U WORLD (STEP 1) – DERMATOLOGY (EDUCATIONAL OBJECTIVES)

Last Updated: Mar 27 2020

Disclaimer:
These notes are made only for the sole purpose of rapid revision & overview of a particular system.
It is highly recommended to buy online UW subscription, as new questions & explanations are updated on
daily basis.

NEWLY ADDED QUESTIONS (Since Oct 2019)

1. Mar 20 – 17600 – Hyper Sensitivity Reactions

2. Mar 20 – 17855 – Wound Healing
3. Mar 13 – 17853 – Thermal Burn
4. Feb 28 – 17854 – Wound Healing
5. Feb 08 – 18565 – Drug Interaction
6. Nov 16 – 15439 – Lichen Planus
7. Nov 16 – 16852 – Epidermolysis Bullosa
8. Nov 09 – 15441 – Ichthyoses
9. Oct 17 – 17062 – Psoriasis
10. Oct 17 – 17230 – Lice Infestation

1
 PIGMENTED SKIN DISORDERS

Vitiligo
1110
• Vitiligo
✓ Loss of Epidermal Melanocytes.
✓ Occurs MC in patients with autoimmune disorders (auto-immune thyroiditis, type 1
diabetes)
✓ Results in well-defined, variably sized patches of Hypo Pigmentation.

COMMON SKIN DISORDERS

Acne Vulgaris (AV)

15373
• Risk factors for acne
✓ ↑ Androgen Levels
✓ Obstruction of Pilo Sebaceous Glands by oil based hair products
✓ Mechanical irritation of skin follicles
• Sports participation frequently triggers acne due to use of
✓ tight fitting clothing
✓ protective gear

15374
• AV is an inflammatory disorder of pilo sebaceous follicles.
• Contributing factors
✓ Hyper-keratinization & obstruction of follicles
✓ Sebaceous glands enlargement with ↑ secretion of sebum
✓ Colonization & proliferation in the gland by Propionibacterium (Cutibacterium) acnes
✓ Follicular & peri-follicular inflammation.

15379
• Acne typically arises in Adolescents & Young Adults due to
✓ Adrenarche-associated enlargement in sebaceous glands
✓ with subsequent ↑ in sebum production.
• Follicles clogged with Sebum provide the Anaerobic, Lipid Rich environment necessary for
proliferation of Propionibacterium Acnes, the skin commensal responsible for acne lesions.

2
Androgenic Steroids

7585
• Androgens stimulate
✓ Follicular epidermal hyper-proliferation
✓ Excessive sebum production,
thereby promoting acne development
• Anabolic Steroid Misuse is a known cause of acne, especially in Competitive Athelets

Atopic Dermatitis

876
Atopic Dermatitis (Eczema)
• Common, chronic inflammatory disorder
• Caused by impairment of skin’s Barrier Function
• Eczema
✓ Pruritis
✓ Erythematous papules & plaques
✓ A/w other atopic diseases, such as Allergic Rhinitis & Asthma.

1214
Chronic Topical Corticosteroid (CS) - Local Cutaneous Adverse Effects
• Atrophy/thinning of dermis that is a/w
✓ Loss of Dermal Collagen
✓ Drying
✓ Cracking &/or
✓ Tightening of Skin
✓ Telangiectasias
✓ Ecchymoses

3
Contact Dermatitis

1133
Poison Ivy Dermatitis
• Is a form of allergic contact dermatitis,
• which is a Type IV HSR mediated primarily by T lymphocytes.
• It manifests as
✓ intensely pruritic erythematous papules, vesicles or bullae
✓ that often form linear patterns.

1115
Acute Allergic Dermatitis
• Caused by type IV (delayed) HSR to an antigen on skin surface.
• Gross findings:
✓ Erythematous
✓ Papulo-vesicular
✓ Weeping
Lesions.
• Histology:
✓ Spongiosis, an accumulation of edema fluid in inter-cellular spaces of epidermis
• With chronic exposure, lesions become Less Edematous, with thickening of stratum
spinosum & stratum corneum.

