococcal antigen)
- Skin-allergic test with the gonococcal vaccine
7. Methods of provocation
- After artificial exacerbation of the inflammatory process
- Combined provocation (biological by injecting the gonococcal vaccine, alimentary, thermal,
chemical and mechanical)
8. Treatment
- Antigonococcal agents (antibiotics and sulphanilamides)
- Stimulating specific and non-specific immunity, local therapy
- Antibiotic therapy in acute fresh uncomplicated gonorrhoea. Complex methods in protracted,
complicated and chronic forms
- Antigonococcal – benzylpenicillin, ecmonovocillin-1, bicillin-1, bicillin-3 and bicillin-5, ampicillin,
tetracycline, chlortetracycline, oxytetracycline, erythromycin, oletetrin, kanamycin
- Double antibiotics doses for patients with persistent, chronic and complicated gonorrhea
- In gonococcal sepsis, gonorrhoeal arthritis and pelvioperitonitis, benzylpenicillin injected daily
- Antibiotic intolerance, long-acting sulphanilamides, sulpha-monomethoxin and
sulphadimethoxin, are prescribed
- Polyvalent gonococcal vaccine (gonovaccine) is injected in specific immunotherapy of chronic,
complicated and torpid forms
- Lacto-, autohaemotherapy, pyrogenal for increasing non-specific reactivity
- Local methods – irrigation of the urethra, instillation of silver nitrate 0.25% and Protargol 1-2%
solutions, metal bougies and tamponades, physiotherapy (paraffin and ozocerite application,
diathermy, electrophore-sis, UHF therapy, massage, etc)
Page 48 of 67
40) Trichomoniasis: etiology, environment resistance, condition and routes of affection, classification,
clinical signs, methods of diagnostics
1. Etiology
- Trichomonas vaginalis
- Outside the human body the organisms perish rapidly because they do not form any means of
protection and are poorly resistant to unfavourable environmental factors.
- Dessication, heating to temperature above 45°C, exposure to direct solar rays and changes in
osmotic pressure have a particularly harmful effect.
- In males, trichomonads may parasitize in the urethra, paraurethral ducts, prepuce, epididymis
and accessory sexual glands
- In females they parasitize in the urethra, vestibular glands, vagina, and cervical canal
- Rare cases, the parasites penetrate into the uterus and induce an ascending infection of the
urinary tract (cystitis, pyelonephritis)
- In girls they cause vulvovaginitis
4. Routes of affection
- Transmitted sexually
- Rarely by non-venereal contamination through contaminated objects
5. Classification
According to the course
a. Fresh trichomoniasis – acute, subacute and torpid
b. Chronic trichomoniasis – of a duration of over two months
c. Trichomonad carriage
6. Clinical signs
- In acute case – frequent and imperative urges to urinate, pain at the end of urination, total
pyuria, terminal haematuria
- Chronic case produces exacerbations at times resembling acute or subacute forms of the
disease. Epithelial changes, infiltrative foci and cicatricial strictures in the urethral mucosa.
