Dr. Athele Weed. —24 - sea S “AFMG SKIN (Academy For Foreign Medical Graduates) 24 br helpline 9810608460 Structure and Function of Skin + Skin is the largest organ of the body. It is about 4kg Layers of skin- epidermis & dermis Full thickness of skin-1.5-4 mm Ridges of the epidermis known as rete ridges project into the dermis Below dermis- fatty layer! panniculus Two kinds of human skin- Glabrous skin. — abrous skin Mair bearing skin & / Epidderns : seat Thickest on palms and soles and thinnest on eyelids Layers- Stratum corneum Stratum lucidum Stratum granulosum| Stratum spinosum Stratum basale Cell types in epidermis keratinocytes melanocytes | Langerhans cells | Merkel cells Dermis Thickest on the back Ratio of epidermis to dermis is approximately 1:20 Represent 70% of dry weight of skin ‘Two types of fibres- collagen and elastin Layers- i Papillary dermis Reticular dermis Cell types in dermis Major-fibroblast Others- mast cells, histiocytes Dermo-epidermal junction ‘Also known as basement membrane zone Provides mechanical support for the epidermis Comprises of hemidesmosomes, lamina lucida, lamina densa, anchoring fibrils Skin appendagesAFMG SKIN (Academy For Foreign Medical Graduates) 24 he helpline 9810608460 Eccrine glands, apocrine glands and sebaceous gland, hair and nail Ecerine gland Most numerous on palms, soles, forehead and a: Secretion is controlled by cholinergic nerve fibres. Regulates body temperature. a and least on the Apocrine glands Present op’gXilla, anogenital{region, and areol: Respons 1 body odo: Hair Passes through three phases-anagen, catagen and telogen Rate of growth of scalp hair is 0.35 mmiday Nail Parts of nail nail plate, proximal nail fold, nail matrix, nail bed Growth of nail- finger nail-3mm/rnonth Toe naik4 mm/ month ‘Sebaceous gland Maximum on face and scalp_ i Not present on palm: Example - Meibo ce spots, Tyson glands. Function of skin Acts as barrier Regulates percutaneous absor Vitamin D synthesis in presence of UV light Temperature regulation Immunological function Sensory function Diagnosis:of Skin DiseasesAFMG SKIN (Academy For Foreign Medical Graduates) 24 hr helpline 9810608460 Types of skin lesion "+ Primary-macule, papule, maculopapular, Mp rpnp WY, Bi Rut nodule, plaque, wheal,vesicles & bulla Lichenification, pustule + Secondary-erosion, ulcer, excoration, EVESCSA, Pet, coy Scale, crust, scar, atrphy Petechiae, ecchymosis ‘Techniques used for diagnosis P&tch tes! Biopsy Histopathological terms, Acantholysis Acanthosis Hyperkeratosis Hepergranulosis Parakeratosis Apoptosis Basal cell liquefaction Pigment iicontinence Spongiosis Munro’ microabscess Psoriasis + Incidence-1-2% of the population + Age of onset- any age + Basic defect- increase epidermal cell turn over time Clinical feature- + Sharply demarcated border + Pinkish/ reddish appearance + Silvery white loosely adherent scale © Auspitz sign —> Heed on evar ot + Koebner phenomena (4,6 > {ots Clay € tee), iuaasy Ge 1O9< bo Strelelyr Dre t7 PPro suhag ila, Pay Fa NST Cee Veumenglents tthlye capes) areuarg > ad se Codked « Tapmarybde resens MAES - — Wy Scleydegens tomsbojosis Iipo ubéca tereAFMG SKIN (Academy For Foreign Medical Graduates) 24 hie helpline 9810608460 Sites- extensor aspects, scalp in around 31 s oration, thickéning nychodysi{gphy , «No oral mucosa involvement Nail changes; + Variants- Guttate, annular, inverse Pustular, erthroderma