Niacin Deficiency

1064
Niacin (Vit B3)
• Can be synthesized endogenously from Tryptophan
• Is an essential component of NAD & NADP
• Def of this vitamin results in Pellagra
✓ Dermatitis
✓ Diarrhea
✓ Dementia

12276
• Niacin is a precursor for NAD & NADP, two important cofactors for many Dehydrogenase &
Reductase Enzymes
• Niacin Deficiency: Pellagra (Diarrhea, Dementia, Dermatitis)

4
Chronic Venous Insufficiency

14984
Stasis Dermatitis
• Characterized by
✓ Chronic erythema
✓ Fibrosis
✓ Reddish brown discoloration due to deposition of hemosiderin
(from breakdown of extravasated red cells)
• Symptoms
✓ Bilateral
✓ Worse at or above ankles
• Complications:
✓ Poor wound healing
✓ Weeping
✓ Ulceration

Wound Healing

17854
Vascular Endothelial Growth Factor (VGEF)
• Fibroblast & vascular proliferation (granulation tissue) induced by VGEF is essential to
normal wound healing
• If this tissue proliferation becomes Excessive (in wounds left to heal by secondary
intention), the resulting Hyper Granulation Tissue can impair wound re epithelization &
remodeling

17855
• Elevated Blood Glucose
✓ Induces the release of reactive oxygen species & Pro Inflammatory Cytokines from
neutrophils
✓ While, Inhibiting the production of Anti Inflammatory Cytokines (IL 10) & growth factors
needed for fibroblast proliferation & re epithelialization in a healing wound.
• As a result, patients with uncontrolled diabetes frequently have Non Healing Wounds with
evidence of ongoing inflammation

Melanocytic Nevus

11502
Compound nevi
• Benign proliferations of Melanocytes that involve both dermis & epidermis
• Lesions appear as
✓ Slightly raised papules
✓ with uniform pigmentation & symmetrical sharp borders

5
Psoriasis

1116
• Common complications of psoriasis:
✓ Psoriatic arthritis
✓ Nail changes
✓ Uveitis

1117
Psoriasis
• Characterized by
✓ Hyper Keratosis & Confluent Para Keratosis of striatum corneum
✓ Epidermal hyperplasia (acanthosis) with elongated rete ridges
• Neutrophilic foci in stratum corneum & epidermis may coalesce to form micro abscesses
(Munro Micro Abscesses)

8569
Psoriasis – Treatment
• 1st line treatment options for localized psoriasis
✓ High potency topical corticosteroids
✓ Vitamin D analogs
• Vitamin D Analogs
✓ Inhibit T cell & keratino cyte proliferation
✓ Stimulate keratino cyte differentiation
• Corticosteroids
✓ Have anti inflammatory & anti proliferative properties
✓ Their MOA is complementary to Vit D analogs
15408
Psoriasis
• Histology
✓ Hyper keratosis & confluent para keratosis of striatum corneum (producing the
characteristic silvery scales seen on gross examination)
✓ Diffuse epidermal hyperplasia with elongated & clubbed rete ridges (corresponding to
typical erythematous plaques)
✓ Dilated capillaries in dermal papillae
17062
Psoriasis
• Common inflammatory skin disorder
• Characterized
✓ Hyper keratosis (overgrowth of striatum corneum)
✓ Epidermal hyperplasia
• Plaque Psoriasis
✓ MC form
✓ Presents
➢ Chronic, well demarcated, erythematous plaques
➢ with a thick, silver scale

6
Seborrheic Keratosis (SK)

1112
SK
• Common epithelial tumor
• Presents
✓ Tan or brown, round lesion
✓ with a well demarcated border & “Stuck On” appearance
• Microscopic examination:
✓ Small cells resembling Basal Cells, with
➢ Pigmentation
➢ Hyper Keratosis
➢ Keratin Containing Cysts
• Rapid onset of numerous lesions is often a/w internal malignancy (Leser Trelat Sign)

7649
SK
• Pigmented macules or plaques with
✓ Greasy surface
✓ Well demarcated borders
• Rapid onset of numerous lesions is an indicator of internal malignancy (Lesar Trelat Sign),
especially Gastric Adeno Carcinoma

Urticaria

1114
Urticaria
• Transient Hyper Sensitivity Disorder
• Characterized by
✓ Pruritic erythematous plaques
✓ that arise suddenly & resolve over hours
• They are most often caused by IgE mediated degranulation of mast cells, leading to
↑ permeability of micro vasculature with edema of superficial dermis

11852
• Medications that trigger IgE independent mast cell degranulation
✓ Opioids
✓ Radio Contrast Agents
✓ Some Antibiotics (Vancomycin)
• Common symptoms
✓ Diffuse Itching & Pain
✓ Broncho Spasm
✓ Localized Swelling (Urticaria)