- Signs of vaginitis (hyperaemia and mild bleeding of the mucous membrane of the vagina and
cervix uteri, thin, purulent, often foamy secretions), and may be combined with urethritis,
endocervicitis, cervical erosions, and affections of the vestibular glands
- In acute vaginitis, the copious secretions induce burning and itching of the skin of the external
genitals
- In the torpid and chronic forms often no subjective disorders
- Repeated examinations by smears and/or cultures with microscope
- In males, scrapings or washings from the urethra, the secretions of the sex glands (prostatic
secretions, ejaculate) and the precipitate of freshly excreted urine examined
- The secretions from the cervical canal, urethra, and posterior vault of the vagina are examined
in females
- Material collected from the deep part of the vagina is examined in girls
- Both native (in a hanging or crushed drop) and stained specimens are examined with a
microscope
- Cultures are grown on special nutrient media
Page 49 of 67
41) Chlamidiosis: etiology, clinical picture, complications, methods of diagnostics, treatment (specific and
non-specific)
1. Etiology
- Chlamydia oculogenitalis
2. Clinical picture
- Torpid course and very few symptoms as well as a tendency for a protracted course
- Cases of an acute character resembling the clinical picture of acute gonorrhoeal urethritis
(cutting pain at the beginning of urination, painful erection, frequent imperative urges to
urinate )
3. Complications
- Urethro-oculosynovial syndrome (Reiter's syndrome)
- Prostatitis, vesiculitis and epididymitis
- Repeated bacterioscopy and bacterial tests for gonococci and trichomonads are stably negative
and no gonorrhoea or trichomoniasis is found in the sex partner
5. Treatment (specific and non-specific)
a. Specific
- Tetracycline, erythromycin and some of the water-soluble sulphanilamides
- Persistent, protracted and complicated cases are managed by non-specific immunotherapy
b. Non-specific
- Local treatment in accordance with the topical diagnosis
Page 50 of 67
42) Gonorrhea: classification of gonorrhea, clinical picture of acute total gonnorrhoeal uretritis, methods of
provocation, methods of diagnostics, treatment
1. Classification of gonorrhea
a. Fresh gonorrhoea
- Acute
- Sub-acute
- Torpid
2. Clinical picture of acute total gonorrheal urethritis
- In inflammatory of anterior urethra and if the patient urinates into two-glass test, the urine in
the first glass washed the pus in the urethra will be cloudy, the second glass will be clear.
- Patients with acute anterior gonorrhoeal urethritis feel cutting pain at the beginning of urination
(strong stream stretches the eroded urethral mucosa)
- Painful erection, penis is continuously in a state of semierection
- Purulent discharge may be sanguineous
- If treatment is not applied the acute inflammatory phenomena abate gradually in 2-3 weeks, the
urethral discharge reduces, the subjective disorders are alleviated and urethritis turns into the
subacute and then into the chronic form
- Acute total gonorrhoeal urethritis develops when gonococci gain entrance from the anterior
urethra to the posterior part of the urethra
- Signs of posterior urethritis (urethrocystitis) appear in attendance to the symptoms of anterior
urethritis
- Complains of frequent imperative urges to urinate at the end of which sharp pain is felt
- In the two-glass test urine in both glasses is cloudy because pus flows from the posterior urethra
into the urinary bladder (total pyuria). In some cases a few drops of blood are discharged from
the urethra at the end of urination (terminal haematuria), which lends the appearance of meat
washings to the urine in the second glass.
3. Methods of provocation
- After artificial exacerbation of the inflammatory process
- Combined provocation (biological by injecting the gonococcal vaccine, alimentary, thermal,
chemical and mechanical)
5. Treatment
Page 51 of 67
43) Gonorrhea: etiology, morphologic structure, classification, clinical picture of acute anterior gonorrheal
urethritis, methods of diagnostics, treatment (specific and non-specific)
1. Etiology
2. Morphologic structure
- Gram negative diplococcus, arranged in pairs with their concave surfaces facing each other
- Lentil-shaped cocci about 1.5 um long and 0.75 urn wide
- Stain readily by all aniline dyes
- Have capacity for assimilating a certain colour
- Under unfavourable they becoming L-shaped which appear in laboratory cultures and in the
human body when chemotherapeutic agents are used or when in a chronic course
- It consists of two elongated cocci with a septum between them
- On the outside it is completely covered with a scalloped six-layered wall, which preserves the
shape of the microorganism like framework. Immediately under the outer wall is the three-layer
cytoplasmic membrane containing cytoplasm, grains, ribosomes, and a nuclear vacuole
3. Classification
a. Fresh gonorrhoea
- Acute
- Sub-acute
- Torpid
4. Clinical picture of acute anterior gonorrheal urethritis
- In inflammatory of anterior urethra and if the patient urinates into two-glass test, the urine in
the first glass washed the pus in the urethra will be cloudy, the second glass will be clear.