Palmoplantar + Drugs exacerbating- beta blockers, ACE inhibitors, antimalaria Lithium, Withdraw of corticosteroid Pathology Parakeratosis Neutrophilic abscess ‘Suprapappilary thinning Treatment 4. Topical therapy- emollients. Anthranil Coal tar |. ealcipotriol tazarotene corticosteroid 2. Phototherapy PUVA : uvB E 3, Systemic therapy- methotrexate, cyclosporine, retinoids Pityriasis Rosea Acute self-limiting condition Starts with herald patch Sites- upper half of the body Christmas tree appearance Collarette type of scaling Total course- 6-8 weeks, Treatment- calamine lotion Lichen planus « Characterised by- purple, polygonal, pruritic, plane-topped, papuleASST fe AFMG SKIN ts : (Academy For Foreign Medical Graduates) | 24 he alpine 9810608460 Skin, mucous membrane, nail, hair wickham striae koebner phenomena b> sites- extrimit b=» heals with Pigmentation sariants + Configuration- Annular : Linear +2 Morphology Hypertrophic i Atrophic i Follicular i Bullous : Erosive (2. Sites- Palms and soles f Mucous membrane Nail i Scalp H) Pathology = * : . Hyperkeratosis, basal cell degeneration, re band like T-cell infiltration, pigment incontinence Topical- corticosteroid ). Systemic- antihistamine a Corticosteroid i Retinoids/ cyclosporine a PUVA . "| Autoimmune vesiculobullous diseases f Pemphigus Pemphigoid DH Level of spilt Intraepidermal___| Subepidermal Subepidermal ‘Age Middle age Elderly Young age Ab Ics Hemidesmosome _| Not known Skin Flaccid blister Tense blister Pruritic, grouped . papulovesicle Sites Any* scalp More on flexures | B/L symmetrical iL i extensor aspects LNikolsky sign We ve ve Mucous: Almost all cases | 10-30% Uncommon | membrane [Association Malignancy Not seen GSEAFMG SKIN (Academy For Foreign Medical Graduates) 24 hr helpline 9810608460 Duos Penicillin, Frusemide, No penicillamine, Sulphasalzine captopril ia Pathology Suprabasal cleft, | Subepidermal Subepidermal Row of tombstone | Eosinophil in Neutrophil at tips Acantholytic cell__| dermis _ of dermal papilla a aus | 'gG on the surface | Linear IgG IgA at tips of Tanrsuino of epidermal cells _| deposits at 8MJ__| dermal papilla Treatment Corticosteroic Corticosteroid Dapsone+ Gluten immunosuppresive | Alone free diet vulgaris Pathogenesis 1. Increase in sebum production 2. Follicular hyperkeratinisation 3. Propionibacterium acne 4, Role of inflammation Clinical feature Non: inflammatory -comedones Inflammatory- papules, pustules, nodules Pitted acne scars Treatment Topical: antibiotic Benzoyl peroxide Retinoids ‘Systemic- antibiotic Retinoids. Rosacea Acne like eruption Middle aged pereon Central area of the face Characterised by persistent erythema, telangiectasia Papules, pustules, nodules + Comedones are absenti t } | Teatment AFMG SKIN (Academy for Foreign Medical Graduates) i ECZEMA ‘cernwmon ‘Tharacteristic features Pruritus: Papules sige 2 eyiene rusting Licheriteatn Scaling Pecs'texiion linea Aina | Sub-acute | Chronic A ogica Soya Srapenatls tigation ~patch test Avoidance of allergen General measurees Antibiotic. Antihistamine Acute Condy’s compress Topical Corticosteroid Sub-acute Topical corticosteroid Ctironie Top: Corticosteroid with Salicylic acid Extenseive ‘Complications Systemic corticosteroid P41. Infection 2. Ide eruption Histopatholgy ~Spongiosis 3. Enythroderma i pic dermatitis 7 by » Extremely pruritic, recurrent, symmetric eczema > Typical distribution Personal / Family history of atopy > Tabilty to form Ig ‘essification~ Depending on the age of onset > Infantile Childhood Adult Aecortca dermatitis Aetiology Increase sebum production Genetic predisposition Matassezia furtur 24hr. Helpline 98410606460, S810686070 See pisit'us at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG (Academy for Foreign Medical Graduates) SKIN Clinical patterns > Cradle cap > Dandruff > Typical /sebortheic distribution Contact dermatitis, Classification Irritant CD Allergic CD Irritant CD * Non — immunologically mediated * Occures in all individuals Alleregic CD Type IV hypersensitivity phenomena Example ~ Plants- parthenium - Jewellerey - Nickel + Cement. Chromate - Hair dye— PPD “Patch test ~ Confirms the diagnosis vyy Nummular eczema Pompholyx Neurodermatitis/Lichen simplex chronicus 0 Stasis dermatitis, © Diaper dermatitis . © Pihyriasis alba DISORDER OF PIGMENTATION Vitiligo Treatment Autoimmune aetiology, Incidence ~1 % population Genetic predisposition/Familia! predisposition Clinically seen as chalk-white /milky white macules with +- leucotrichia (poliosis) Koebner phenomena + Patterns- focal Mucosal Segmental Generalised Acrofacial Natural course- unpredictable Photo therapy Corticosteroid Melasma / Chloasma Sites — symmetrically on checks, nose, forehead Precipitating factors —-Pregnancy, Genetic influence, UV rays ‘Treatment —-Hydroquinone + Retinoic acid + topical corticosteroid Freckles /lentigines ‘Abnormal vascular Response vyyy Erythema ——_-Multicforma Cause Viral oF, Target lesion MM 1 24nr. Helpline 9810608460, 9810686970 visit us at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG SKIN (Academy for Foreign Medical Graduates) Course short » Treatment ‘Symptomatic > Recurrent. Acyclovir ) > SIS/TEN Syojem yawn > Drugs : bf > Tlesions + peeling of skin > > 4 mucous membrane > Prolonged course > Acute phase- Short course Systemic corticosteroids BRTICARIA ‘+ Characterized by itchy, evanescent wheals, + IgG mediated + Triggers-Food drugs, inhalant allergens, Infection Physical stimuli, Idiopathic + Variant- angioedema / Anaphylaxis ‘+ Dermographism + Treatment- antihistamine YTHEMA NODOSUM + Cutaneous reaction patterns to variety of stimuli ‘+ Tender, erythematous nodules - LL + Causes- Tuberculosis Sarcoidosis ~ Streptococcal infection 24hr. Helpline 9810608460, 9810686970 9 Uyisitus at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG SKIN (Academy for Foreign Medical Graduates) ALOPECIA 4. Types Non-Scarring _-Alopecia areata “Androgenic alopecia ‘Scarring -Telogen effiurium: -Lichen planus, Trauma = Morphoea, Deeper foliculs | parodw DLE — Disuad- Lope or ene™ 2. Alopecia areata + Immunologically mediated | Prmreth patch of alopecia with Exclamation Mark hair at the edge + Piting of nails 3. Androgenic alopecia Genetic predisposition & androgen dependant Miniaturization of hair follicle Variable patterns Treatment — Minoxil, Finestride 4, Telogen Efluvium + Diffuse hair loss + 2-3 months after the precipitating factor + Regrowth- usual -in 6 month Hirsutism / Hypertrichosis Genodermatoses. \yosis + Heterogeneous group of disorders -Heredltary, Acquired + Characterised by fish ~ like scales + Worse in winter + Associated features-frequent + Causes of acquired lethyosis Leprosy Malignancy Hiv Drugs-clofazimine Old age ‘Nutritional deficiency TUBERLOUS SCLEROSIS + Autosomal dominant + Characterized by others + Adenoma sebaceum Seizures + Ashleaf macule Mental retardant | + Shagreen patch Eye / bone/ renal Periungual fibroma NEUROFIBROMATOSIS | + Autosomal dominant | + Charactersized by Others + Neurofibromas isch nodules + Cafe-au-lait macule cNs + Axillary freckles “Baht. Helpline 9810608460, 9910686970 visit us at: www.afmg.co.in, E-mailz:contact@afmg.co,inAFMG SKIN (Academy for Foreign Medical Graduates) WNNECTIVE TISSUE DISORDERS jpus Erythematosus DLE — ‘Aggravation on exposure to UV rays Erythematous sealy plaques with follicular plugs with central scarring - on sun ~exposed areas DIF - IgG deposit at DEJ (Lupus Band) Rx- Localised ~Steroid Resistant / Generalised Chloroquine beets Dis void (agn o> SLE ‘Shteria for diagnosis 1. Maler rash Autoimmune 2. Discoid rash Female >males 3, Photosensitvity Drugs * Procainamide “Hydralazine Oral Ulcers Rx, Sys.steroid Arthritis Serositis Neurological Renal Haematological 40. Immunological 11. ANA rial | simultaneous Presence of 4 Criteria PERMATOMYOSITIS + Autoimmune + Characterised by skin lesions - Heliotrope rash FS Gottyoh's paplies - f + Gottron’s sign 4 f yy Set + Gdlcinoisls Cutis - + Proximal myositis Investigation - Pk EMG Muscle biopsy Rx Sys, steroid Scleroderma ------~-Localised ~Morphoea Systemic systemic Sclerosis, Hy) = indurated plaque | 1 Loss of Hair & sweating + Systemic sclerosis Skin- Raynaue's phenomena, binding down of skin ‘Systemic -- Dysphagia, dyspnoea & others Penicillamine interferes with cross-linking of collagen ; Zant. Helpline 9810608460, 0810686970 u L visit us at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG (Academy for Foreign Medical Graduates) BACTERICAL INFECTION SACTERICAL INFECTION PYODERMA = Primary - Secondary Scabies Pediculosis Eczema Milfaria’ PRIMARY Non-FolliGular ‘llicutar (Stepto or Staph, (Staphylococcal) NON-FILLICULAR 1, Localized: 2. Spreading FOLLICULAR 1. Folliculitis--—-Sup, Superficial -Imp, Deep — Ecthyma “> Superficial — Erysepelas , Deep Deep 2. Perifollicultis -Furncle Carbuncle 1. Impetigo > Types Impetigo contagiosum f Bullous Impetigo Actiology ILC -Staph or streto B1 - Staph. i: > Characterised by honey ~coloured crust > Usually seen in children, + Tx Local Localised - Lopical Ab 5 Extensive- Systemic Ab. 2888s > Cause release of exotoxip (exfoliative toxin) > Infants \ ——~ iN —— \ f \ > Onsetis Acute with fever j “sf oy 3 ues ge > Erythema & tenderness of. ‘skin followed by Peeling of skin in thin sheets, > TtIV anti staphylo-coceal Ab 3. Ecthyma > Aetiology ~strepto / staph, Adherent crust —removal of crust reveals an irregular ulcer. > Heal by scarring Superficial folliculitis, Aet -Not always infectious ~ Infection ~ staplococcus, ~ Non-infective-Mineral oils, petroleum, te iyielpline 8840608460, s870686075 visit us at: www.atng.co.th,, & mailzcontact@afmg.co,inAFMG SKIN (Academy for Foreign Medical Graduates) Peeudofolicultis bread region, port waxing |) - Clinically seen as dome-shaped flicuarpustule | Beep folliculitis |) © Aetiology ~ stapl ||» Sycosis barbae- Beard region urculosis (Boils) if > Deep folliculitis -Perifoticulitis > Recurrent attacks -HIV, diabetes > Tender, erythematosus nodule with pain sometimes become necrotic discharging (single Opening) terbuncle + Deep infection of multiple, contiguous hair follicle + Tender, indurated, erythematosus plaque discharging pus from many openings (Cribiform cerebritorm ) | i + Diabetes