7
Hyper Sensitivity Reactions (HSR)

• Late Phase of dermatologic Type 1 HSR manifests as an indurated skin lesion Hours after
exposure to allergen due to allergen due to local tissue damage caused by major basic
protein (MBP) released from eosinophils
• Type IV HSR develop over Days because of time needed to produce a cell mediated immune
response

8
 SKIN - VASCULAR TUMORS

Lymphedema

1937
• Axillary Lymph Node Dissection
✓ Risk factor for development of chronic lymphedema involving ipsilateral arm
• Chronic lymphedema predisposes to development of Angio Sarcoma
(Stewart Treves Syndrome)

Bartonella

1898
Bartonella henselae
• Bartonella henselae causes
✓ Cat scratch disease
✓ Bacillary angiomatosis
✓ Culture negative endocarditis
• Cat scratch disease is characterized by
✓ Low fever
✓ Lymphadenopathy
✓ Self limited course

Glomus Tumor (GT)

467
Benign GT (Gloman Gioma)
• Produce a very tender, small (a few millimetres in diameter), red blue lesion Under Nail Bed
• This type of tumor originates from modified smooth muscle cells that control thermo
regulatory functions of Dermal Glomus Bodies

Cherry Angioma

826
Cherry Hemangiomas
• Small, red, cutaneous papules common in aging adults
• They do not regress spontaneously & typically ↑ in number with age
• Light microscopy:
✓ Proliferation of capillaries
✓ Post capillary venules in papillary dermis

9
Hemangioma

827
Superficial Infantile Hemangiomas (Strawberry/Capillary Hemangiomas)
• Benign vascular tumors of childhood
• They
✓ Appear during 1st weeks of life
✓ Initially grow rapidly
✓ Typically regress by the time the child is 5-9 years old
• These tumors are composed of Blood Filled Capillaries separated by connective tissue

10
 BLOOD

Ecchymosis

1878
• Ecchymoses frequently indicate a Deep Haemorrhage (Hematoma) due to
✓ Bony fracture
✓ Ligamentous rupture or
✓ Muscular injury
• They Do Not Blanch under pressure as the RBCs are not contained within vasculature
• Ecchymoses often pass through an evolution of Color Change (blue or red to brown, green,
yellow), which can can be used to estimate the Age of Injury

Histiocytosis

588
Langerhans Cells
• Dendritic cells found in skin that act as professional Antigen Presenting Cells (APCs)
• Derived from Myeloid Cell Line
• Possess characteristic Racquet Shaped Intra Cytoplasmic Granules (Birbeck granules)

Febrile Neutropenia

973
Ecthyma Gangrenosum
• Cutaneous necrotic disease with a strong a/w Pseudomonas aeruginosa bacteremia.
• It occurs from Peri-Vascular Invasion & release of Tissue Destructive Exotoxins, causing
✓ Vascular destruction &
✓ Insufficient blood flow to patches of skin that become edematous & subsequently
necrose.
• Pseudomonas infections are common in patients who are
✓ Neutropenic
✓ Hospitalized
✓ Have burns
✓ Have indwelling catheters.

Graft Versus Host Disease

1613
GVHD
• Occur following transplantation of organs rich in Lymphocytes (liver).
• T lymphocytes
✓ Found in donor organ become sensitized against the MHC antigens of recipient &
subsequently attack the host’s tissues.
✓ The skin, liver, GI tract are most frequently affected.

11
 AUTO IMMUNE BLISTERING SKIN DISORDERS

Pemphigus Vulgaris (PV)

2065
PV
• Auto immune bullous disease
• Characterized by auto antibodies directed against Desmosomal Proteins (Desmo Glein)
• Presents
✓ Painful flaccid bullae & erosions
✓ affecting skin & mucosal membranes
• Bullae Spread Laterally with pressure & New Blisters may form with gentle rubbing

Bullous Pemphigoid (BP)

1105
BP
• Auto antibodies against Hemi Desmosomes along basement membrane of dermal
epidermal junction
• This causes the entire epidermis to separate from dermis, forming Tense, Sub Epidermal
Blisters

12
 OTHER BLISTERING SKIN DISORDERS

Dermatitis Herpetiformis (DHP)

