= General Dermatology [issssssasssssssssssssreussssseni anatony 08:55 2. §.Grandosum (56) “rend” Derm eiermaluneton cept gi epee 3. §.Spinosum ($5)- pine” Cutaneous Dermis 7 ftastin Spineus projections (Desmosomes)-> max desmosames isin SS Cider te Rage ea 1 4. Baza ($B) > sol epidermis oh = Veene + 5S Luc (teow 5) = Inpeirse ewrat patie ah «renee ‘Andogy for DED * “clear ore" + ph reco teeth ae Ma wm ein = ofo, t Lobules septa. Hi ea watin —Sibevtneous et ka ponicdas colgen oss -> Love / winked 3 ee Ang elle 4) Hyper heratoss - ThickenedS. corneum 2) typer gronlests Thick S. granaasum —> Lichen EPIDERMIS 153 planus > Wlayers 3) Agraniosis Lost S. granulosu > Psoriasis 1. Top~S. Corneum (5C)-> keratin -> max keratin is ee |) canttosis ~ ‘ick S. spinosum > In eczema, ori lichen plans (conta = spine)5) Acantho - Lysis - cut desmosome - in pemphigus “a ; ay eC Basal cell to falling > 28d 4 Transit Time Acantho- spine (desmesome) Lysis - “ut ALL epidermal Layers are Joined to each other —> No movement b/u layers > Hf visible fll of SC => Scale ( HCG (INICET)] NIKOLSKY SIGN INICET NOV 22 - SCALES (n putting tangent finger pressure 41) Silvery —> Psoriasis vor epidermal ayers 2) Fine/ Bronny/ Powder > pityriosis versicolor 5/0 - epidermal blisters 3) Collarate > Pityriasis Rosea 1) FisheLike > lethyosis anatoor er 5) Yellow, greasy ->seborrhalc dermatitis (Dandruff) \Nofe- thicker the skin is > darker It Looks = SB> Rocket Leia (0g nuda)EPIDERMAL CELLS 5515 (4) Kertincyt (KC) peuy gor { Fitaggrin Tine vewatin Ly desmosomes Function: Hain - strength Hinor- Immurcogical > KC secrete cytckins against microbes (2) Helanocyte m/c ony inthe basal epidermis } dendritic cen Tyrosine Wetanin - Fore wu 4 thnenic wv Light Ceouses. skin Ca] ‘Analogy = Rotan Tata —> Helanocyte celt — HCG - 1 HC ghes melanin to 36 KC = 136 (€pidermal melanin unit) perinuclear: (2) Langerhans eet) > Ag presenting cell (AC) > Dendritic ett > S* Analogy = India -Pok -LOCmicrobes > dendritic ces L ag ao a a te mainte | pepe £ 1 wk hie Th Ta 4 L Ocets Oun ee viru baclerva scamneun {ple HEL = wie Auto immunity Tells ' Alay Uc picks Demsane StN-Fenphiats sare Nat Brelle(Ab) present at et (4) Hertel cells - Touch receptors in bso ayer 5 Andlagy — Normal keratiniaation => Good's tain = Psoriasis = Bullet train Borrier function > Lost in burns‘6 ANALOGY microbes No Entity Fee me nereae| Kann oN. 1 nsans Denmal Fluidd — desmosomes (b/u hertincyfes) = suture -poka Desmosomes pls out the KC Intercellular junction worna QO BOP en povygona <2, ae ene tn oe 9) TH Qe “Sr TR op ee tl ‘\ ‘ ! = Hemidesrmasomes (bu the basal call) shanen Pa oon © — Sem Vesicle. Pee — 205em —> Bulla es Oa eee:Penpmiaus 01:45:08 > Lamellar body aka oland body inside (KC) make shislipid hiv ples sae te « | * Sa \ eczema 015135 gy. | Dermat Serer {seta ee (pps) : oe aw Teeastne apeanance Bh é nO, Fl Sebati a ‘ANALogr + ae seemen Hk Ke 7 ‘eatin Filaments Brick 7) fitagptn l= Mrtealin AY 7 8Tas Pare a > Interceluar cement (Lipids)Circilor, veoh KC: since birth a Crear, strong KC: Ptaggnia ee. 4 {Compensatory 7 of keratin} pois Ga