- Patients with acute anterior gonorrhoeal urethritis feel cutting pain at the beginning of urination
(strong stream stretches the eroded urethral mucosa)
- Painful erection, penis is continuously in a state of semierection
- Purulent discharge may be sanguineous
- If treatment is not applied the acute inflammatory phenomena abate gradually in 2-3 weeks, the
urethral discharge reduces, the subjective disorders are alleviated and urethritis turns into the
subacute and then into the chronic form
a. Specific
b. Non-specific
Page 52 of 67
44) Syphilis: full classification, prodromal period, secondary fresh period of syphilis, clinical kind of macular
syphilis, clinical kind of papule syphilis
1. Classification
o. Tabes dorsalis.
2. Prodromal period
- Elevated body temperature, headache, pain in the bones and joints
3. Secondary fresh period of syphilis
- Begins with prodromal phenomena, preceding secondary syphilis by 7 to 10 days
- Mostly encountered in females, weakened patients and coincide in time with the dissemination
of treponemas in the patient's body by the haematogenous route
- Weakness, diminished working capacity, adynamia, headache, pain in the muscles, bones and
joints, body temperature elevates (to moderate values, less frequently to 39°- 40°C)
4. Clinical kind of macular syphilis
- Elevated roseola
- Urticarial roseola
- Coalescent roseola
- Granular roseola
- Haemorrhagic roseola
5. Clinical kind of papule syphilis
- Lenticular papules
- Miliary papules or lichenoid syphilids
- Nummular papules
- Hypertrophic papules
- Plaque-like papules or condylomata lata form
- Erosive papules
- Moist papules
- Palmar-plantar syphilid
- Seborrhoeic syphilitic papules
Page 53 of 67
45) Syphilis: the etiology of syphilis, conditions of affection, ways of transmission, classification of hard
chancre, clinical signs of hard chancre
2. Conditions of affection
- Sexual
- Household
- Diaplacental
4. Classification of hard chancre
a. Erosive
Ulcerous
Herpetiformis
Petechial
Chancre-print
Crustous
Burnous
Diphteroid
b. Atypical – chancre-amygdalitis, chancre-panaritium and indurative swelling
5. Clinical sign of hard chancre
- Single, round or oval, saucer-like erosion with discrete boundaries
- Size of the little finger nail
- The erosion has the colour of raw meat or spoiling fat, slightly elevated edges and sloping
towards the floor (saucer-shaped)
- Serous sparse secretions lend to a shiny ('polished') appearance
- Infiltrate of dense elastic consistency in the base of the erosion
- Ulcerous hard chancre edges are elevated more, the infiltrate is more pronounced
- On healing, an ulcerous hard chancre leaves a scar while an erosive chancre heals without a
trace
- Mild tenderness
Page 54 of 67
46) Syphilis: classification of tertiary period syphilis, ways of transmission, types of lesions of tertiary period,
clinical kind of tubercular syphilis, clinical kind of syphilitic gumma
1. Classification of tertiary period syphilis

- Active tertiary syphilis
- Latent tertiary syphilis
- Old and very young age, traumas (physical, psychic, medicamentous), chronic diseases and
toxicosis, and alcoholism
3. Types of lesions of tertiary period
- Tubercles form – necrosis, ulcer, scar
- Gummata – ulcer, scar
4. Clinical kind of tubercular syphilis
- Grouped tubercular syphilid
- Group without coalescing
- Serpiginous (creeping) tubercular syphilid
- Dwarf syphilitic tubercle
5. Clinical kind of syphilitic gumma
- Gummatous osteoperiostitis or osteomyelitis
- Gummatous ulcer
- Solitary gummata or diffuse infiltration
Page 55 of 67
47) Syphilis: full classification, syphilitic leucoderma, alopecia (clinical kind of alopecia), explain the Pinku’s
sign, explain the Lukashevich-Jarisch-Herxheimer reaction
1. Classification
o. Tabes dorsalis.