is to be ruled out, + Erythematous indurated plaque with = Sharp margin ~erysipelas = Diffuse margin — Cellulitis + Re = Parenteral /1V Ab~ penicilin F sed by resident flora P| Pited keratolysis Aetiology Corynebacterium species Ppt factor — wet feet } siveaty feet Fine [confluent pits # sotes / Aetiology — Corynebacterium minutissimum Well ~ defined scaly brown macules on folds ~ axila groin Wood's lamp- Coral red appearance ‘Aetiology. ~ Corynebacterium species Gio - yellow brown staining of clothes in the area of arm- pits OJE- Axillary hair is beaded with yellowish concretions, Exogenous source Tuberculous chancre ‘Tuberculosis verrucosa cutis Endogenous source Lupus vulgaries f Scrofuloderma 24hr. Helpline 9810608460, 9810686970 B visit us at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG (Academy for Foreign Medical Graduates) ‘Orificial tuberculosis Miliary tuberculosis Tubereulid Lichen Scrofulosorum Papulonecrotic Tuberculid Erythema nodosum Lupus vulgaris Sites - Face. Buttocks, lower limb ‘Weil ~ Demarcated plaque ~ slowly extending Periphery shows erythematous to brownish deep-seated nodules- (Apply jelly) Center ~ Scarring Scrofuloderma 1. Direct extension from underlying tubercular focus- Mostly Lymph node. 2,, Multiple discharging sinuses mixed with puckering, ‘Scarring, Viral infections Warts (Verruca) 1. Aetiology ~ Human Papilloma virus DNA virus . ‘ > 70 types Mode of transmission = Direct skin-to-skin contact & by auto-inculation. + Anogenital ~ STD Clinical types Verruca vulgaris \Verruca plana Filiform wart Paimo ~ plantar wart Palmo — plantar wart Anogenital wart vvvwy vv Verruca vulgaris > Single / Muttiple — firm papule with verrucous surface > Site ~ anywnere= atk of hands / Fingers Pi yotherapy ye fe \ a Hae Multiple, slightly elevated, flat & smooth papules Site- face koebner phenomena + Tie TCA / Retinoic acid Verruca plana Filiform wart — finger like projection PLANTAR WART Painfut ‘Mosaic wart — multiple tightly packed warts, ‘T+ wart paint, cryotherapy Anogenital wart > Condyloma acuminata -6,11,16,18,31,33. > High risk HPV — Cervical Ca. 24hr. Helpline 9840608460, 9810686970 visit us at: www.afmg.co.in, E-mai ontact@afmg.co,in SKINi AFMG SKIN (Academy for Foreign Medical Graduates) > T+ - Padophylin, Gryctherapy ‘Yolluscum contagiosum > Aetiology - Pox ~group of virus > Mode of transmission ~ Direct spread / ST D > Pearly — white, umbilicated papule T+ Expression followed by chemical cautery Zoster Infections Primary Chicken ~pox Latent Herpes zoster Cricken -Pox > Mode of transmission - droplet route > Incubation period ~ 2 wk. > Erythematous macule * Polymorphic Transient papule Centripetal Distributions Vesicle with perivesicular Erythema + Crust / scab formation Hypopigmentation -Mild cases -Calamine lotion, antihistamine -Severe cases - Acyclovir - 800 mg — § times for 7 days Herpes zoster > Reactivation virus from sensory root ganglia Grouped vesicles on an erythematous base distributed it @ particwie associated with pain. > T+ Acyclovir 800 mg —5 times * 7 days. 5 simplex virus inte 1.Aetilogy -HSV = 2 types -Types | - Herpes labialis I - Types I! - Herpes genitals 2. Mode of transmission = Direct contact “i /ST 3, Clinical features - Primary infection : Recurrent infection || Primary infection ‘Type | - Acute gingivostomatits with malaise, Fever, Lymphadenopathy Type Il Vesicles rupturing to form painful