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PSORIASIS VULGARIS LICHEN PLANUS PITYRIASIS ROSEA

dusky red erythematous plaque
+ silvery white lamellar scale

site:
- extensor surface (elbow/knee)

histopatho:
1. parakeratosis
2. absent stratum granulosum
3. test tube acanthosis
4. dilated capillary
5. elevated dermal papillae

other types:
- ps. vulgaris
- pustular ps
- eryhtrodermic (>80% of body)
- arthropathic tyoe
- linear/zosteriform
- palmoplantar ps.
- flexular ps.
- circinate ps.
- guttate ps.

*Auspitz sign = on removal of scales
 bleeding point

3 topical Rx:
- emollient (Vaseline)
- keratolytic (salicylic acid)
- Vit D analogue
- steroid in localized case
- PUVA
*topical steroid may cause relapse +
pustular psoriasis

3 systemic Rx:
- methotraxate
- cyclosporine
- syst retinoid (acetritine)
- systemic PUVA (etamercept)

*phototherapy
- UVB (narrow band, broad band)
- UVA (topical, systemic PUVA)
- well defined, flat topped violaceous
papules
- central umbilication

*Wickham’s striae

site:
- flexors of UL (WRIST!)
- inner aspect of thigh
- genitalia
- face & around the neck
- in scalp causing cicatricial alopecia

histopatho:
1. hyperkeratosis
2. wedge shape/irregular
hypergranulosis
3. saw tooth acanthosis
4. liquefactive necrosis of basal cell
layer
4. band like mononuclear infiltration
5. melanophages


clinical types:
1. LP of the nail (pterygium)
2. lichenplanopilaris (follicular)
3. oral mucosal LP
- reticular type (most common)
- erosive type
4. annular
5. photosensitive
6. hyperkeratotic (palm & sole)

associated oral lesion:
- reticular *benign
- ulcerative/erosive *malignant

associated systemic disease:
- Hep C
- autoimmune disease

Rx:
1. topival anti-histaminic
2. antibiotic for septic focus
3. topical & systemic steroid
4. calcicotriol
5. keratolytic

*steroid in LP :
- acute guttate LP
- generalized




etio:
reactivation of Human Herpes Virus
(HHV) 6,7

initial lesion: Herald patch
- central café au lair
- collarete scales
- erythematous margin


prognosis/course :
self limited in 6 weeks

Rx:
- anti-histamine (itching)
- keratolytic (scaling)

DDx
- 2ry syphilis *most serious
- pityriform eruption
- acute LP















ACNE VULGARIS PEMPHIGUS VULGARIS PEMPHIGUS FILACIOUS
*Area of large sebaceous gland + fine hair

pathogenesis:
1. follicular hyperkeratinisation
2. ↑ sebum production
3. Pripioni bacterial proliferation
4. inflammation
5. androgen

i) non-inflammatory = comedone
 open (black heads)
 closed (white heads)
Rx: (acne vulgaris)
topical retinoid

ii)inflammatory = pustules/ nodular cystic
/erythematous papules

Rx of mild (topical)
1. topical retinoid
2. benzoyl peroxide
3. antibiotic (clindamycin, erythromycin)
4. azeleic acid


Rx of NODULAR CYSTIC ACNE
- systemic retinoid (isotretinoin) *of choice!
- systemic antibiotic (deoxycycline, tetracycline,
clindamycin, erythromycin)

complications of inflammatory acne:
- scar
- post eruptive hyperpigmentation

Rx of scar:
- dermal abrasion
- peeling
- laser

= flaccid vesicles, easily rupture,
leaving raw area

histopatho:
suprabasal acantholysis

antibodies against desmoglial 3

initial lesion : bullous eruption

*Nilkolsky sign:

Rx:
1. high dose steroid
1-1.5 mg/kg/day PO
2. other immunosuppressive:
- aziothioprine -
cyclosphosphamide
3. syst antibiotic to prevent 2ry
bacterial infection
4. water fluid replacement

complications:
- 2ry bacterial infection
- septic shock
- sepsis
- water loss  electrolyte
imbalance
- protein loss  edema
(complication of steroid)
- Cushinoid face
- DM, HTN
- intraepidermal subgranular
acantholysis






EPIDERMOLYSIS BULLOSA XERODERMA PIGMENTOSA ICTHYOSIS
hemorrhagic bullae at extremeties

types:
- simplex
- junctional
- atrophic??