ATPase Pump venalin ia « ® Dorier disease [D0] < 4 ® Nay: Heiny tenes (1) Over compensation creates too much keratin 4 (hyperkeratosis) -»Seen clinically Hutton in Co-ATPase pump since Birth (2) Also blisters [de to drelr ells] -pNot sen 1 dinilly 1) Weak KC “ 2) Crear KC (genetic couse of canes] =nenattcs et Blisters (since birt) SC itt ts CAAA to tmp cera L “compe -grain” ss DARIER DISEASE 01:58:40, i In HAD - No compensatory hyperkeratosis —sHence it presentsosWsters EPIDERMOLYSIS BULLOSA (£8) 02.0635 > Congenital bistersGENE > Trouma induced blisters (Pick -up words In HC@) Types of B- 3 Types 41) €8-5(€8 simplex) Absent KS or K14 birth In the bata Layer —> Bacal blister 2) EBV (EB Junction) —> chsent Laminin bith) > Junctional blister 3) EBD (EB bystrophice) > absent collagen ¥ birth —> Dermal blister EPIDERHOLYSIS BULLOSA SIMPLEX + 8 \ = Nokeratin 514 since birth Cert] — desmasome Norma “Trauma induced blisters SPRIPY ~ Fogtebont eatin panna fat TS Simplex Sister Tne scarey NAAN sie in ne Brick | Cement | Desmosome | Dx ok ok Bai | Pemphigus Bad ok ok EBS ok Bad ok | eczema oF ozaasat > Direct immune furescene (DF) —> Picks up antbedy in Bistering diseases (1) Pemphigus 8 »DF © (2) HHD/ E8S/ £8,/ £8 — DIF (-)idi:c« APPENDAGE / RONEXA ene 0527 + ‘Rene. q t ‘ene wlgaris Hormonal acne Heanscommon EgPcoott pam “a { ri pene Leremorphe- cameo, a) pute, 2. = 6 Naa "SY pute to pd Wis hbcalace Henomerphie + + With steroids, ATT, opps Eccrine sweat gland | ~ nue Antiepiieptics On chest, back : = Areola Evnyutere cee PATHOPHYSIOLOGY OF ACNE. Hiliaria [Occlusion due to staph. Epidermiis) COctopic Gebacenut Glande) Keratin: Topica retinoid [Keratolytic] —> ‘Atpalene [photosensitive —> apply ot night/ ‘retinone/ Tozorotene(INICET Nov 211 Stage -2 > Comedone + popule > Due fo untreated stage 1 and sebur/ Pacres bursting into dermis > derma inflammation (pepues) > Re: Topical retinods + Topical anthietcs (CUindanycn, —Carttromycin, Dapsone, Nadorci) > Rx: Antibiotic resistant acne —>Topleal benaoyl peroxide —>’Nascent oxygen” ~> Bactericidal. ‘Stage -3 A Stage 2+ pushle > Rx: Topical retinoids + Ora doxy/ Aathromyein/ Hinceyaine (S/E: Blush nal skin pignentation)/ Lymecyctine. ‘Stage -4 > Stage 3+ Nodles/ cysts (Noddocystic acne) > Re: Oral isotetinan (orl retinoid) 41) Sebum (Sebeytie) > Prenes —> Dry skin (m/e= Ups)» Cracked tips2) Keratolytic Removes comedone SIE —Teratogenic {Til one month after Last dose) ypertipizemio (176) MYTHS: 1) dvater 2) Constipation 3)_ Blood impurity 4) Dandruff 5) Scrubs Yocne 6) ‘Steam 4 acne [Steam - Blocks pore] Oily fod t acne TRUTH > Refined carbohydrate —> Acne [arb not having fbre associated to it} + Inadin resistance + Comedone fibre @ “ \ Refined Complex ’ 4 = Witeriee = rumrice Orange uce orange WoRMONAL ACNE siz 40:00 Anseagen Nicer Recapeare Nov a <— OAT 40:00Refined carbs INVERSE ACNE 4 Insulin R-oobesty,ftty Liver, acanthosis nigricans 4 PCOD-sc/o one, delayed menses + ‘Sak (T)—>DHT > Hirsutism > Hairloss on scalp (androgenetic alopecia) feat Hore obstruction [comedone] ts More inflammation 1) Ufestyie changes (L