ulcers with inguinal Lymphadenopathy 24hr. Helpline 9810608460, 9810686970 15 visit us at: www.afmg.co.in, E-mail:contact@afmg.co,in(Academy for Foreign Medical Graduates) ‘Recurrent infection * Reactivation of virus from sensory root, ganglia * No constitutional symptoms / * Complication ~ Erythema multiforme * Investigation — Tzank smear * Treatment - Acyctovir— 200 mg—5 times *8-7 days Maculo ~ papular viral exanthem Mesies Z _Koplik’s spots in buccal mucosa * Maculopapular rash in a cranio, “caudal fashion Erythema infectiosum > Fifth disease > Aetiology - Parvovirus Characterised by- Slapped cheek ‘appearance face + inte /MeMatous lacy eruption trunk Aetiology HHV-6 and HHV-7. i ROS® Pink macules on trunk-blanches on Pressure “Qwasaki Syndromes Muco-cutancoue 'ymph node-syndrome) > Aetilogy-? Viral ? Bacterial * Generalised oedema & Erythema —acral Parts with fever & 'ymphadenopathy * Characteristic ~ desqumation of skin — Palms, soles Sel-limiting,4 % —cardiae complication Fungal infections " Superficial” -Dermatophytc infections - Pityriasis versicular i - Candidiasis 2. Deep -Mycetoma : - Sporotrichosis : ~ Chromoblastomycosis Dermatophytic infection / Tinea / Ring worm 1. Aetiology - Trichophyton eae - Microspofum ~ Epidesmophyton 2. Site of infection 2 ~ Trichophyton + + + + Microsporum. + “ = Epidermophyton + = + 3. Types T.capitis T.pedis T.barbae T-Corporis, T.Cruris T.Manuum T.Unguium > T Capitis + Gray. scaly patch Black-dot 24hr 1 60, 9810686970 Visit us a mail:contact@atmg.co,in(Academy * Kerion + Favs 7 Corporis * Topical - Systemic + Miconazole + Clotrimazole + Ketoconazole + Terbinafine + Butnafine is versicolor . ~ Selenium sulphide AFMG for Foreign Medical Graduates) SKIN Anywhere Typical ~ ring shaped lesion Inner side of thighs & scrotum Men + Pedis / Athelet’s foot & T. Manuum. Interdegital cler. ‘Well— defined scaly patch Vesicular eruption Discoloration ‘Sub- ungual hyperkeratosis Onycholysis 1.KOH preparation 2. Culture ~ Sabouraud's agar media 3.Wood's lamp - Griseofulsin - Terbinafine - Fluconazole = Itraconazole © Aetlogy - Malassezia furfur © Characterized by ~ Hypopigmented / Hyperpigmented mildly scaly macules ‘on upper trunk shoulder,neck. © Inv—KOH mount © T+ Topical Systemic -Imidazoles - Ketoconazole - Fluuonazole Aetitogy — Candida albicans Ppt factors Moisture _use of broad spectrum Ab \ -Obesify Pregnancy Z. \ “Diabet —imminoinroniay ste . Gircl ypes | Ee Flexural LAntertrigo es Paronychia Gerital candidiasis Oral candidiasis + Investigation — KOH mount + Treatment - Topical ~ imidazoles + Systemic — Fluconazole / Itraconazole ‘Deep funaal Info Mycetoma = —» —Actinomycetoma Eumycetoma = Organism is implanted in trauma prone parts of the body by a penetrating injury 24hr. Helpline 9810608460, 9810686970 17 visit us at: www.afmg.co.in, E-mail:contact@afmg.co,inal Graduates) *_ Gharacterised by ~ Multiple discharging sinuses +- associated deeper tissue (bone ) involvement > Inv—KOH grenutes , cutture * T+ Actino — Streptomycin + septran ~ Eumy ~ Itraconazole Sporotrichosis + Aetiology ~ Sporothre schenckii 7 Heatly arranged nodulo — Utcerated lesion ~ T+ Potasium iodide , itraconazole Chromoblastomycosis - Trauma prone site ~ _ Verrucous plague T+- Itraconazole Infestations 1. Peiculosis Species P. Capitis P.Corporis P. Pubis (Pthirus pubis ) 2. Pediculocis capitis . . ; Usually affects enidren b. Itching ++ © Presence