Rx:
- prevention of trauma
- smooth dressing


- RNA enuclease

complication:
- malignant

Rx:
- sun protection
- polygonal translucent scale
- attached at centre
- detached at periphery

etio :
fillagrin gene mutation



CRUSTED IMPETIGO BULLOUS IMPETIGO
ULCERATIVE IMPETIGO
(ECTHYMA)
ERYTHRASMA
etio : strep/staph
site : periorificial

complications :
- ASPGN
- eczematisation
- cellulitis/erysipelas
- 3septicaemia

Rx:
- K permanganate compression
- dry with gentian violet
- topical antibiotic
etio : staph

complications:
- 2ry eczematisation
- sepsis
- disseminated bacterial
infection
(erysipelas, 4s syndrome)
etio : strep

shin of tibia


complications:
scarring
etio : corynebacterium
minutissumum

flexural area

Wood’s light : coral red

Rx:
- topical azole
- systemic
erythromycin

CRUSTED ULCERATIVE
- yellowish - brownish (hemorrhagic)
- friable, easily removed - adherent, diff to remove
- eroded skin after removal - ulcer after removal
- peri-oral - shin of tibia, bony prominence
- any child

needs predisposing factors
- iron-def anaemia
- recurrent trauma
- parasitic dis (scabies,pediculosis)
- heals by normal skin heals by scar



SCABIES PEDICULOSIS
ACUTE ANTERIOR
GONOCOCCAL URETHRITIS
ERYTHEMA
MULTIFORME
polymorphic eruption
- excoriated papule
- scratch marks

site:
- finger web
- flexor of rist
- ulnar border of arm
- under axilla
- around umbilicus
- genitalia - groin - breast

cause :
adule female Sarcoptes Scabii

antiscabitic Rx:
1. malathion0.5 %
2. benzyl benzoate 10%
3. crotamiton 10%
4. gamma benzene hexachloride 1%
5. pyrethrin 5%

*systemic = ivermectin

Number of mites/case = 12

complications:
- 2ry infection - eczematisation
- urticaria - acarophobia
lice : pediculus
humanus capitis

complications :
- lymphadenopathy
- 2ry bact infection
- urticaria
- lichen eczema

rx:
- malathion 0.5%
cause :
Niesseria Gonorrhea
- gram stain : gram –ve
- intrecellullar
- kidney shaped
- diplococcic
*Thayer Martin culture
* test : oxidase,
fermentation

Rx:
ceftriaxone250mg IM single
dose

non-gonococcal cause:
-chlamydia
- mycoplasma
-
initial lesion : target
lesion
-
-
-
* herpes iris

etio:
1. drugs
- NSAID
- anti-epileptic
2. post-infection
(HSV)
3. malignant

subtypes:
- macula-papular
- vesiculo-bullous
- Steven-Johnson
-

Rx:

TINEA CAPITIS
NON-INFLAMMATORY INFLAMMATORY
FAVUS
GREY PATCH BLACK DOTS KERION CELSI
etio:
black dots = Trychophyton violeceum
grey patch = Microsporum

inv:
- scrapping & KOH
black dots grey patch
endothrix ectothrix
No hair stumps w hair stumps
scales
- culture
- Wood’s light

DDx of non-cicatricial alopecia:
- alopecia areata
- 2
nd
stage syphilis
- trichotillomania
- trichocryptomania

Rx of choice:
Griseofulvin 12.5mg/kg/day for 6 wks

other Rx:
- itraconazole
- terbenafine

*TOPICAL antifungal has NO role in T.capitis
& onychomycosis
= boggy swelling w/ multiple oozing point

etio: Microsporum canis

complications :
- cicatricial alopecia
- 2ry bacterial infection

inv:
- scrapping & KOH
- culture w/ seborrheic dextrose
- Wood’s light

DDx of cicatricial alopecia:
- kerion selci
- discoid lupus
- severe trauma
- 3
rd
stage syphilis
- LP pilaris

