Layers of Skin:

1. Corny Lads get Schmexy Babes

Stratum Corneum

Stratum Lucidum

Stratum Granulosum

Stratum Spinosum

Stratum Basalis

2. Munro’s Microabscesses in Stratum corneum (Psoriasis)

3. Microabscess of Kogoj in Stratum gran/spin (Psoriasis)
4. Darier’s Microabscesses are true name, Pautrier’s microabscesses are a misnomer.
Mycoses Fungoides. French bois going and presenting abroad in the good ol US of
A.
5. Wood’s Lamp (360-364nm):
BGM: Blue Green Microsporum (T. Capitis)
DBtS: Dull Ble Trichophytom sp. (T Capitis)
PYM: Pytriasis versicolor, Yellow, Malassezia (Globosa>Furfur)
ECR: Erythrasma, Coral Red, Anaerobes (Corynebacteriuem minitissimum)
(Copoporphyrin-3 causes the red color, is water soluble, so may be absent in case
patient washed before examination.) While on the subject, porphyria cutanea tarda
urine is also pinkish red fluorescence.

Vitiligo, sharper borders, bluish white usually.

Ash leaf macules in Tuberous Sclerosis, similar to vitiligo.

Gunther’s disease (Congenital rare type of porphyria) Erythrodontia (Red Teeth)

6. Exclamation mark hair, swarm of bees appearance peribulbar infiltrate -> Alopecia
areata.
7. Morphoea is a type of scleroderma? En coup de sabre lesion. No systemic
symptoms.
HLA B7, HLA DRB1.04
8. Scutula: Yellow crust, T.schoenkii, endemic in Kashmir, Favus (Inflammatory T.
capitis)
9. Kerion: Boggy scalp swelling, easily pluckable hair, lymphadenopathy.(Inflammatory
T. capitis)
10. Folliculitis decalvans: Tufted hair loss and perifollicular lesions.
11. Pseudopeladae of Brocq. Footprints in snow type of hairloss. (Histo shows concentric
perifollicular infiltration.)

12. Miliaria: Blocked eccrine sweat glands. M. crystalline (Whitish spots) -> S. Corneum.
M rubra (In the name innit) -> S. Spinosum. At level of dermo epidermal jn (Patchy
red spots/blotches)-> M. Profunda.
 13. Fox Fordyce Disease: Blocked apocrine sweat glands. Skin coloured papules. Other
apocrine issues are bromhidrosis (Bromine is stinky) and chromhidrosis (Coloured
sweat)

14. Hidradenitis suppurativa : Red tender nodules -> Discharging sinuses -> Bridging
scars. Rx: Isotretinoin, Adalimumab.

15. Ectopic sebaceous glands: Glands of Zeiss, Meibomian gland, Montgomery tubercle,
Tyson’s glands.

16. Acne vulgaris. G1: Comedones. (Adapalene + Retinoids)

G2: Papular (Clindamycin ointment + G1)
G3: Pustular (Azithro, doxy tab + G2)
G4: Nodulocystic (Oral Isotretinoin {Cat X} + G3)

17. Rosacea: Convexities of face. Demodex mite or bacillus. Tretinoin + antibiotics.

Ivermectin, doxycycline.

18. Paronychia: Infection of the nail fold. Acute is Staph. Chronic is Candida.

19. Onychomycosis: Infection of the nail plate. Distal lateral is common, but proximal is
usually indicative of HIV (Immunocompromised)

20. Terbinafine 250mg OD x 6 weeks for fingernails, 12 weeks for toenails.

21. Itraconazole 1 week/month is one pulse. 2 pulses is for fingernails. 3 pulses for
toenails.

22. Mee’s Lines: Arsenic poisoning (White lines on nails)

23. Green Nail syndrome : They suggest Pseudomonas infection.
24. Muehrcke’s bands: Alternating white bands, seen in hypoalbuminemia.
25. Lindsay’s nails: Half brownish, half whitish pink nails. Seen in CRF.
26. Terry’s nails: 90% pale nails, 10% brown tip. Seen in CLD.
27. Pemphigus: Common ones are desmoglein

1. P. foliaceous Paraneoplastic P(lakins). 3. P. vulgaris IgA P. Drug induced P.

P. erythematosus (Variant) P. vegetans(Rarest variant)

28. Pemphigus vulgaris. Nikolsky, bulla spreads, involves mucosa. IgG mediated Type 2,
Histo shows suprabasal split, intact basal layer, row of tombstones appearance. Fishnet
appearance on IF. C3, IgG. Rx: Systemic steroids, Cyclophosphamide (Causes
haemorrhagic cystitis, handled using Mesna.) Rituximab also given (Blocks CD20 on B cells)

29. Pemphigus foliaceous. Limited to subcornual split because there’s more concentration of
desmoglein 1 at stratum corneum, therefore does not involve mucosa. Lesions usually in
seborrheic areas i.e. chest, scalp, and face.
30. Drug induced pemphigus – Penicillamine, Captopril, Rifampicin

31. Paraneoplastic pemphigus: NHL commonest, also seen with CLL, Castleman Disease,
Thymoma

32: Pemphigoid group of diseases.

Bullous pemphigoid: 60+ year olds BPAG 1, BPAG 2, tense pruritic bullae, erodes on
itching. Nikolsky sign absent, Tzanck smear shows eosinophils, no acantholysis. IF shows
linear IgA pattern. Rx: Low dose steroids, Azathioprine.

Pemphigoid gestationis:AKA Herpes gestationis. Bullous pemphigoid in pregnancy.

33. Dermatitis herpetiformis:

IgA, Transglutaminase 3, HLA DQ2, DQ8, B8. Associated with gluten sensitive enteropathy.

Extensor/buttocks. Papulovesicular, pruritis, develops into excoriated cluster.

Histo: Neutrophilic microabscesses on tip of dermal papillae.

IF: Granular appearance, IgA deposition.

Rx: Gluten free diet, Dapsone.

34. Epidermolysis Bullosa: Mechanobullous disorders. Seen in genetic cases usually,

especially if consanguinity present. Mther notices blisters on handling the baby. Ks-4.
Laminin etc. implicated.

33. Autosomal dominant pemphigoid congenital diseases.

Hailey Hailey, Chr 3, ATP2C1 Benign familial pemphigus. Plaque on flexures -> macerated
plaque. Histo broken down brick house appearance, suprabasal split. Rx: Oral steroids, Ab
for secondary infections.

Darier: Chr12 ATP2A1 Keratosis follicularis. Dirty warty lesions in seborrheic areas.
Cobblsteone appearance of palate. Histo shows dyskeratotic cells. Corps ronds, Corps
grans. Rx: Oral retinoids.

34. Psoriasis: HLAB27 is psoriatic arthritis, HLACW6 is early onset psoriasis.

GAS infection-> Guttate psoriasis.

Goeckerman regimen: Phototherapy + Coaltar

Ingram’s regimen: Goeckerman + Anthraline