1111
DHP
• Erythematous pruritic papules, vesicles, bullae
• Appear Bilaterally & symmetrically on Extensor Surfaces
• DHP is strongly a/w Celiac Disease

Erythema Multiforme (EM)

11662
EM
• Cell mediated inflammatory disorder of skin
• Erythematous papules evolve into Target Lesions
• MC a/w HSV

15695
EM
• Target shaped, inflammatory skin lesion
• Typically arises in setting of infection, particularly with
✓ HSV
✓ Mycoplasma Pneumoniae
• It is caused by deposition of infectious antigens in Keratino Cytes,
leading to strong Cell Mediated (Cytotoxic T Cell) immune response

ICHTHYOSES

Ichthyosis Vulgaris (IV)

15441
IV
• Dermal Xerosis (Dryness) & Scaling that primarily affect
✓ Trunk
✓ Extensor surfaces of extremities
• Caused by mutations of Filaggrin Gene, resulting in
✓ Epidermal hyperplasia
✓ Defective desquamation
✓ Loss of normal barrier function

13
 INHERITED SKIN DISORDERS

Epidermolysis Bullosa (EB)

16852
EB
• Group of inherited disorders
• Characterized by Epithelial Fragility (bullae, erosions, ulcers) triggered by Minor Trauma
• Caused by mutations of proteins of Intra Epidermal & Dermo Epidermal adhesion
complexes in Basement Membrane Zone

SKIN – MISCELLANEOUS DISORDERS

Acanthosis Nigricans (AN)

936
AN
• Thickening & Hyper Pigmentation of skin in Flexural Areas
• Lesions have a classic “Velvety” Texture
• Commonly a/w
✓ Insulin resistant states (diabetes mellitus, acromegaly, obesity)
✓ GI malignancies

Actinic Keratoses (AK)

935
AK
• Develops on chronically Sun Exposed areas of skin in predisposed individuals
• Lesions consists of Erythematous Papules with
✓ a central scale
✓ a rough “Sand Paper Like” texture
• AKs
✓ Considered Pre Malignant Lesions
✓ Have the potential to progress to squamous cell carcinoma (SCC)

1993
AK
• Small (usually <1 cm), erythematous epidermal lesions with Adherent Scale that are result
of chronic sun exposure
• Histology:
✓ KeratinoCyte Atypia
✓ Hyper Keratosis
✓ Para Keratosis
• Small % of AKs progress to invasive SCC; therefore, frequent monitoring is necessary

14
Lichen Planus (LP)

16395
LP
• Pruritic, purple/pink, polygonal papules & plaques
• Affect flexural surfaces of Wrists & Ankles, along with
✓ Nails
✓ Oral Mucous Membranes
✓ Genitalia
• Histology:
✓ Hyper keratosis
✓ Lymphocytic infiltrates at dermo epidermal junction
✓ Thickened stratum granulosum with sawtooth rete ridges
✓ Eosinophilic colloid bodies in papillary dermis

15439
LP
• Immune mediated condition
• Presents
✓ Pruritic, pink papules & plaques,
✓ often with lacy, scaly, white markings (Wickham Striae)
• Lesions typically occur on flexural surfaces of wrists & ankles but can also involve nails, oral
mucous membranes & genitalia

Sunburn

1477
Pyrimidine Dimers
• Formed in DNA as a result of UV light exposure
• They are recognized by a specific Endonuclease Complex that initiates the process of repair
by nicking the damaged strand on both sides of pyrimidine dimer
• Damaged segment is then excised, & replacement DNA is synthesized by DNA polymerase

Thermal Burn

17853
• Earliest morphologic change that occurs after a Superficial thermal burn is Erythema due to
release of preformed mediators (histamine) from mast cells
• Deeper (Partial Thickness) burn wounds form Blisters due to fluid extra vasation through
gaps between damaged venule endothelial cells

15
Aging

1860
Photo Aging
• Product of excess exposure to UV A Wavelengths
• Characterized by
✓ Epidermal atrophy
✓ Flattening of rete edges
• In addition, there is
✓ ↓ Collagen fibril production
✓ ↑ Degradation of collagen & elastin
in dermis.

