NATIONAL COLLAGE

School of medicine

DERMATOLOGY

Fourth Year
Examination (December 2008)

Time-one&half hour

Each question should be answered in separate sheet

:Answer all questions

:Write short notes about .1

:a) The epidermal layers from above downwards

Horner layer, 2- Granular cell layer, 3- Prickle cell, 4- -1
.Langerhans cells, 5- Basal cell layer
:b) Epidermal cells
Keratinocytes make up about 90% of epidermal cell their
main function being to synthesis insoluble proteins, keratins.
Keratinocytes are generated by division of cells in the basal
layer & become the flattened dead cells in the most
.superficial horny layer, finally being shed at the surface
:c) Define

Hyperkeratosis; is thickening of the stratum corneum, often

associated with a qualitative abnormality of the keratin,and also
usually accompanied by an increase in the granular layer.

Acanthosis; is diffuse epidermal hyperplasia (thickening of the

skin).It implies increased thickness of the Malpighian layer (stratum
.basale and stratum spinosum)

Patch; A circumscribed area of discoloration, greater than 1 cm,

which is neither elevated or depressed relative to the surrounding
.skin
:Give short notes about .2

a) Impetigo;

:b) Clinical varieties of tinea capitis

Gray patch: well-defined, rounded or oval patch covered -1
with small grayish-white scales which tend to be more densely
around the opening of the hair follicles. The hair broken off into
.small stumps
Black-dot ringworm: Round or oval patch studded with -2
black dots (represents the upper ends of infected hairs broken-
.off just at the point of their emergence from the scalp)
Kerion (honeycomb): Boggy elevated purulent inflamed -3
nodules and plaque which is painful draining seropus with
regional lymph node enlargement. It heals with scarring alopecia
.Favus -4

:c) Clinical varieties of viral warts

Common warts or verruca vulgaris (HPV 1, 2, 4, 26, 29, -1
57, 65)
Lesions are circumscribed, firm, elevated papules with rough
hyperkeratotic surface or like horny projection from horny base
.mainly on the face and the scalp
The most common sites are dorsal aspect of fingers, hand, and
.knee and around nail fold in nail biters
Plane warts (HPV 3, 10, 28.38.49) -2
.Affect young children of both sexes
Smooth, flat or slightly elevated papules usually skin colored
rounded or polygonal in shape, the common sites are face, dorsa
.of hands and shins
Planter warts (HPV 2, 4, 1) -3
Planter warts have rough, keratotic surface studded with
.multiple black dots and surrounded by a collar of thick horn
Condyloma accuminata (HPV 6, 11, 15, 16, 18, 30…..) -4
It is an exophytic (cauliflower-like) papules nodules or plaques.
.It develops in genitalia of both sexes

:d) Types of scabies

Nodular scabies: Nodules seen on the scrotum, penis, groin, -1
axillae and buttocks. It may persist for wks or month after
.treatment
Crusted (Norwegian): Heavy infestation with severe crusting -2
and 100s-1000s of adult mites on the body. It is usually found in
mentally retarded, HIVpts, and pts with severe systemic disease
.such as D.M
Asymptomatic crusting with generalized lymphadenopathy
.and Eosinophilia
.Infant type -3
.Animal type -4
.Scabies in clean -5

:e) Herpes zoster

It is an acute localized viral infection caused by Varicella-
Zoster- Virus(VZV) characterized by pain and a vesicular
eruption limited to a dermatome innervated by a corresponding
.sensory ganglion
During the course of chicken pox the virus passes from the
lesion to the sensory nerve------ sensory ganglion ------latent
infection, when CMI affected the virus start to replicate within
the ganglion and then passes again to the sensory nerve
.innervating the dermatome causing pain and skin lesion
:EPIDEMIOLOGY
.It is a common disease-
.It occurs in immunocompromised pts-
:CLINICAL PICTURE
Closely grouped red papules become vesicular in an area of one
.or two dermatome
Zosteriform arrangement
.It may dries within 1-2 wks forming crusts
.Site -Thoracic
.Trigeminal-
.Lumbosacral-
.Cervical-
.The regional lymph node enlarged and tender
:COMPLICATIONS
.Postherpitic neuralgia (PHN)-
.Ophthalmic disease-
/Motor palsy-
.Zoster encephalitis-
:DIAGNOSIS
.Clinically-
.Tzanck smears-
.Direct fluorescence antibodies-
.Viral culture-
:TREATMENT
.Analgesics-
.Antiseptics-
.Antiviral-
.Carbamazepine (Tegretol)-

:Write short notes about .3

:a) Histopathology of the epidermis in psoriasis
We fine Para keratosis, micro-abscesses, dilated & tortuous
capillary loops, irregular thickening of epidermis, also upper
.dermal T- lymphocyte infiltrate
b) Explain the pathophysiology of these epidermal signs
The symptoms are caused by an allergic reaction of the host's body to
mite proteins, the female mite proteins are also present from the gut,
in mite feces, which are deposited under the skin. The allergic
reaction is both of the delayed (cell-mediated) and immediate
(antibody-mediated) type, and involves IgE (antibodies, it is
presumed, mediate the very rapid symptoms on re-infection) The
allergy-type symptoms (itching) continue for some days, and even
several weeks, after all mites are killed. New lesions may appear for a
few days after mites are eradicated. Nodular lesions from scabies
may continue to be symptomatic for weeks after the mites have been
.killed
.Etiology of genital ulcer syndrome .4

:Write short notes about .5

:a) Koebner and reverse Koebner phenomena
Psoriasis is one of several conditions in which
various types of
trauma may elicit the disease in previously
uninvolved skin.
The Koebner reaction usually occurs 7–14 days
after injury, and the reported incidence has
varied between 38 and 76% of patients with
psoriasis . In a
given patient, an all-or-none phenomenon occurs
at multiple
sites of injury, that is if psoriasis occurs at one site
of injury it
does so at all sites of injury. Clearing of existing
psoriasis
following injury has been observed and termed the
reverse
Koebner reaction. This reaction also obeys an all-
or-none
rule, and the Koebner and reverse Koebner
reactions are mutually
exclusive. Using a standardized injury, one study
found
that 25% of patients gave a Koebner reaction and
67% a reverse
Koebner reaction.
The Koebner reaction is often thought to be more
frequent in
actively spreading, severe psoriasis. Although this
may be true, it
has yet to be established by prospective studies
[1]. The reaction
does, however, appear to be a marker for a
subgroup of patients

:b) Etiopathogenesis of acne vulgaris

:Increased sebum productions -1
Sebum production is under hormonal control mainly
androgen hormone. During the prepubertal period the increase
in adrenal androgens will lead to enlargement of the sebaceous
.gland with consequent increase in sebum productions

:Ductal hyperkeratosis -2
Normally sebum flows through the canal of the sebaceous
follicle which is lined with keratinizing epithelium. In acne pts.
There is increased production of the corneocytes lining the
follicle and retention of these cells within the follicle to form
.microcomedons
:Proliferation of Propinobacteria acne -3
Acne is not infectious. P.acne is an anaerobic normal flora
of the skin found in the follicle. The enclosed, sebum-rich
environment of the seb. Follicle is ideal for P.acne proliferation,
these bacterium produce chemo tactic factors and inflammatory
mediators such as IL-2, IL-4 and others which play an important
.role in causing inflammatory lesions
:Others such as -5
.Genetic aspect
.Premenstrual period
.Smoking
.Pressure on skin by leaning face on hands
.Emotional stress
.Sweating