2. Syphilitic leucoderma
- Appears in patients, 5 to 6 months after infection in the secondary recurrent period
- Whitish if depigmented, round or oval spots resembling lace-work or a net
- Form on hyperpigmented skin on the side and back of the neck, in the axillae, and on the sides
of the chest
- Leucoderma is sometimes attended with alopecia with patients of recurrent syphilis
3. Alopecia
- Microfocal alopecia (alopecia areolaris)
- Diffuse alopecia
- Mixed alopecia
4. Pinku’s sign
- Syphilitic alopecia in the region of the beard, eyebrows and eyelashes
5. Lukashevich-Jarisch-Herxheimer reaction
- Exacerbation reaction develops after the diagnosis of primary syphilis and specific treatment
(with water-soluble penicillin) was made
- It also confirms the correctness of the diagnosis
- This reaction results from mass disintegration of treponemas and the release of the endotoxin
- The reaction is manifested by a chill, pain in the muscles, bones and joints, and a rise in body
temperature, sometimes as high as 40° C
- Very rare cases the reaction to be so severe (dimmed consciousness, fever of more than 40° C)
Page 56 of 67
48) Syphilis: the etiology of syphilis (morphologic structure), conditions and ways of transmission,
environment resistance, enumerate and describe all complications of hard chancre, definition of
“reinfection”
1. Etiology of syphilis (morphologic structure)

- 8 to 14 uniform spirals
- It is covered with a triple-layered coat, fibrils found under the layers.
- Next, the cytoplasmic membrane compose three layers covering the cytoplasm
- Fibrils attaches itself to blepharoblasts
- Ribosomes, nuclear vacuole and mesosomes contain inside cytoplasm
- Sexual
- Household
- Diaplacental
- External environment outside the body it dies rapidly. Drying kills it. Heating to 60°C destroys it
within 15 minutes and at 100°C instantly.
- Various disinfectants (0.5 per cent phenol solution) produce rapid effect
- More resistant to low temperatures
- In a moist discharge, treponema lives for up to 12 hours and longer
5. Complications of hard chancre
- Balanitis and balanoposthitis develop as a result of attendant coccal or trichomonadal infection,
swelling, bright erythema, and maceration of the epithelium around the chancre, secretion on
the surface of the chancre becomes seropurulent
- Phimosis is a condition where balanoposthitis lead to constriction of the prepuce so that the
foreskin cannot be retracted, swelling of the prepuce gives the appearance of an enlarged penis
which is red and painful
- Paraphimosis happen when attempt to retract the prepuce in phimosis with force, in which the
oedematous and infiltrated preputial ring strangulates the glans. As the result of mechanical
disorders of blood and lymph circulation, the swelling increases. Necrosis of the tissues of the
glans penis and prepuce may occur
- Gangrenisation and phagedaenism encountered in weakened patients and alcoholics as the
result of attendant fusospirillary infection. A dirty-black or black scab (gangrene) forms on
the surface of the chancre and may spread beyond it (phagedena). The scab covers an
extensive ulcer and the process may be attended with elevated body temperature, chill,
headache. A coarse scar remains after the gangrenous ulcer heals
- Postitis
- Haemorrhage
6. Reinfection definition
- Repeated infection (reinfection) or recurrence of the disease after a person cured of the disease
does not acquire immunity; congenital immunity is also absent
Page 57 of 67
49) Syphilis: ways of transmission, conditions of affection, kinds of saprophytic spirochaeta, making the
differential diagnosis of hard chancre, definition of “super infection”
- Sexual
- Household
- Diaplacental
3. Kinds of saprophytic spirochaeta
- Spirocheta dentium, buccalis, refringens, balanitidis
4. Differential diagnosis of hard chancre
- Traumatical damages
- Soft chancre
- Acute Chapin`s ulcer of vulva
- Diphterial ulcers
- Trichomonous ulcers and erosions
- Pemphigoid lichen
- Cancer
- Scabies ectima
5. Super infection definition
- When the body of a patient receives additional infection, as if a new infection is superimposed
on the old one, a condition called superinfection develops
Page 58 of 67
50) Chlamidiosis: etiology, life cycle, ways and conditions of affection, clinical picture, complications,
treatment (specific and non-specific)
1. Etiology
2. Life cycle
- On entering the urogenital organs, chlamydias multiply in the epithelial cells of the urethra,
rectum, vagina and neck of the uterus (and conjunctiva in contamination of the eye) and cause