16
 SKIN CANCER

Melanoma

1113
Melanoma
• Has an early horizontal growth phase with low metastatic potential followed by
nodular, vertical growth phase with a significantly ↑ risk of metastasis
• Depth of invasion (Breslow Thickness)
✓ Is the most important prognostic indicator in malignant melanoma

1960
• MC Metastatic Tumors to Brain
✓ Lung Cancer
✓ Renal Cancer
✓ Melanoma
• Melanoma
✓ malignancy of melanocytes,
✓ which are embryologically derived from neural crest cells

7707
BRAF
• Is a Protein Kinase
• Involved in activation of signaling pathways for Melanocyte Proliferation
• BRAF V600E Mutation is seen in 40-60% of patients with melanoma

16862
Melanoma
• Lesions often have Multiple Color variations.
• The different colors represent different activities within the tumor.
• Whitish/Gray Areas
✓ Occur when cytotoxic T cells recognize tumor antigens & destroy malignant cells,
✓ leading to melanocyte regression.
• Red Areas arise due to vessel ectasia & local inflammation
• Brown or Black Areas are generally due to advancing malignant melanocytes.

16865
Melanocyte Markers
• Melanoma is often diagnosed when Immuno Staining of biopsy samples reveals multiple
melanocyte markers (S 100, HMB 45, MART 1)

17
 BREAST

Accessory Nipple

8904
Accessory Nipples
• MC congenital breast anomaly
• Result from failed regression of Mammary Ridge in utero
• They are usually asymptomatic but can become Tender along with breast tissue during
times of Hormonal Fluctuation

COLLAGEN

Ehlers Danlos Syndrome

1244
• EDS is a heritable connective tissue disease a/w Abnormal Collagen Formation
• Clinical Features
✓ Over Flexible (Hyper Mobile) Joints
✓ Over Elastic (Hyper Elastic) Skin
✓ Fragile Tissue Susceptible to
➢ Bruising
➢ Wounding
➢ Hem Arthrosis

1245
EDS
• Group of rare hereditary disorders characterized by defective collagen synthesis
• It can be caused by Pro Collagen Peptidase Deficiency, which results in impaired cleavage
of Terminal Pro Peptides in extra cellular space
• Patients
✓ Joint Laxity
✓ Hyper Extensible Skin
✓ Tissue Fragility
due to formation of Soluble Collagen that does not properly cross link

18
Vitamin C Deficiency

1061
• Ascorbic acid (Vit C)
✓ Is a cofactor in hydroxylation of proline & lysine residues
✓ Is important in synthesis of collagen
• Deficiency (Scurvy)
✓ Micro Vascular Bleeding
✓ Gingivitis
✓ Impaired Wound Healing

1247
• The hydroxylation of Proline & Lysine residues in collagen helps in attain its maximum tensile
strength
• This process occurs in RER (Rough Endoplasmic Reticulum) & requires vitamin C as a cofactor.
• Impaired collagen synthesis resulting from Vit C Deficiency (Scurvy) can lead to Fragile Vessels,
predisposing to
✓ Gingival Bleeding
✓ Ecchymosis
✓ Petechia

Keloid

874
• Keloid result from Excessive Collagen formation during Remodeling Phase of wound
healing
• Present
✓ Raised, Painful, Pruritic nodules
✓ that grow beyond the wound borders

11738
Transforming Growth Factor β (TGF β)
• Is critical for
✓ Fibroblast migration, proliferation
✓ Connective tissue synthesis
• ↑ TGF β activity is responsible for
✓ Hypertrophic/keloid scarring
✓ Fibrosis of lung, liver, kidney that occur with chronic inflammation

19
 BACTERIA

Staphylococcal Scalded Skin Syndrome

680
Staphylococcal Scalded Skin Syndrome
• Occurs in infants & children due to production of Exotoxin Exfoliatin by Staph species
• It causes widespread epidermal sloughing, especially with gentle pressure (Nikolsky’s Sign)

Skin & Soft Tissue Infections

974
“Hot Tub Folliculitis”
• Is a superficial & self limited Pseudomonas aeruginosa infection of Hair Follicles
• Tends to occur in Minor Outbreaks following exposure to a Pool or Spa in which the
chemicals have not been maintained at appropriate concentrations.
• Pseudomonas
✓ Gram Negative, Oxidase Positive, Non Lactose Fermenting, Motile Rods
✓ Produce Green Pigment

8334
Granulomatous Inflammation
• Form of chronic inflammation
• Aggregates of activated macrophages that assume an Epitheloid Appearance
• Persistent granulomatous inflammation with subsequent fibrosis can cause Organ
Dysfunction, which is seen in a number of granulomatous diseases

8858
Pseudomonas Aeruginosa
• Major pathogen in burn patients
• Only a few specific Penicillins (ticarcillin, piperacillin) & Cephalosporins (ceftazidime,
cefepime) have activity against it.
• Certain Aminoglycosides, Fluoroquinolones (cipro, levo floxacin) & Carbapenems
(imipenem, meropenem) are also effective.

