Dermatology Chapter-25 Recent & High Yield Updated Points Most common STD world wide Hsv-2 - Bacterial STO. Chiamydia> gonorrhea protozoal STD Trichomoniasis STO in india candidiasis ‘cause of genital ulcer in India HSV-2 Leopard syndrome ‘Autosomal dominant Carney complex LAMB or Name syndrome Taugier hunziker syndrome Bannayan riley Ruvaleaba syndrome PathoGenesis of Disease Bullous pemphigoid ‘eatricial pemphigoid & linear IgA disease Epidermolysis bullosa junctional Epidermolysis bullosa dystrophica PLPNII Gene mutation ‘CAFE AU LAT ECG changes Hypertelorism Pulmonary stenosis PRKARIA gene mutation Psammomatous melanotic schwannomas ‘mucocutaneous lentigines longitudinal melanonychia Genital melanosis, PTEN gene mutation Penile>vulvar lentigines Upormas Hemangiomas blistering disorders Pathology ‘Antibodies against BPAg2 >BPAgi Antibodies against BP-2 ‘Absence of laminin since birth ‘Absence of collagen Vil since birth Epidermolysis bullosa acquisita ‘Antibodies against collagen Vil Endogenous eczema Exogenous Eczema ‘Atopic dermatitis ‘© Irritant contact dermatitis, Sebortheic dermatitis, + Allergic contact dermatitis Nummular eczema © Photodermatitis Pompholyx (dyshidrotic ecrema) Asteatotic eczema Stasis dermati Juvenile plantar dermatitis, Lichen simplex chronicus Brocq phenomenon ‘Seen in Lichen planus Plare polygonal pruritic Infectious eczematoid dermatitis ‘Auspitz sign’ ‘+ seen in psoriasis + erythematous plaque with silvery Plaque showing subepidermal Hemorrhage + white scaling with pinpoint bleeding SpotTABLE 4 TZANCK SMEAR FINDINGS IN DIFFERENT DISORDERS Disorder ‘Site of acantholysis ‘Taanck smear findings “Pemphigus vulgaris Suprabasal Large number of Tzanck cells Pomohique vegstens Suprabasal ‘Tzanck cells with abundant eosinophils. Pemphigus foliaceus ‘Subcomeal ‘Acantholytic cells, Halley Halley disease Entire epidermis “Abundant acantholytic cells rr) Se aaaie Upoer eps means a Bullous impetigo Subcorneal Dpperatoti Aeantoly ceils with newtrophis a Base of vesi a Herpes infections eee Balloon cells wth multinucleated giant cells ‘Toxic Epidermal Necrotysis. WNecrotic cells & TABLE 2: DIFFERENCES BETWEEN PEMPHIGUS VULGARIS AND BULLOUS PEMPHIGOID saan ea a RSS 2 “Age of onset 30-60 years 60-80 years Ss Antibody Directed against desmoglein 1 | Directed against BPAg 180, BPAg230 a and 3 3 Mucosal involvement 100% 10-30% of cases g ‘Area involved Face, scalp, trunk and extremities | Flexural aspects of extremities, trunk and & ee 3 Pruritus: ‘Usually absent ‘Mild to severe intractable pruritus is seen in. 2 L most of the cases z= Nikolsky sign and bulla spread . op S Sige, > Lesions Flaceid bullae which rupture on | Tense bullae seen on apparently normal or ne ee ee | ere eS ‘normal appearing skin. = Histopathology ‘Suprabasal acantholysis with | Subepidermal bullae with eosinophilic oS acantholytc cells in the blister | spongiosis with eosinophils in the blister cavity. yy cavity and the attachment of the <¢ basal cells to the basement membrane is typically described as “row of tombstone 4 appearance. OF Intercellular igG deposition with | Linear IgG and C3 deposition is seen along the classical fish net pattern basement membrane. - je Better compared to pemphigus TABLE 3: TARGET ANTIGENS OF DIFFERENT SUBEPIDERMAL BLISTERING DISORDERS DisorderDermatology Bullous pemphigoid BPAgI and BPAg2 Herpes gestationis BPAg?2 ‘Mucous Membrane pemphigoid Laminin 332, BPAgL BPAg2, Integrin 2684, laminin 6 Linear IgA bullous dermatosis. won Epidermolysis Bullosa Acquisita Collagen Vil Bullous Lupus Erythematosus Collagen Vil TABLE 4 DIFFERENT AUTOANTIBODIES IN AUTOIMMUNE CONNECTIVE TISSUE DISORDERS Antibodies Disorder Anti-ds DNA Systemic Lupus Erythematosus ‘Anti Sm systemic Lupus Erythematosus ‘Anti Ro and Anti La Drug induced LE, SCLE, Neonatal LE Anti-centromere antibody (CREST syndrome ULRNP. Mixed connective tissue disorder Anti-topoisomerase 1/anti scl 70 Systemic sclerosis, TABLES: NEW EULAR CRITERIA FOR SLE ‘+ All patients classified as having systemic lupus erythematosus must have a serum