an inflammatory reaction
- Urethritis developing in males after an incubation period of two or three weeks is usually
subacute or torpid
- Chlamydial infection in females usually has no noticeable clinical manifestations, in rare cases
mild endocervicitis develops
- Sexual intercourse
- Non-infectious nature (mechanical and chemical injury of the urethral mucosa, allergy, new
growths)
- During intimate contact (urethritis of venereal origin) or from descending urogenic infection,
causative agents brought from a prostate infected by the haematogenous or lymphogenous
route (non-venereal urethritis)
5. Clinical picture
- Torpid course and very few symptoms as well as a tendency for a protracted course
- Cases of an acute character resembling the clinical picture of acute gonorrhoeal urethritis
(cutting pain at the beginning of urination, painful erection, frequent imperative urges to
urinate )
6. Complications
- Urethro-oculosynovial syndrome (Reiter's syndrome)
- Prostatitis, vesiculitis and epididymitis
a. Specific
- Persistent, protracted and complicated cases are managed by non-specific immunotherapy
b. Non-specific
- Local treatment in accordance with the topical diagnosis
Page 59 of 67
51) Trichomoniasis: etiologic factor, condition and routes of affection, classification, methods of diagnostics,
treatment
1. Etiologic factor
- Trichomonas vaginalis
- In males, trichomonads may parasitize in the urethra, paraurethral ducts, prepuce, epididymis
and accessory sexual glands
- In females they parasitize in the urethra, vestibular glands, vagina, and cervical canal
- Rare cases, the parasites penetrate into the uterus and induce an ascending infection of the
urinary tract (cystitis, pyelonephritis)
- In girls they cause vulvovaginitis
3. Routes of affection
- Transmitted sexually
- Rarely by non-venereal contamination through contaminated objects
4. Classification
According to the course
a. Fresh trichomoniasis – acute, subacute and torpid
b. Chronic trichomoniasis – of a duration of over two months
c. Trichomonad carriage
- Repeated examinations by smears and/or cultures with microscope
- In males, scrapings or washings from the urethra, the secretions of the sex glands (prostatic
secretions, ejaculate) and the precipitate of freshly excreted urine examined
- The secretions from the cervical canal, urethra, and posterior vault of the vagina are examined
in females
- Material collected from the deep part of the vagina is examined in girls
- Both native (in a hanging or crushed drop) and stained specimens are examined with a
microscope
- Cultures are grown on special nutrient media
6. Treatment
- In acute and uncomplicated cases – oral specific antitrichomonal agent Metronidazole
(Trichopol, Flagyl), or its derivates
- A complex of measures (non-specific immunotherapy and local measures) is applied in
complicated and chronic cases
- In acute gonorrhoeal-trichomonal infection antigonorrhoeal and antitrichomonal agents are
prescribed simultaneously
- Chronic and protracted forms – immunotherapy (pyrogenal, lactotherapy) combined with
Metronidazole (Trichopol), then antigonorrhoeal antibiotics
Page 60 of 67
52) Syphilis: etiology of syphilis, conditions and ways of transmission, laboratory identification of
Treponema Pallidum, classification of secondary period of syphilis, secondary syphilis of the mucous
membranes
2. Condition of transmission
- Sexual
- Household
- Diaplacental
4. Laboratory identification of Treponema pallidum
- T.pallidum examined in the living state, with an ordinary light microscope in dark field
illumination produced by paraboloid condenser or disk of thick black (photographic) paper
(Arkhangelsky's method)
- Variety of shining hard particles (leucocytes, epithelial cells, tiny particles) and T. pallidum are
detected in the dark field in a drop of serous exudate collected from the focus
- Examination of the aspirate of a regional lymph node
- Blood tests for syphilis (Wassermann's serological test)
5. Classification of secondary period of syphilis
a. Secondary early or active or fresh syphilis (syphilis II recens)
Secondary recurrent syphilis (syphilis II recidiva)
Secondary latent syphilis (syphilis II latens)
b. Macular Syphilid or Syphilitic Roseola or Vascular spots (Syphilis Maculosa, Roseola Syphilitica)
Papular Syphilid (Syphilis Papulosa)
Pustular Syphilid (Syphilis Pustulosa)
Vesicles syphilis
Secondary Syphilids of the Mucous Membranes
Syphilitic Alopecia or Baldness (Alopecia Syphilitica)
Syphilitic Leucoderma, or Pigmentary Syphilid (Leucoderma Syphiliticum)