15339
Cellulitis
• MCC of Non Purulent Cellulitis is beta hemolytic streptococci, particularly group A
streptococcus (GAS).
• MCC of Purulent Cellulitis is Staph Aureus

15361
• Bullous Impetigo (BI) is a superficial infection by Staph Aureus, that is MC in young children
• Characterized by a blistering skin rash with tan to honey colored crusts
• Blistering in BI is caused by exfoliative toxin A, which targets desmoglein 1 in epidermal
cellular junctions & causes a loss of cell adhesion
20
Leprosy

1313
M Leprae
• The Severity of Leprosy, a systemic illness caused by M Leprae, depends on the strength of
cell mediated immune (CMI) response
• Tuberculoid leprosy representing the Milder form (intact Th1 CMI response)
• Lepromatous leprosy, the more Severe form (weak CMI response)

1314
Lepromin Skin Test
• Positive in patients with tuberculoid leprosy as they exhibit a Strong CD4+ TH1 cell
mediated immune response to M Leprae
• Patients with lepromatous leprosy will test Negative due to their Weak TH1 cell mediated
immune response

21
 VIRUS

Rubella

1669
• In a susceptible child, a Febrile Maculo-Papular Rash that begins on face & spreads to trunk
& extremities is suggestive of Rubeola (Measles) or Rubella (German Measles).
• The additional finding of Post-Auricular Lymphadenopathy indicates that rubella is the
most likely etiology.

Herpes Zoster

1042
Pemphigus Vulgaris (PV)
• Acantholysis forming Supra Basal Blisters is characterized of PV.
• Immuno Fluorescence:
Deposition of IgG containing deposits in a reticular pattern around keratino cytes
• Immune target in PV is Desmosome Protein Desmoglein 3

1641
• …… are all Nucleoside Analogues that require both Herpes Viral & Cellular Kinases for
conversion to their active nucleoside triphosphate form
✓ Acyclovir
✓ Acyclovir pro drug Vala cyclovir
✓ Fam ciclovir
✓ Gan ciclovir
• Cido Fovir
✓ Nucleoside mono phosphate (a nucleotide)
✓ Requires only cellular kinases for activation

1553
• Unilateral Vesicular Rash localized on a Single Dermatome in an older patient is most likely
herpes zoster.
• Post-Herpetic Neuralgia is the MC neurologic complication of VZV infection.

Hand Foot Mouth Disease

15550
• Hand foot mouth disease is a common childhood illness
• Characterized by
✓ Painful, Vesicular Mouth Lesions
✓ Ulcers on Extremities
✓ Low Grade Fever
• It is caused by ingestion & subsequent dissemination of an Entero Virus (Coxsackie Virus)

22
 FUNGI

Tinea Versicolor

104
Pityriasis Versicolor (Tinea Versicolor)
• Superficial skin infection caused by Malassezia Species
• It causes erythematous, hyper or hypo pigmented macules & patches.
• Malassezia
✓ Forms spores & hyphae, producing the characteristic “Spaghetti & Meatballs”
appearance on KOH preparation light microscopy.

836
Terbinafine
• Used for treatment of Dermato Phytosis
• It inhibits synthesis of fungal membrane Ergosterol by suppressing the enzyme squalene
epoxidase

15579
Tinea Corporis
• Round or ovoid lesions with a raised, scaly border & central clearing.
• Trichophyton Rubrum
✓ MCC
✓ Infects keratinized matter in the stratum corneum of superficial epidermis
✓ but does not invade the dermis & subcutaneous tissues.

Sporo Trichosis

270
Sporothrix Schenckii
• Dimorphic fungus that causes a Subcutaneous Mycosis.
• It is often transmitted by a Thorn Prick.
• The disease manifests with nodules that spread along lymphatics.

