Dermatology

Hot topics
Dr Saurabh Jindal
MD
 Sure shot topics
• Pigment disorder
• Hansens disease
• Blistering disease
Piebaldism

White fore- lock

N. Achromicus
 Diascopy- no increase
No areas of normal skin
inside patch, onset since
birth
Nevus anemicus
Hypopigmented lesions
P versicolor
P versicolor
BT hansens
 BL hansens PKDL

Almost symmetrical hypopig. Similar symmetrical hypopig.

patches – hypoaesthesia, patches – but with H/o past
hypohidrosis, nerve fever (s/o past kalaazar) ,
thickening, no scales normal sensations, Normal
nerves, no scales
Indeterminate hansens P. alba

Normal sensations, Child, Normal sensations, Child,

normal sweating, atrophy+, normal sweating, No atrophy,
from endemic areas Fine scaling, h/o atopy+
P. versicolor
Depigmented
• Vitiligo
• Contact leucoderma
Vitiligo
Vitiligo- Segmental
 Contact leucoderma

Patterned patch- due to Patterned patch- due to

rubber slippers kumkum
How to differentiate
colored lesions on face ?
Rosacea
Rosacea
Acne
Acneform eruptions
Acneform eruptions
Melasma
SLE- Malar rash
Nevus of Ota
PWS
Infantile hemangioma
2. Hansen
 TT

Dry, anesthetic, Hypopigmentation,

anhidrotic,hypopigmented, well defined borders
single patch
BT- satellite lesions
BT- 3-10 lesions
 BB

Annular, erythematous Annular lesions- 2

plaque, punched out in centre borders
 Annular itchy lesions on trunk-
Annular itchy lesion- Multiple lesions in a fir-tree
Tinea pattern- Pityriasis rosea
BL- Uncountable
lesions
LL
LL

Clof Pig
Type 1 lepra Type 2 lepra

Inflammation of existing lesions Inflammation of new nodules on extremities

and face

No fever Fever

Neuritis may coexist Arthritis, Orchitis, Hepatitis, Uveitis,

glomerulonephritis, lymphadenopathy may
coexist

After MDT Usually after MDT, sometimes even before

MDT
 Type 1 Lepra Type 2 lepra

Tender, edematous,
erythematous plaque on
leprosy lesion itself Tender, erythematous,
(no new lesion) nodule- New lesion
 EN Erythema induratum

Tender, edematous, Tender, erythematous,

erythematous nodule nodule- calf- sometimes
on shin- no ulceration ulcerates
3. Blistering disorders
 Situation A
Flaccid blisters
+ raw skin
+ mucosal lesions
Raw areas on mucosa and skin- NO Targetoid lesions, NO
black necrotic skin- PEMPHIGUS VULGARIS
TEN PV
• Bleeding crusts on • Raw lesions on lip,
lip, eyelids eyes, mouth, but no
• Targetoid lesions on bleeding crusts
skin • No Targetoid lesions
• Black necrotic skin • No black necrotic
• h/o drug intake skin
• Nikolskiy + • Nikolskiy +
bleeding lip crust- TEN Bleeding crusts on lip and
(Note the black facial skin) eyelid crust- TEN
Targetoid lesions
(2 zones)- TEN
Black necrotic skin (Red arrow) with Nikolskiy + (Yellow
arrow) in TEN
 Situation B
Flaccid blisters/Scaly lesions
+ No raw skin
+ No mucosal lesions
 SSSS PF

Scales-crust, Seborrheic Scales-crust, Seborrheic area,

area, Mucosa is normal- Mucosa is normal- but adult, no
but child, fever, DIF -ve fever, DIF +ve
 Situation C

Tense blisters
+ No mucosal lesions
 BP

Tense itchy blisters- limb, elderly pt

PV

Row of tombstones
 PF

SC

blister

SB
 Histology of BP

Normal
basal cell

Eosinophils
Subepidermal
blister
 DH- Histology

Papillary
tip
blister

Papillary
tip
Neutrophils
Dilapidated brick wall-
Hailey-Hailey disease
Fear will be your biggest enemy

- Fear of failing
- Fear of ‘What if I don’t make it’
- Fear of losing respect
- Fear of losing your dreams