6. Secondary syphilis of the mucous membranes
- Oral cavity, throat, larynx, vermilion border and mucous membranes of labia majora and
minora which macular, papular and pustular syphilids occur just on the skin
- Large erythematous areas of coalesced roseolar lesions on the tonsils and soft palate
(erythematous, syphilitic tonsillitis) without subjective sensations or general symptoms has
discrete boundary of erythematous foci and bluish shade
- Syphilitic papules are the most common lesions of the mucous membranes
- Lenticular papules are flat, round, intensively dark red, hard to the touch, sharply demarcated
and slightly elevated above the skin surface
- Epithelium of oral mucosa macerated, papules acquire a whitish opal with a dark-red ring on the
periphery undergo erosion, and coalesce
- Soft palate, tonsils, lips, tongue edge and gums are the sites of oral syphilitic papules which
usually cause no subjective sensations, but if erosion and secondary infection occurs, tenderness
develops and a hyperaemic zone forms around them
- Papules in the larynx, vocal cords, causing the voice becomes hoarse, rarely total aphonia
develops
Page 61 of 67
53) Syphilis: etiology of syphilis, ways of transmission, condition of affection, classification of syphilis,
clinical kinds pustular syphilis (enumerate and describe)
- Sexual
- Household
- Diaplacental
4. Classification of syphilis
o. Tabes dorsalis.
p. General paresis—paralysis progressive
5. Clinical kinds of pustular syphilis
a. Impetigo syphilitica
- Pustule forms in the centre of the papule and rapidly dries to a crust
- No peripheral growth and coalescence, no subjective disturbances
b. Acne syphilitica
- Resembles acne vulgaris, localization of the eruption on areas not typical of seborrhea
- Also other symptoms of the secondary period of syphilis.
c. Varicella syphilitica
- Occurs in weakened patients
- Spherical pustule with the size of small pea. The centre of the pustule dries rapidly to a crust and
is retracted, and a swelling of brownish-red infiltration forms around the lesion
- Usually a few lesions (10-20) and lasts for 5-7 weeks, and leaves no scars
d. Ecthyma syphilitica
- Few lesions (up to ten)
- Localized on the anterior aspect of the legs, less frequently on the trunk, limbs and scalp
- It is malignant course of syphilis and occurs in weakened individuals suffering from tuberculosis
and alcohol abused
- Develops later than six months after infection
Page 62 of 67
- It marked by deep pustule, covered with a thick greyish-brown crust if pressed into the skin
- An ulcer forms under the crust leaving a smooth scar after healing. A hard copperred infiltrate
forms on the periphery of the lesion
- Comma forms of ecthyma are usually found in the small of the back and оn the buttocks
- Diffuse redness complicated by secondary infection
e. Rupia syphilitica
- A variant of ecthyma in which a layered conical crust forms
- Peripheral growth of the lesion and the presence of a large fleer under the crust are
characteristic features
- Rupia develops later than a year after the onset of the disease and is evidence of the malignant
course of syphilis
Page 63 of 67
54) Syphilis: full classification of congenital syphilis, clinical symptoms of early congenital syphilis,
enumerate and describe stigmata, pathognomic signs of late congenital syphilis, laboratory
identification of congenital syphilis
1. Full classification of congenital syphilis

a. True congenital syphilis
i. Early congenital syphilis
- Syphilis of the placenta
- Syphilis of the foetus
- Infantile congenital syphilis
- Congenital syphilis of early childhood
ii. Late congenital syphilis
b. Latent congenital syphilis
2. Clinical symptoms of early congenital syphilis
a. Syphilis of the placenta
- Oedema, proliferation
- Placenta mass and the foetal mass is 1:4 or 1:3
- Lesions of the vessels and central part of the villi are pronounced in the placenta
- Endo-, meso- and perivasculitis and sclerosis of the villi
- Hyperplasia of the connective tissue cells, proliferation of granulation tissue, formation of
abscesses in the vessels of villi because of necrotic foci resulting from obliteration of the vessels
b. Syphilis of the foetus
- Severe changes in the internal organs and bone system
- Foetal parenchymatous organs enlarged and firm
- Liver, spleen, lungs, kidneys, pancreas and gonads have diffuse inflammatory changes
- Diffuse interstitial hyperplasia, copious desquamation of alveolar epithelium, growth of cells in
the interalveolar spaces in the lungs may give rise to white pneumonia.