Refined carbs, 4 Sugars, : No.of meals) (2) AR blocker - OCP ie = Spronlactone fae (3) Hirusutism - Laser hair removal ‘ (9) Lik-by metformin ie MIORADENITIS SUPPURATIVA sO ULE LG aL > Hira uate seat (apocrine) xenon fice > Adis —> gland inflammation 4 Lesions Uke acne, but In epcrie areas, hence > Supprativa —> pus discharge ‘called “inverse acre” Secondary stuph aureus causes abscess —> charging sinusFOX FORDYCE DISEASE 01:05:15 Less obstruction > No comedone > Less Inflammation —> only til popule Less heratin obstruction than H. sppurativa (n comedone) Only inflammatory tcy, papules inthe axa FORDYCE SPOTS ‘+ Ectopic sebum glands ‘+ Asymptomati, yellow papules on Up/Buceal mucasa 12 NoRerequired MILinRia 01:05:10 ‘+ Obstruction of eccrine duct by S. Epidermis ‘+ Prickly heat (pricy, itchy sensation in summer/ hot weather) >, deere gland + baad + eyEye Helanin Dseas ———— (1) DISORDERS OF HYPO/ DEPIHENTATION — Less (Creamy wie) —Nocelour (Hie site) Las 0122 ke > BAndagy Bus (HC) ~ Bus depot (neural crest) - Passenger (retanin) > No tyrosinase: Birth > No melanin (No passenger) sDepigrented Skin/ Hair/ Eye Birth But HC present (Bus present) Nevus beptamenrosus 09:00 ‘Aka ~ News echromicus (a+ No, Chromi= “ebrome”«means celeur Nevus~ Birth mark De-No Mento - pigment ented nce bieeth) ‘Newus vs Abinism aed tae ady eed | sonepgmenr@ |S > fa me sade. eure dine) > Ay | mw a Yeu —fie] cre vine FF »- EF Black hair = @Levcorichia wee air) oor prognosis — Up-tip vitiligoLeucotrichia = kee, Elbow Vitiligo a/ tryrod || Parnicous | [ types | | adden sznse_| | ere on as CLASSIFICATION OF VTIUGO (1 Located © Focal = Segmental © Upp (2) Generalized = Aerofacil ‘© Vitiligo wulgois (means ve) - M/C: llaterelly symmetrical © Universal ht o » Heda therapy (immune suppressive) — Steroids — Tecrolirus ‘Aacthoprine ‘ slew = phototherapy —r — T-cell suppresors Surgie, 4 ‘Skin grafting For stable vitiligo patients PHOTOTHERAPY (1) Uv-A (320-4000m) Psordten [absorbs UV-A] =| Luv-a (PUVA) (2) uv-8 (290-3200) No prorlen Broad band UVB(2%0-320nm) ‘Narrow band UVB (3tInm)Seca o Bindi Para tertiary butyl pheno (PTBP) li. Hair de PPD (Para phenylene diamine) = Re~ stop the agent Me * GENITAL LICHEN SCLEROSUS. a8 Excess ellagen in dermis 4 Tight; hard skin Premalignant lesion SALT & PEPPER PIGHENTATION Skin sign of systemic sclerosis IN NOV 2022 DISORDER OF HYPER PIGMENTATION 4700 Helanocytic Newus = “me” to What's app group of melanocytes Epidermal melanocytic news frau ns we A) Congenital melanocytic news (CHN) Birth male ~ Identifying mark> Smal siae ~ Benign > Large sie - gaint CHN -Halignancy chance (Helonomal 8) Acquired melanocytic news (AHN) ©) News of ofa - AIMS News -Birthmark SY seem melanooytic nevus (active) se are te hin dang reve ce lateral, rth) D) News of ito ‘On back & shoulders 1) Morgen spot => “0 Anaogy-o€abit-fortise Nt melanocytic nevus ee wo yy tr yh ftw & migeatn aan a py ‘Deep dermal arrest of HC ‘© Blue patch on sacra area Self - resolving ‘Single dermal blue melaracyteFY Becker's nevus (Net at birth) Epidermal melanocytic: Newus 7 \ ea ci SSte- shoulder, arms, chest (Onset puberty Hore hair & acne due te DT actionSEs $i) (Ce?) Rea entotocy 02205 4. Chronic UV ight 2. Fair skin 3. HPV genta HPVI > 6 £9 proteins — (Tumour suppressor gene = CD Apeptosis 4 Immune suppression ‘Cancers ¥ ¥ % oF OF Of dermal T cells + spiral epidermal Catereous Tcl ba Ma Lymphoma ece 4 (cra) 3 sce = Ako-mycos's fungoldes = Nota fang infection eee 06:10 > HIC skin Ca in immunocompetent people > HIC site ~ shin of nose > Louer eyelid (Sun exposed areas) > om (1) Node > Maza aaa CTelegiedaiad (2) Ulcer (Rodent weer) = Beaded, eds su Fut oP Metastasis very rare Locally destructive shin Ca [Like a rodent) see 18:40 => HUC skin Cain organ transplant pts inane appressed) —> Sun exposed & sun covered areas both > Frequent metastasis (C/R-Cauliflover Uke mass (hard) ‘Tumor (vegetative mass) OLMELANOMA > Hekignancy of melanocytes > Mubtpleeators Criteria for malignancy- ABCD criteria Hea A 8. « > E ‘Anyrenetry Border (rregder) Caour (Huge) Diameter > bm Eralution ‘TYPES OF MELANOMA (1 Lentigo maligna (meLanoma in-sit) mite inside epidermis —> Horizontal spread > Good prognosis ao: > Brom ed vl (2) Superficial spreading melanome-H/C TS = pores pags ime cough veel(W) Amelanotic nodilar melanoma => Non pigmented melanoma A-No Helane - Melanin (5) eral melanoma + fsruntes H/C type in Asan skin ere 48:00 erupt phocytes cled- @& O]- Patrermerescss Sse nas lmis- TT sen © tanebrifonm ———vigrant dermal Tl Semry uceus al)+ Ke Tear SSSSSSSESEEEacial Lesions MELASMA 0051 > Helanocyte stimulation on UV exposed areas rene pausngera er. Bus eit | ae ei > Broun patches on cheek, nse, forehead > Photosersitve (Te wth exposure) Re (1) Sunsereen ~UVA protection '++4] — UVB protection (F-(30/40/50)] 2) 4 Helain tyrosine inhibitors) Topicals — Hydroquinone [2-4] gold standard = Kejie acid = elle — pebytin (6) Tope steroids — Hil steroids > shin thinning > reduction of calor atrophy Cskin honing) tian C due to ‘wiing) (8) Topical retinoids [Keratolytic] = Topica retinoids remove KC-melanin Eg Tretinoin ® (6) Kgnon regimen o @ @1) Tope hydroquinone 2) Topica steroids [Futicasone, Homentasone] 3). Topica retinoid (Tretinoin) (©) Chemical pees ~ @ycatic oad = Tri chloro acetic acids ~ Sdcyc acid CHIKUNGUNYA FACIAL PIGMENTATION 17:18 © Fever/ severe joint pain ‘© HC stimulation on face. ~ Looking Uke melasma {chik sign) 10" Alay ra L \ , Foret fire Hurricane in forest a as sn e + © Female © Systemic @ skin Seoreng alopecia Non Scarring dapecia © Autoimmunity triggered by UVROSACEA 28:05 Rose = Red involves NaseLabial fold PATHOPHYSIOLOGY UV ight —> destroys the collagen of the dermal blood ‘ess > permanent diaton of the blood vessels [Telangectasial STAGE-4 Erythema (Intermitent)—> Flushing Diseose of vasodilation of focoh vessels (Telengiectasa] — Hot spicy food — Emohiona upsets ~ Brereise fr Topical steroids > damage collagen around derma blood vessels = > Inflammation Infiltration) Pople ~ Pustule on face resembling acre but no {vasodlation > Lymphocyte© Naso sage faka-Rhinophyma-potato nose] Naso issue is inflamed scarred © H/P: Sebceous gland over act frosts + ke (1 Pvoid riggers (2) Ant inflammatory = Topica > dindamycin, metroridaache Ora ->Deryeylin, Hinacylin,Aathromyein (6) For stoge-3 — tetretinin = ‘ir-paty ACANTHOSIS NIGRICANS 43s ‘© Dark skin in flexures (Neck folds ila), foce © Not due to excess melanin but due to thick skin ‘© Due to insulin resistance (peor feed choices) —> NGF skin thick A ANALOGY ‘© Insulin resistance = Big tree cael EN NY powonem ‘ype io " sao “ree om Nt + catg fry T cceved ~ Shin lesions — Proximal muscle inflammation ‘Aut immune photosensitiveEee al paae-poun ow PtGe Alppecia es 4. Andro Genetic Alopecia (RGA) Heir oss groded fom Get 69 - by the Nerd | eet stantionsele | Due SDAT Genetic factors Har loss Ger ee + Aka patterned Alopecia me Hale poiern female pattern 1. Topica 5% Hines /orl Hino > vasodators Non Scanning dpecia 2. SeRinhitor > a © Finasteride © uestere 3. Platelet ich plasma (PRP) MALE AGA © Har tne Recession Front / vertex Balding v Cceiput / Lateral Seap is Norma,FEMALE AGA 15:50 No hui Ure Recession, But widening of centro parting Grated from 1 3by Ludlg sede Re A. Topical 2% minoxdl/ ora mined 2 AR Blockers [Sane asin PCOD] 3. PRP 4 FolledarTronsplont pie 17:13 = ‘ = <> Discid (coin. Lpus——_—rytitosus Uke) v v Enfen by wolf Redness Chronic Skin + Hor auto immunity of Trigered by UvLight Scarring lopecta © Skin ~ Foe / Sap sun exposed] = oF. har #_Seup hairs, Fac hair fovea TW See «Carpet TS sun YE eugene sae sem ats) — Toeells ions mage vorecin nena 2sao Non Scarring lapecla eu netataes sa ma ylOr E Complete Loss of Hair wth smeoth skin under patch ca a (Fails not inflamed) ‘Ag= isthe melanin in the Bulb White | Grey Har not affected Sparring of the Grey & Gee i 2 Alpeci Tots - Fl scalp air Lost: x 3. Alopecia Universes ’ Ful body Hair ast InfraLesona steroids Pook PROGNOSIS FACTORS 4. Ophiosis- areata tthe Hair Line margins4. Exclamation Hai -Pathognomic enrawes iat ja Nannowest alopecia axeata | S. Presence of atopy & Nal changes (Reger pitting) 7 Underlying Thyroid ease TRICHOTILLONANA 3920 vv oir Pu ocd © Femdes cr 4. Vertex hair loss, spring of margin 2. Damian hod side - hopecio 3. Heirs of varying engi in lopecia area 4 Nen~ scoring H/P —Fllelar Hermorrhogeis —— Mast Cell Disorders as alhagenesid - Plasma Cells > 0 a ye Y as mast cells, ‘Atopic people make 5 a more I pti. ‘axle Urcaria ~ peepinDeris/Fat CCévenig) | Chon Urticaria ues) = Tough membrane 1 Food 1 Physic + 2 Infections | ~ Scarehing _ Do not Rupture Easily 3 bruge (Dermographisn) = Cold (Cold Urticaria) > Sun scar Urticaria) 1) uRTiCARia/aIvE oa, Water (Aqungenic Urticaria) i} = Stress (Adrenergic Frage Derma mast ells Urticaria) Histamine = Sweat (Cholinergic Rupture to release Urticaria) + Leukotriene 2. Autoimmune Urticaria > o/s ‘Atoimmune Thyroiditis wate oo Investigation heal (Redness, Ich, Edna) Food allergy = Prick Test > wheal at prick site of te oh > Resembles insect biteRe 41) Ant Histamine - Eg Cetrigne, Fexofenodine 2) Anti Leukotriene - Eg: Honfeikast 3) Steroids -For autoimmune urhcaria 4) Inj Omaizumnab - Removes IgE Horeclorak Antibedy 2) ANGIO EDEMA 17:20 wey ork