titer of antinuclear antibody of atleast 1:80 on human epithelial -2 postive cells or an equivalent positive test. * In addition a patient must tally at least 10 points from these criteria. ‘+ Acriteria is not counted ifit has a more likely explanation than SLE * Occurrence of the criterion only once is sufficient to tally the relevant points, and the time when a patient is positive for one criterion need not overlap with the time when the patient is positive for more than one criteria. ‘© SLE classification requires points from at least one clinical domain, and if a patient is positive for more than one criterion in a domain only the criterion with the highest point value counts. Clinical domains Points Constitutional domain Fever 2 Cutaneous domain Nonscarring alopecia ‘Oral ulcers Subacute-cutaneous or discoid lupus Acute Cutaneous lupus ‘Arthritis domain ‘Synovitis in at least two joints or tenderness in at least two joints and at least | 6 30 mins of morning stiffnessNeurologic domain Delirium Psychosis Seizure Serositis domain Pleural or pericardial effusion Acute pericarditis Hematologic domain Leukopenia Thrombocytopenia ‘Autoimmune hemolysis Renal domain Proteinuria >0.58/24hr Class I or V lupus nephritis Class lll or lV lupus nephritis, Immunologic domains ‘Antiphospholipid antibody domain Anticardiolipin IgG >40 GPL or anti-B2GPI IgG>40 units or lupus anticoagulant Complement proteins domain Low C3 or low C4 Low C3 and low C4 Highly specific antibodies domain Anti-dsDNA antibody Anti-Smith antibody TABLE 6: TYPES OF SCALES IN DERMATOLOGY: TYPE OF SCALE Silvery or mica coloured scales Greasy scales Collarette of scales DISEASE Psoriasis ‘Seborrhoeic dermatitis, Pityriasis Rosea Jethyosis Bullosa of Siemens(Mauserung Phenomenon) Chapter - 25 Recent & High Yield Updated Points Pityriasis versicolor Bran like scales ie od ton syndrome Double edged scale wether a nto ae Ichthyosis vulgaris Carapace like scaleDermatology Reversal reaction in BL patients: upgrading to more resistant state (7 destruction of bacill) or downgrading to less resistant state become acutely inflamed, rare new lesions; neuritis with rapid-onset pain, swelling, tenderness, and loss of function of affected nerves + Downgrading lesions acutely inflamed, new lesions; neuritis Warthin-Starry Spirochetes Black. Steiner Spirochetes Black. Giemsa Teishmania, Histoplasma, | Purple to blue Rickettsia DNA/RNA Methyl green-pyronin RNA Pink-red DNA DNA Feulgen DNA only Magenta Fang! {GMS (Gomori methenamine sver) | Donovan bodies, fungi Black AS (Periodic acid Schiff Fung, neutral MPS, | Red elycogen Grocott an Fungus cell wal: Black TABLES: LEPRA REACTIONS. Reaction Pathogenesis Clinical Findings ‘Treatment ‘Type 1 Reaction ‘Change in cell-mediated immunity | * Upgrading: lesions | Systemic corticosteroid (40. mg to 80 mg) and taper over several weeks Type 2 Reaction Erythema nodosum leprosum (ENL) Upgrading reaction in BL and UL patients during treatment: antibody levels leads to immune complex deposition in vessels > ‘small vessel vasculitis Presents with deep, painful erythematous nodules on face or trunk Fever, malaise, neuritis, iridocycltis, arthralgias Thalidomide Clofazimine and systemic corticosteroid may also be added Type 3 Reaction | Extensive, severe vasculitis in | Presents with pink, painful | Systemic corticosteroid Lucio reaction untreated LL patients hemorrhagic or necrotic nodules, + ulceration, bulla formation, eschars, TABLE 10; WARTS, HPV Type Type of Wart 1,2,27,57 ‘Common, palmoplantar 3,10 Flat 7 Butcher's 611 Condyloma acuminata, Buschke- Lowenstein, conjunctival papillomas, recurrent respiratory papillomatosis 16, 18, 31, 33-35, High-risk anogenital/cervical; bowenoid papulosis 13,32 Heck’s disease10. 11 2. 3B. 4, 15. 16. v7. 