23
 PROTOZOA

Leishmaniasis

15448
Leishmania Species
• Obligate intracellular protozoa
• Mature in macrophages
• Biopsy: Rod Shaped Kinetoplasts
• They are transmitted to humans by infected sand flies
• Cause the clinical syndrome of Cutaneous Leishmaniasis, characterized by a chronic, pinkish
papule that evolves into a nodule or plaque.
•

HELMINTHS

Cutaneous Larva Migrans

15431
Hookworm Infections
• Transmitted via direct contact between human skin & contaminated soil/sand (walking
barefoot).
• Dermal Penetration is often characterized by an Intensely Pruritic Papule that may form
serpiginous tracks due to subcutaneous migration of hookworm larvae.

24
 ECTO PARASITES

Scabies

10168
Scabies
• Highly contagious disease
• Presents with an intensely pruritic rash (usually worse at night) in the flexor surfaces of
✓ Wrist
✓ Lateral Surfaces of Fingers
✓ Finger Webs
• Patients usually have Excoriations with small, crusted, red papules scattered around the
affected areas.
• Diagnosis: Skin scrapings from excoriated lesions how Mites, Ova, Feces (Light microscopy)

13911
Scabies
• Human mite infection
• A/w a pruritic popular rash with excoriations & burrows.
• Patients with Impaired CMI (HIV) often develop a very high mite burden.
• Treatment
✓ Topical Permethrin and/or
✓ Ivermectin

Lice Infestation

17230
Pediculus Humanus Capitis (Head Lice) Infestation
• Common in school children & adults who come into close contact with infested individuals.
• Transmission is usually by direct contact.
• Eggs (Nits) are attached to hair shaft & can be identified on inspection.
• Head lice do not carry infection, but the bite can induce a pruritic allergic reaction.
• 1st line treatment: Topical Pediculi-cides (permethrin, ivermectin)

25
 HAIR

Hair Loss

1725
Androgenic Alopecia
• MCC of hair loss in both males & females
• Pattern & severity of baldness depend on both Hormonal (circulating androgens) & Genetic
factors & vary between Males & Females.
• The condition is Polygenic with variable expressivity

1726
Androgenic Alopecia
• Causes hair loss primarily at Anterior Scalp & Vertex
• It shows polygenic inheritance, with Di Hydro Testosterone (DHT) being the primary
pathogenic factor
• 5 α Reductase Inhibitors
✓ ↓ the conversion of testosterone to DHT
✓ Are affective for treating this condition

26
 GENERAL

Splice Site Mutation

2038
• Splicing is performed by Spliceosomes, which remove introns containing
✓ GU at 5’ splice site
✓ AG at 3’ splice site
• Splice site mutations may result in inappropriate Removal of Exons & Retention of Introns, leading
to formation of Dysfunctional Proteins

Xeroderma pigmentosum (XP)

883
XP
• Develops due to a Defect In Nucleotide Excision Repair
• This disease is characterized by
✓ ↑ Sensitivity to ultra violet radiation
✓ High incidence of cutaneous malignancy

1476
XP
• AR disorder
• Characterized by defective nucleotide excision repair often caused by a Deficiency In UV
Specific Endo Nuclease
• Affected children
✓ Severe photo sensitivity
✓ Hyper pigmentation in sun exposed areas
✓ ↑ risk for skin cancer

Diabetic Foot

15675
Neuropathic Foot Ulcers
• Occur in diabetic patients
• Occurs when loss of pain sensation & proprioception delays recognition of injury due to
✓ Trauma
✓ Friction
✓ Sustained Pressure (on plantar surface of foot bones)
• Risk is greatest in patients with Long Standing Diabetes who have poor glycemic control

27
Dyslipidemia

1108
Xanthomas
• Are suggestive of Hyper Lipidemia
• Especially when present in conjunction with a family history of early cardiac death

Tetra Cyclines

18565
Tetracyclines
• Interact with polyvalent cations (iron, calcium, aluminium, magnesium) to form Non
Absorbable Chelate Complexes in GI tract
• This can lead to ↓ drug absorption & therapeutic effect
• Fluoro Quinolones & Thyroxine are also susceptible to chelation

Primary Biliary Cholangitis

1867
Xanthelasma
• A yellowish eyelid papule or plaque containing Lipid Laden Macrophages is most likely
xanthelasma
• Xanthelasma may occur in a/w Primary or Secondary Hyper Lipidemia
• Cholestatic Conditions such as primary biliary cirrhosis are a potential cause of hyper
cholestrolemia leading to xanthelasma

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