Rx: (all SYSTEMIC)
1. antifungal
- ultragriseofulvin 10mg/kg/day
- azole group (flucoazole/itraconazole)
- terbenafine
2. systemic antibiotic
3. systemic steroid

etio:
trichophyta sconlei

initial lesion :
scutulum

























TINEA CORPORIS
(CIRCINATA)
EROSIVE INTERDIGITALIS ONYCHOMYCOSIS PITYRIASIS VERSICOLOR
well defined circinate
patch
- scaly patch
- healing centre
- active margin

other types:
- t. facii
- t. pedia & manuum
- t. corporis
- t. circinata

T. Pedis subtypes:
- vesiculo-
bullous/eczematous
- hyperkeratotic
- toe web maceration
(athletic foot)
- circinate type

2 topical Rx:
1. anti-fungal
2.

DDx of other circinate
lesions:
-
-
-

























etio:
1. fungal
- dematophytes
- candida
2. bacteria
- gram –ve
- pseudomonas
3. mixed
4. physical factors
(hyperhydrosis, trauma)

Predisposing factors:
- DM
- hyperhydrosis
- fitting shoes/socks
hypo/hyperpigmented macules +
fine branny scales

etio : yeast-mycelial shift of
commensal pitysporum ovale,
orbiculare into malessezia furfur

site :
seborrheic area
- neck, chest, upper back, upper
extremeties

inv:
1. scrappig & KOH
= spaghetti & meat ball app
2. culture
3. Wood’s light
= golden yellow

Rx:
1. topical anti-fungal (main)
2. systemic anti-fungal
- fluconazole
- itraconazole
3

CHICKEN POX HERPES ZOSTER HERPES LABIALIS
- discrete vesicle on erythematous
base

cause:
= 1ry infection of Varicella Zoster
virus

MOT:
= droplet infection

- in groups, discrete
- pleomorphic (vesicles + papules +
crust)
*NOT monomorphic (6entrip-
vesicular urticaria)/polymorphic
(scabies)

distribution : 6entripetal

complications:
1. 2ry bacterial infection
2. scar
3. viral pneumonia
4. encephalitis
5. hemorrhagic chicken pox

Rx:
1. Anti-histamine
2. Soothing agent
3. Topical antibiotics to prevent 2ry
bact infection.

























- grouped vesicular eruptions
overlying erythematous base in
dermatomal distribution

cause:
= reactivation of latent Varicella
Zoster virus

- pain (1
st
obvious manifestation)
- vesicular eruption overlying
erythema
- unilateral
- dermatomal/zosteriform


complications:
1. post-herpetic neuralgia (most
common)
2. gangrenous & hemorrhagic type
3. dissemination causing viral
meningitis, viral pneumonia
4. nerve palsy

systemic Rx:
1. systemic anti-viral
- acyclovir
- famicyclovir
- valacyclovir
2. systemic antibiotic
3. systemic analgesics


cause:
= reactivation of Human Simplex
Virus type 1 (HSV-1)

*HSV-2  genital warts

Types of 1ry lesions:
1. 1ry gingivo-stomatitis
2. herpetic kerato-conjunctivitis
3. herpetic whitlow
4. Kaposi varicelliform eruption
5. 1ry genital herpes

Dx :
- Tzanc smear
 intracellular inclusion bodies
NON VENEREAL WARTS
VENEREAL WART
CONDYLOMA ACUMINATA
MOLLUSCUM CONTAGIOSUM
*Herpetic whitlow = infection of
herpes virus around finger nail

VERRUCA VULGARIS
- dome shaped papules with rough
mamillated surface
- single/few on hands & feet

cause: HPV-2
other types:
- verruca plana
- verruca plantaris
- verruca filiform
- verruca digitiform

Rx
1. electrocautery
2. cryocautery
3. laser
4. chemical cautery
- Trichloro acetic acid (TCA)
- 25% podophyllin

VERRUCA PLANA
- HPV
-minute, multiple flat topped papule
w smooth surface
- skin coloured
- ↑ on the face & back of hands
*may show Koebner’s phenomenon

Rx : topical retinoid






cause:
Human Papilloma Virus (HPV)