8 19, | _tpidermodyspiasia verructormis Epidermodys Pidermodysplasia verruciformis— squamous cell carcinoma Lee ‘arao Perkin bodies Multiple elastic clumy ic clumps found inthe stellae a Alder-Reilly bodies: 7 nthe stellae seen in Androgenetic alopecia. hese are Sere ee basophilic granules seen within neutrophils and sometimes within lymphocytes or a ; in incompletely degraded mucopolysaccharides. They are seen in mucopolysaccharide storage disorder like Hurler syndrome. ‘oid bodies: These are star shay F res id ree Se ese © star shaped eosinophilic structures with centre that is brown red and radiating blue spikes wit “ytes oF multinucleated giant cells. They are seen in Sarcoidosis, Sporotrichosis and Actinic granuloma. Banana bodies: Crescentic banana shaped pigmented bodies in the upper dermis. Itis seen in Ochronosis. Comma shaped bodies: Cytoplasmic bodies on Electron microscopy seen in Benign Cephalic Histiocytoss. Civatte's /Colloid bodies: Apoptotic keratinocytes that may be found in epidermis or extruded in papillary dermis. it is seen in Interface dermatitis. Chapter - 25 Cigar bodies: At 37 °C, Sporothrix schenckii may be present inthe tissue as a yeast like form or as an elongated cigar bodies. They are seen in Sporotrichosis, ‘Cowdry A bodies : They are also known as Lipschitz inclusions. These are intranuclear inclusions surrounded by 2 «= clear halo. They ate seen in Herpes simplex and Varicella Zoster infection. Cholesterol clefts: Needle like crystals seen in fat cells, seen in Sclerema neonatorum. Dohle bodies: These are small, basophilic, round or oval shaped bodies found in the periphery of Polymorphonuclear leukocytes Donovan bodies: Intra Histiocytic inclusions comprising the bacili that stain positively with Warthir Giemsa stain seen in Granuloma inguinal. Dutcher bodies: These are eosinophilic intranuclear pseudo Inclusions within plasma cell, formed due to cytoplasmic invagination into the nucleus. They are smooth, membrane bound and surrounded by clumped chromatin. They are seen in Lymphoplasmacytic Lymphoma, Multiple Myeloma and Waldenstrom 2 Macroglobulinemia, Flame figures: Dermal eosinophils and eosinophilic granules surrounding central masses of brightly pink amorphous ints Starry stain or id Updated Poi collagen seen in Well's syndrome, arthropod bites. Farber bodies: Curvilinear bodies seen in the cytoplasm of fibroblasts and endothelial cells on Electron Microscopy seen in Farber's disease. Glomus bodies: These are specialized arterio-venous shunts that connect an arteriole with a venule without intervening capillaries. They are found abundantly inthe pads and nail beds of fingers and toes. They help in @ temperature regulation. 3 Guarnieri bodies: They are also known as Paschen bodies. They are intracytoplasmic eosinophilic aggregation of virus O& particles. They are seen in Variola, Vaccinia and Cow pox. Heinz bodies: These are basophilic inclusions found within RBC’s composed of denatured hemoglobin. They appear attached to the membrane. They are seen in GSPO deficiency nt & High Yie a5 single or multiple inclusions and often appear anaemia Henderson-Patterson bodies: These are ovoid, eosinophilic structures in the lower cells of the stratum malpighi. In the upper layers ofthe epidermis, they compresses the nucleus ofthe ello thatt appears asa thin crescent atthe periphery ofthe cell Is seen in Molluscum Contagiosum. Kamine bodies , These are eosinophilic globules seen in basal layer above the tips of dermal papila, they are seen in Spitz nevi and pigmented spindle cell nevus.5,8 as Epidermodysplasia verruciformis ae 5,8 Epidermodysplasia verruciformis— squamous cell carcinoma coe 4. Arao-Perkin bodies : Multiple elastic clum, ic clumps found in the stellae seen in Androgenetic alopecia, 2, Alder-Reilly bodies: These are basophilic ieee 10. 1. 