- Affection of several vitally important parenchymatous organs leads to the death of the foetus
- The macerated wrinkled and flabby skin makes the stillborn infant look old.
- Some cases, clusters of cell elements seen around the vessels or within the parenchyma of the
affected organ (miliary syphilomas), baby’s defence forces are weak; dies (without treatment)
within the first weeks or first months of life.
- Intensified growth of bones. Grade I, II and III specific osteochondritis of the long tubular bones
at the junction of the epiphyses and diaphyses; osteoperiostitis occurs in some cases
c. Infantile congenital syphilis
- Lesions of skin, mucous membranes, bones, internal organs, nervous system and sensory organs
- Children is retarded both in growth and weight, they are weak, restless and hypotrophic
- Skin is wrinkled, dry and sallow. Hydrocephalus, periostitis of skull, dilation of the cranial veins
- Hochsinger's diffuse papular infiltration (specific lesion on face, palms, soles and buttocks skin)
- Lesion on the face are skin around the mouth, the chin, the forehead and the superciliary arches
- Several spots or diffuse erythema appear first, skin becomes indurated and thickened and
acquires a dark-red colour, gradually covered with laminar scales and form extensive infiltrate
- Radial scars remain for life in place of the fissures (Robinson-Fourniet scars)
- Loss of hair, eyebrows and eyelashes occurs if the diffuse infiltration formed of coalesced
papules involves the skin of the eyelids, superciliary arches and scalp
- Syphilitic infiltrate in the nasal mucosa narrows the nasal meatus causing breathing difficulty
d. Congenital syphilis of early childhood
- Moist and eroded papules or condylomata latum, or papular lesions and flat condylomata form
simultaneously in the anal region and on the genitals
- Papular eruption is large lesions localized on the genitals, limbs, buttocks, rarely on the face
- Papules in the inguinal, axillary undergo erosion and hard
- Gummatous nodules may form
Page 64 of 67
- Affections of the mucous membranes of the mouth (eroded papules), larynx, vocal cords
(making the voice hoarse), and nose
- Syphilitic rhinitis with purulent secretion in the last case
- Periostitis of the long tubular bones (tibia, less frequently the forearm bones), and ocular coats
- Involvement of the liver and spleen are less frequent without gross enlargement or firmness
- Syphilitic meningitis, meningoencephalitis, mental retardation and other nervous system
3. Stigmata
a. Avsitidiisky's sign consisting in thickening of the sternal end of the clavicle as the result of diffuse
hyperostosis. The right clavicle is affected most frequently. A radiograph verifies the clinical
diagnosis;
b. a high 'lancet-like', or 'gothic' hard palate;
c. infantile little finger (Dubois-Gissard's sign); the little finger is short (Dubois sign) and the crease
of the distal joint on its dorsal surface is below the crease of the middle joint of the middle
finger, while the little finger is somewhat deformed and turned inward (Gissard's sign);
d. axiphoidia, i.e. absence of the sternal xiphoid process (it should be borne in mind, however, that
the process may be turned inward, which creates the impression that it is absent);
e. Carabelli's cusp, the presence of a fifth auxiliary cusp on the mastica-tory surface of the first
upper molar;
f. diastema, gaps between the upper incisors;
g. hypeftrichosis in boys and girls and growth of hair on the forehead almost to the eyebrows;
h. dystrophy of the skull bones, bossing of the frontal and parietal eminences but without a
separating groove.