of nits Secondary infection with Lymphadenopathy Tt GBHC 1 % 1 Permeatnrin 1% ovenight apptoain Rot atter 7 day 3. Pediculosis corporis 2. Unhygienic individuals’ i ye © Vagabond's aissase” = oy eo 6! Excorited paphies unk J a — 4. Exam of cloth -reveals tice ©: T+ = Treatment of cloth, 1% GBHC /5 % permetnain 4. Pediculosis pubis a sto ®. Severe itching in public area BARDS Hilla 28.5" pas eo wr wots is ting on to hair SCABIES 1. Actiotogy ~ Sarcoptes scabies 2. Mode of transmission 1 Prohanged contact W STD ~ sexual transmission 3. CIF a. Incubation period ~400mg b.Can Occur Of any age ~ chikdren (mostly) Burrow ©. Pathognomonic lesion — ¢. Due to Hypersensitvety Papuies g A otis 24hr. Helpline $810608480, sai0s86e7O 18 visit us at: ww fmg.co.in, E-mait: fontact@atmg.co,inPe OTT EEE AFMG SKIN (Academy for Foreign Medical Graduates) Papulovesicie 4. Sites -webs of fingers, wrist axa, Peniumbilical region genitalia. 4, Complication 1 Infection 4 Eczematisation MAGN 5. Inv Demonstration of mite “Variants ~1.Typical distribution | Infantile 2. Itching at night Il, Norwegian 3. + Ve Family history IIL.Nodular I Animat V. Genital 6. Treatment 1. General 2. Specific a. T+ of ali family members a. GBHC 1% b. T+ of cloth b. BB lotion 25 % C.Permethrin 5% d. Crotamiton 10% 24hr. Helpline 9810608460, 9810686570 19 sisit us at: www.afmg.co.in, E-mail:contact@afmg.co,in“ctiolegy Mycobacterium leprae camot be cultured Grown in experimental anna) ~ Mouse footpad ~ Nine banded armadillos foreredvedl leer Classification 4 2 Ridley ~Jopting -T7, er, ap, BL IL Jepamalretersy > Indian classification [ Cardinal Features Border bone 1. Anaesthetic patch Nerve involvement “Ngave thickening, tendernessisensoryimotor Sequel 3.Presence of AFB ty Vand __ are Fodenetud: Lipa i { ieymunh (by os nese Raritan) | OMNIS - Brsfibone Feber cot 1. Typer ee Type Il ave “PE — Bin dlebre Rypelitng Complications she = anil dre 1. Deformities Banke ey 2. Trophic ulcer li- Leprurrndey-y my, 3. Loss of vision 4. Testicular dysfunction Renal involvement > Investigation - Sitsmear f-ve= BR RG LL Tape Lepay > Lepromin test € —_ ~ Histopathology No. of lesions No. of nerve trunk Presence of AFB Pe <5 1 VE MB 5 1. +VE > Paucibacillary Supervised Rifampicin 600mg once month Unsupervised Dapsone 100 mg- daily Duration 6 months > Multibacitiary ‘Supervised Rifanfpicin \ 800 mig (once a i Clofazimine: / \309/mg month) Unsupervised Dapsone {100 mavdaily) | — Clofazimine “80mg (daily) Duration 12 month > Treatment of Reaction Type Corticosteroig Type ENL —Thalidomide System — corticosteroid Syphilis 1. Stages ~ Primary, Secondary, Jatent, Testing, 24hr. Helpline 88 808460, S8i0686a79 20 USE Ua att Www atieg eg bee ‘Batizcontact@atmg.co, pies: AFMG (Academy for Foreign Medical Graduates) 2” Treponema pallidum = Corkscrew shaped Motile with characteristic movement 3. Secondary syphilis + Rash - _ Lymphadenopatny - Condyloma tata + Mucosal lesion 3. Tertiary syphilis '@. Mucocutaneous ~ Gumma ~ Punched out ulcer with wash leather slough * b. Cardiovascular c. Neurosyphilis, ‘Congenital syphilis 1 ‘Skin rash with lymphadenopathy I Snutffles (Rhinitis ) IL Systemic Musculoskeletal system Hepatosplenomegaly CNS J ocular NV. : Dark ground examine D. Serological test Non treponemal -VORL Treponemal ~ TPI,TPHAFTA ABS ‘Gonococcal infection a. Actiology ~ neisseria gonorrhoeae b. Incubation period ~ 1- Sdays © Manifest as profuse, purulent discharge with burning micturation Complication I Ascending infection I. Urethral stricture Wh Infertitity Vv. pel INV. -Gram stain ~ Culture “Thayer martin medium tT ~ In) Ceftriaxone ~250 mg IM single dose Azithromycin ~ 2.gm NGV ( Non -gonococcal urethritis) ® Actology ~ Chlamydia trachomatis Trichomonas vaginalis > Incubation period ~ 2 weeks > Manifests as. mucous discharge 24hr. Helpline 98410608460, 9810686970 visit us at: www.atmg.co.in, E-mail:eontact@afmg.co,in SKIN aeAFMG (Academy for Foreign Medical Graduates) > T+ Azithromycin —2 am single Doxycyline’~100 mg BD * 200 mg 8. Syndrome management > vvy Syndrome of GUD. ‘Syndrome of urethral discharge ‘Syndrome of vaginal discharge ‘Syndrome of inguinal bubo ‘Syndrome of scrotal swelling > Syndrome of lower abdominal pain, % Syndrome of Ophthaimia neonatorum, Dermatological manifestation of HIV 1Lnfections “Viral - Herpes simplex * Bacterial “Infestatun Herpes zoster Oral hairy leukoplakia Warts ‘Molluscum contagosium Folliculit ,Furnculoses = Bailary angiomatosis + Cause- bartonella species + Ganbidiasts [~~ * = , Bematophing Fite 4 Piyriosporum folliculitis = Cryptococosis ~ + Penicillium marnetfi - Scabies -Norwegian scabies 2. Non- Infections Skin disorders + Seborthea dermatitis + Psoriasis + Papular & Pruritic eruption + Eosinophilic folliculitis = Iethyosis = Drug eruption 3, STD ~ Chance of transmission increases + Uleer~ 10 times + Discharge - 4 times 4. Opportunistic neoplasms > Primary Cutaneous neoplasms 24hr. Helpline 9810608460, 9810686970 visit us at: www.afmg.co.in, E-mail:contact@afmg.co,inAFMG SKIN (Academy for Foreign Medical Graduates) =~ Tymphoreticular malignancy ~ _ Kaposi sarcoma lly transmitted diseases cup ‘Syphilis Chaneraid 3-30 25 a “Treponema Palidum | Haemophilus ducreyi z Herd chancre ‘Soft chanere Sotty, mobile discrete | Matled.tender (bubs) 82 ‘Bubo-rupture phimoses phagedenis ulcer Dark ground VORL | Gream stain Penicilin ['Inj. Gefiriaxone Tab Azithromycin ciprofloxacin cup ‘Sonovanosis tev Herpes Genitalis 1 Te reeks 2 weeks < Tweaks | [ Ssimmamacenim Crise vadhomas 72 HST + f Sranulomatis wk svt | ely, fed appearance Transient Femoral Grouped (resicles polyclicy Scudobubo Tnguinal femoral Tender Ln-Pr. | vagedenic malignant Erthiomene | Secondary infec 7 ssue smear Z CFT Trank smear xyeycline Sepiran DOxyeyciine | Acyetoier ie 24hr. Helpline 9810608460, 9810686570 23 [visit us at: www.afmg.co -in, E-mailzeo ntact@afmg.co,inAFMG (Academy for Foreign Medical Graduates) DERMATOPATHOLOGY 1. Hyperkeratosis :- Hypertrophy of the S. corneum 2. Parakeratosis :- Presence of nuciel in S. comeum 5 Dyskeratosis —:- Disordered keratiniztion with groups of abnormal celts in the prick cell layer 4. Acanthosis :- Thickening of prickle cell layer 5. Atrophy General thining of epidermis 8. Oedema :- Intra_or extra cellular collection of fluid 7. Acantholysis Loss of adhesion between kerationocytes intra epidermal clefts , vesicle & bullae SOME POINTS TO REMEMBER (1) Commonest in dermatology 1. Symptom; itching 2, Cause ofitching Dry skin Irritant dermatitis - rash + Acne to vulgaris Occupational disease - Contact dermatitis (CD ) 6. Botnical cause of CD ; Po_tenium weed 7. Metallic cause of CD; Nichel 3 4 8. Drug induced rash ; E, mut ( toxic erythema) SKIN t 24hr. Helpline 9840608460, 9870686970 Visit us att www.afmg.co.in,/E-maji:eontact@afmg.co,in