2, 33, ua 15. FU 18, Granules seen within neutrophils and sometimes within lymphocytes or monoeyis {ney contain incompletely degraded mucopalysaccarides, Tey are seen in mucopolysaccharide storage disorder lke Hurler syndrome ‘Asteroid bodies: These are star shaped eosino spikes within histiocytes or multinucleated ‘granuloma, philic structures with centre that is brown red and radiating blue Biant cells. They are seen in Sarcoidosis, Sporotrichosis and Actinic Banana bodies: Crescentic banana shaped pigmented bodies in the upper dermis. Its seen in Ochronosis. Comma shaped bodies: Cytoplasmic bodies on Electron microscopy seen in Benign Cephalic Hstioeytosis. Gwatte's /Colloid bodies: Apoptotic Keratinocytes that may be found in epidermis or extruded in papillary dermis. it is seen in interface dermatitis Chapter - 25 Cigar bodies: At 37 °C, Sporothrix schenckii may be present inthe tssue as a yeast like form or as an elongated cigar bodies. They are seen in Sporotrichosis Cowdry A bodies hey are also known as Lipschitz inclusions. These are intranuclear inclusions surrounded by @ lear halo. They ate seen in Herpes simplex and Varicella Zoster infection. Cholesterol clefts: Needle like crystals seen in fat cells, seen in Sclerema neonatorum, Dohle bodies: These are small, basophilic, round or oval shaped bodies found in the periphery of Polymorphonuclear leukocytes. Donovan bodies: Intra Histiocytic inclusions comprising the bacili that stain positively with Warthin-Stary stain or Giemsa stain seen in Granuloma inguinale. Dutcher bodies: These are eosinophilic intranuclear pseudo inclusions within plasma cells, formed due to cytoplasmic invagination into the nucleus. They are smooth, membrane bound and surrounded by clumped chromatin. They are seen in Lymphoplasmacytic Lymphoma, Multiple Myeloma and Waldenstrom Macroglobulinemia. Flame figures: Dermal eosinophils and eosinophilic granules surrounding central masses of brightly pink amorphous collagen seen in Well’ syndrome, arthropod bites. Farber bodies: Curvilinear bodies seen in the cytoplasm of fibroblasts and endothelial cells on Electron Microscopy seen in Farbers disease. Glomus bodies: These are specialized arterio-venous shunts that connect an arteriole with a venule without intervening capillaries. They are found abundantly in the pads and nail beds of fingers and toes. They help in temperature regulation. ‘Guarnieri bodies: They are also known as Paschen bodies. They are intracytoplasmic eosinophilic aggregation of virus particles. They are seen in Variola, Vaccinia and Cow pox. Heinz bodies: These are basophilic inclusions found within RBC’s composed of denatured hemoglobin. They appear as single or multiple inclusions and often appear attached to the membrane. They are seen in G6PD deficiency anaemia. Henderson-Patterson bodies: These are ovoid, eosinophilic structures in the lower cells ofthe stratum malpighil In the upper layers of the epidermis, they compresses the nucleus ofthe cell so that it appears as a thin crescent at the periphery of the cell. tis seen in Molluscum Contagiosum. Kamino bodies : These are eosinophilic globules seen in basal layer above the tips of dermal papilla. They are seen in Spitz nevi and pigmented spindle cell nevus. Recent & High Yield Updated Points20. a, 2, 2. 24, 25, 26. 21. 28, 29. Lamellar bodies: They are also known as Odland bodies or Cementosomes. They are round or oval granules that possess a highly ordered lamellar structure contains phospholipids, glycoproteins and acid phosphatases. They are located in the cytoplasm of upper spinous and granular layer and play an important role in barrier function and intercellular cohesion in stratum corneum, LE bodies: These bodies appears as homogenous , pale blue to deep purple material pushing the nucleus to the periphery . seen in SLE Leishman Donovan bodies : The cytoplasm of histiocytes is filled with numerous dull blue-grey , round to oval bodies that exhibit @ round basophilic nucleus and a rod shaped paranuclear kinetoplas.Itis seen in Leishmaniasis, Medlar/Sclerotic bodies/copper pennies/muriform cells : Large , thick walled , dark brown ovoid or spherical varyit in size from 6-12u., lying singly , clusters or in chains within histiocytes as well as free within the tissue. It is seen in Chromomycosis. Mallory bodies: They are located intranuclear within epidermal cells or lie within lymph spaces. They are made up of 2 delicate reticulum which stains light blue and the surrounding cytoplasm pink. They are seen in Measles and Scarlet fever. Michaelis- Gutmann