4. Pathognomic signs of late congenital syphilis
- Diagnosed in children at the age of 4 to 15 years and later. May follow a long-term
asymptomatic course similar to that of acquired syphilis.
- Resembles acquired tertiary syphilis because patients develop gummata or gummatous
infiltrations of the skin, mucous membranes and bones (gummatous periostitis and
osteoperiostitis), joints, internal organs and nervous system (gummatous meningitis).
Tubercular syphilids may appear on the skin. The endocrine glands are affected in some patients.
The vessels of the brain or spinal cord may be involved in late con-genital syphilis (which leads
to pareses, paralyses and epileptiform seizures). Tabes dorsalis or juvenile general paresis
occurs in rare instances.
- Three groups of symptoms encountered only in late congenital syphilis
- First group consists of authentic, or unconditional, signs pathognomonic for late congenital
syphilis
- Second group is composed of accessory signs, which suggest congenital syphilis when there are
other signs confirming the syphilitic infection (the results of serological blood tests, abnormal
findings in the cerebrospinal fluid, medical history and results of examination of the mother and
child)
- The third group is formed of dystrophies (stigmata), which are encountered in many chronic
infectious diseases and are not specific for congenital syphilis
5. Laboratory identification of congenital syphilis
- Serological examination of blood and cerebrospinal fluid
- Juice squeezed out of the placenta is examined for treponemas
- TPI (Treponema pallidum immobilization reaction)and I FT(immuno-fluorescence test)
Page 65 of 67
55) Gonorrhea: etiology, conditions and ways of transmission, classification, clinical picture of torpid
gonorrheal urethritis, treatment
1. Etiology
- Urethritis in male
- Hygienic rules in direct contact with sick person or through contaminated objects
- Sexual route
- Through labor or parturition
- rare cases through contaminated sponges, diapers or chamber-pots (usually in very young girls)
4. Classification
a. Fresh gonorrhoea
- Acute
- Sub-acute
- Torpid
5. Clinical pictures of torpid gonorrheal urethritis
- Fresh torpid anterior gonorrhoeal urethritis, hyperaemia and swelling of the lips of the urethral
external opening can hardly be seen or are absent.
- The urethral discharge is scanty and mucopurulent
- The urine in the first glass is clear and contains a few heavy, purulent threads and flakes
precipitating to the bottom or it is slightly cloudy (opalescing)
- Moderate pain at the beginning of urination or a sensation of itching in the urethra
- Extension to the posterior urethra is likewise poor in symptoms
- In fresh torpid posterior gonorrhoeal urethritis, abnormal admixtures (purulent threads and
flakes) are found in the second glass
6. Treatment
Page 66 of 67
56) Reiter’s diseases: etiology, clinical picture, the pathogmonic symptoms, methods of diagnostics,
treatment
1. Etiology
2. Clinical picture
- Simultaneous or consecutive involvement of urogenital organs (urethritis, prostatitis), joints
(poly- and oligoarthritides), and eyes (conjunctivitis, uveitis, iritis). Skin eruptions – keratoderma
blennorrhagica, circinate balanitis, may occur. The oral mucosa is sometimes involved
- It follows a very torpid and persistent course at times which does not respond to any drugs. In
some cases spontaneous total recovery occurs after an attack of some duration
3. The pathogmonic symptoms
- Urethro-oculosynovial syndrome (Reiter’s disease) attended with persistent polyarthritis
- Is a complex pathogenesis in which hereditary predisposition to articular lesions and altered
body reactivity
- Chlamydias mostly found in the scrapings from the urethra, the synovial fluid of affected joints,
and in the skin lesions
- Clinical picture
- Repeated bacterioscopy and bacterial tests for gonococci and trichomonads are stably negative
and no gonorrhoea or trichomoniasis is found in the sex partner
5. Treatment
- Do not respond to penicillin and its derivatives
Page 67 of 67

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