↑ malignant transformation
- in HPV type 16, 18, 45, 31

C. Acuminata C. Lata
HPV 6, 11,
16,18,91
(venereal
verruca)
Treponema
Pallidum
(2ry stage
syphilis)
- cauliflower
- pedunculated
- foul odour
- easily bleeds
on touch
- sessile
- flat topped
- doesn’t
bleeds on
touching
Rx by
podophyllin
Rx by penicillin

Rx = destruction of the warts
i) chemical cautery
: podophyllin 25% *teratogenic
ii) laser cautery
iii) electrocautery
iv) cryotherapy *of choice in
pregnancy
dome-shpaed pearly white papule +
central umbilication

↑ in children

etio:
molluscum pox virus

Rx:
needle transfixation + curettage

DDx of umbilicated skin lesion:
-
-

DDx of other lesion showing
Koebner’s phenomenon:
-
-
-
-
-

VERRUCA VULGARIS VERRUCA PLANTARIS
- dome shaped


other types:


Rx:







etio:

line of Rx:


other types:


VITILIGO ALOPECIA AREATA ATOPIC DERMATITIS URTICARIA
milky white
depigmented
macule/patch

- in any site (↑ at the
site of trauma)

pathogenesis
i. autocytotoxic theory
(by toxic by-product
produced during
melanin production)
ii. auto-immune
destruction
iii. intrinsic defect of
structure & function
iv. neural
v. defective free radical
defense

clinical types:
1. localized
i) segmental
(dermatomal)
ii) focal
iii) mucosal *bad
prognosis (no hair
follicle)
2. generalized (>60%)
- vulgaris
- acrofacial
3. universal
localized area of hair loss
devoid of hair stumps &
scales (normal scalp)

theories:
- immunological
(autoimmune)
- genetic
- precipitating factor
(stress, septic focus,
emotional factor)

subtypes:
- areata type (1/2 patch)
- subtotalis (multiple
patch)
- totalis (all scalp)
- universalis
- ophiasis (occipital)

bad prognostic sign:
- +ve family Hx
- ass w/ nail dystrophy &
autoimmune disease
- subcapsular cataract
- ophiasis type
- subtotalis/universalis
- early onset
*exclamation mark!

2 topical Rx
1. steroid
2. irritant – althralin

DDx of non-cicatricial
alopecia
*if beard & adult  NO
tinea capitis!

*ANDROGENIC ALOPECIA
minoxidil
2% in females
5% in males

Major criteria:
- chronic relapsing course
-pruritis
- +ve family hx of atopy
- typical distribution

Associated feature (minor
criteria)
- pityriasis alba
- increase IgE
- keratoconus
- subcapsular cataract

Precipitating factors:
- winter
- exposure to allergen

infantile childhood adult
acute subacute chronic
wet
oozing
vesicular
dry licheni-
fication
- cheek
-around
eye
extensor flexor

Rx:
ACUTE
1. emollient
2. topical steroid
3. K permanaganate compressive
4. topical antibiotic
5. systemic antihistamine

CHRONIC
1. emollient
2. keratolytic (salicylic acid)
3. topical steroid
4. topical calcineurin inhibitor
(tacrolimus)
.5. systemic anti-histamine

*AD in adults:
- flexural area
- Rx : emollient + steroid



initial lesion : WHEAL
- well defined
erythematous
edematous lesion
- fading of pressing
- evanescence/
migratory

*chronic; > 6 wks

mech:
Type 1 hypersensitivity
(IgE mediated)
-histamine VD
edemawheal

Rx:
- 1
st
gen anti-histamine
- 2
nd
gen anti-
histamine
- 3
rd
gen anti-histamine

*demographic urticaria


*URTICARIAL
VASCULITIS
- NOT evanescent
- NO itching  pain &
burning
- biopsy vasculitis
- NO response to anti-
histamine  √dapsone


*ANGIOEDEMA
- loose areolar CT (lips,
eyelids, larynx, ext
genitalia)

Rx:
- SC epinephrine
- short acting systemic
steroid IV
- systemic
antihistamine

*flexural psoriasis – lack scale
* crusted scabies – lack itching