bodies: These are ovoid-round basophilic inclusions . They are either homogenous or have a target appearance by showing concentric laminations . They are seen in Malakoplakia. Pertinax bodies: These are acidophilic masses which represent remnants of keratinocyte nuclei and are seen in senile rails. Pustulo- Ovoid bodies of Milian: These are large intracytoplasmic granules surrounded by a clear halo. They are seen in granular cell tumour of tongue. Papillary Mesenchymal bodies: They constitute clusters of fibroblasts adjacent to epithelial buds in the germinative portion of the normal hair papilla. They are observed in Trichoepithelioma ‘Schaumann bodies: They are also known as Conchoidal bodies. These are concentric lamellar structures composed of lipomucoglycoproteins impregnated with calcium and iron , they show central birefringent crystals. They are seen in Sarcoidosis. Weibel-Palade bodies: These are electron dense cytoplasmic organelle and are found in endothelium of blood vessel ‘They contain Von-Willebrand factor , P-selectin and CD63. SIGNS IN DERMATOLOGY: Albright’s sign: Presence of a dimple over the knuckle of the fourth metacarpal which is enhanced by clenching of the fist seen in Albright’s hereditary osteodystrophy. ‘Antenna sign: The strands of keratin projecting from hair follicles seen with tangen pilaris. ‘Asboe-Hansen sign: It is also called as “Bulla spread sign’. It is elicited by applying pressure over the centre of the blister using a finger and the blister enlarges due to shifting of the fluid present in it. Positive in pemphigus and Bullous pemphigoid. ‘Auspitz sign: Itis seen in Psoriasis where pin point bleeding is seen on removal of scales using a glass slide, intially a thin membrane like layer separates called “Burkley’s membrane” followed by bleeding. Ths sign can also be positive in Darier’s disease and actinic keratosis Barnett’ sign: Ridging and tightening ofthe skin of the neck on head extension , seen in Scleroderma. Breakfast, lunch, dinner sign: linear group of papules produced by bites of bed bug. Butterfly sign: This refers to sparing of the mid scapular region in patients having prurigo nodularis with neurodermatitis as they are unable to reach the region for scratching, Buttonhole sign: Neurofibromas can be pushed in with the tip of finger back into the subcutis, the lesion again reappearing after release of pressure. Its also seen in anetoderma and dermatofibroma, incident light seen in Keratosis10. Ft 2. B. 4 15, 16, v7, 18, 19, 20, 2, 2 23. 2 2. 26. 2. Yield Updated Carpet tack sign: Its also called as “Tin tack it shows horny plugs that have occupied the “Cerebriform tongue ” SI8n, when adherent scales of discoid lupus erythematosus are removed Patulous hair follicles, Sign: Iti also called as, on the tongue can give rise to cerebriform apps Cluster of jewels sign: In early stage of chrom colder ones, resembling cluster of jewels “Premalatha’s sign”. In pemphigus vegetans , hyperplastic oral lesions. earance, Ve bullous disease of childhood , new lesions appear at the margin of acute pancreatitis or ruptured ectopic pregnancy. hing or rubbing a lesion, seen in Mastocytosis. ules sparing the natural skin creases seen in Papuloerythroderma of Ofuj 2 classic finding in Varicella where clear fluid filled vesicles are seen over Darier’s sign: Wheals occurring after scrate Deck char sign: Widespread coalescing pa Dewdrop on a rose petal: Described as erythematous background. *Fitapatrick’s sign’. Dough nut sign: Central depression with a rim Joints which is seen in scleromyxedema Dubois's sign: shortening of ite finger seen in congenital syphilis, Enamel paint sign: Hyperpigmented desquamated patches and plaques seen in Kwashiorkor. Exclamation mark hair: Tapering ofthe proximal hair, the dot representing the remains ofthe bulb whichis seen in alopecia areata Flag sig: Alternating bands of normal pigmentation and hypopigmentation of hairs seen in Kwashiorkor Gorlin’s sign: Ability to touch the tip ofthe nose with the tongue seen in Ehlers-Danlos syndrome Gottron’s sign: Symmetric, scaly, violaceous erythema over knuckles and interphalangeal joints seen in Dermatomyositis, Groove sign: Masses of inflamed inguinal and femoral groups of lymph nodes separated by inguinal ligament producing @ groove seen in lymphogranuloma venereum. Hutchinson's nose sign: Presence of vesicles on tip ofthe nose seen in Herpes Zoster. indicates nasotiiary nerve invowement and possibilty of Ocular herpes. Of elevated skin seen over extended proximal interphalangeal 28. Leser ~Trelat sign: Sudden eruption of numerous, pruritic Seborrhoeic keratoses, considered to be @ marker of 2. 31 32 33 internal malignancy. Nikolsky’s sign: Detachment of epidermis as a sheet on tangential pressure over normal skin near a bullous lesion, preferably over bony prominence.it is seen in Pemphigus, Toxic epidermal necrolysis and staphylococcal scalded skin syndrome. Schamroth’s sign: In clubbing , there is no diamond shaped window when the dorsal surfaces of the corresponding fingers of the hands are opposed. Shawl sign: Confluent, macular , violaceous erythema seen over the upper back, shoulder girdle and upper arm (“shawl area”) in dermatomyositis. Sheklakov’s sign/ False Nikolsky's sign : When peripheral remnant of roof of a ruptured blister is pulled, resulting in extension of the erosion on the surrounding normal appearing skin . It is seen in: Bullous pemphigoid, Herpes ‘estationis, Linear gh Bullous dermatosis, Epidermolysis Bullosa Acquisita and Bullous Systemic Lupus Erythematosus. Wartenberg’s sign: In Ulnar nerve paralysis due to Leprosy , the little finger assumes the constant abduction secondary to paralysis of adductor digit! minimi and is considered the earliest sign of ulnar nerve involvement. Wimberger’s sign: Presence of bilateral, symmetrical and well defined metaphyseal defects on the medial surface of ‘upper tibia of children with congenital syphilis. Chapter - 25 Recent & High Yield Updated PointsDermatology Recent & High Yield Updated LMRP: Dermatomal vesicle distribution seen in herpes zoster. Erythema Multiforme: Antimalarial drugs Alopecia areata associated with pitting of nails. Antifungal developed resistance in last 2 years and not routinely prescribed for tinea cruris and corporis is Terbinafine. Rash and hypo pigmentations over nose after taking NSAIDS for 1 week due to history of joint pain and fever, the ‘most likely diagnosis is chikungunya.(CHICK SIGN) Incubation period for LGV is 7-12 days. ‘Nerve used for biopsy from lower limb is sural nerve. Meissner corpuscles present in Papillary dermis. Patient present with the rashes in groin region, the most important cause is Three anamorphic (asexual or imperfect) ‘genera causes dermatophytoses are Trichophyton, Micrasporum, and Epidermophyton. 10. A 16 yr. old boy comes with oily skin and multiple nodulocystic lesion since 2 years, best management is oral Isotretinoin. 11. Early lesions of pemphigus vulgaris show supra basal epidermal acantholysis, clefting and blister formation. The floor of the blister may be lined with intact keratinocytes, the “tombstone pattern. 12, More than 30% body surface are blisters involvement of skin occurs due to drugs. 13. Becker nevus: ‘© A Becker nevus (nevus in American spelling) is a late-onset epidermal nevus or birthmark occurring mostly in males. Its also known as Becker melanosis, ‘# Itis due to an overgrowth of the epidermis (upper layers of the skin), pigment cells (melanocytes)and hair follicle. 114, Cutis marmorata occurs due to exposure to cold temperatures, 415. A child has a rash; his family history is positive for asthma, The most probable diagnosis is Atopic Dermatitis. 16. Painless lesion seen in Human papilloma virus. 117. Child scratch his hand with pen, red wheal appears and persists for 30 min is dermographism. 1B. Nerve taken for biopsy to diagnose neuritic leprosy is radial cutaneous nerve. 19. Component of cement causing allergic contact dermatitis is chromium. 20. Pruritus over fingers occur in scabies. 21. ‘Highest concentration of desmosomes seen in supra basal portion.