CCF: Edema on Eyelid Lip Due to rapture of fragile mast cells in | Feat doesnot have itch nerves 4" ‘Anglo Edema is Nonhy) Complication > Respiratory Edema ‘Airs obstruction (Heticl Emergency) Re: I) Hydrocortisone [weer In, Adrendire 3) NASTOCYTOIDS aa0 1 Hostels number shea = (Urcore pgrentoro) onkb > Tunar of many dermal mast els ast fouching DES (Superfii) Touch the Basal Helanocyte Broun Lesions of Trunk in children > Rubbing te Broun Lesions ec (eto superficial mast cel rupture) “Dorie Sign”eee swapes oF sea Lesions 00:30 1) Annular Shape (Ring) ed emanate Cer earng Peripher scale Oo ‘wood's LAMP 07:58 oe, 1 — Hand Held Lamp Trea Pass fosen 8 Hansen's —— (Fungal) (Viral) = I Emit 365 nm Light (Blue) 2) yomorphc Phenomenon OR Koebner' soe memitagy ve sca -peobladiners «1 Thea Cats o © OD problet hak (virus) Seaip her ~~ warts: New warts / molluscum / in Green_on Wood's Lamp ~malluscum seratch Lineeee 2. Erythrasma Groin Lesion aia SW. > Cord Red Color ee In indian skin - Broun calouris see nat red Cause - Cornyn bacterium Hinutissimum 3. Vitiligo ~ ore white - Early faint patches becomes ‘more white under WL & re eosily seen 4, Ash Leaf Macule — Faint Hypoplemented ot birth In Tuberous Sclerosis CConmision becomes ore wife on WL HR 5. Porphyria urine pink / red on WL 6 Pityriasis Verscoour (Fungal) - yellow on WL 7. Burrow in Scabies - Green on WL Eni point of Scabies mite into skin NEUTROPHILIC DERMATOSES 18:40 emis Pleniy of Neutrophils ‘Benaogy > mistchen pic (mekecular mimicry) ‘Ag (Some whee else) } Derma nfammation Oe dedrophits “Molecular mieiery ‘Re: Remove Trigger Ag+ Remove derma. Neutrophils = Dapsone, ~ Colchicine = Steroids [A Pyoderma Gangrenosum - Inter tigger -IbD Hematology Hatigrancy CIF = painfl leg ces with prple margineee 2% ©. Behcet's Syndrome > Recurrent Ore-geitalaphtous leer Undermined ¥ 5 Round mouth / Genital, painful ulcers B. Sweet's Syndrome Orererses ‘Aka: ete febrile Nectrophii dermatosis > Thrombosis / aneurysm > Uveitis CPF Inflammatory popules / Nodes REITER'S DISEASE 31:40 oe adrone meee > New Name [CANT SEE - Uveitis |CAN'T PEE - Urethrits [CAN'T CLIMB A TREE - Arthritiseee Ehology > CNamydi Trackomatis ¥ v Salmonella Senual = H/C Shigella v Yersinia urethra discharge / urethritis Carnpylobocter Ditres or 4. Arthritis - Large, weight bearing joints Uke, knee Tooke g eoneu® ue Fascia altach ment point Inflammation - = a/c HAB2 = al Enthesitis Heel pan 2. Uveths / Conynctivitis 3, Skin Lesions -cirinate bolanits > Glans |-Kerato / Derma /bleno / raga vue Skin Pus o2ing Herd Keratinon sle UCHEN NITIDUS. 4450 C/F: Pinpoint papules on dorsum of hands & genitals Lesion are asymptomatic & do not need treatment eb H/P ~ Chtehing he bl appearance oR “Clow & Bal” appearanceeee ” ete go doun & curve inwards ike adas Lymphocytes look tke a balleee swapes oF sea Lesions 00:30 1) Annular Shape (Ring) ed emanate Cer earng Peripher scale Oo ‘wood's LAMP 07:58 oe, 1 — Hand Held Lamp Trea Pass fosen 8 Hansen's —— (Fungal) (Viral) = I Emit 365 nm Light (Blue) 2) yomorphc Phenomenon OR Koebner' soe memitagy ve sca -peobladiners «1 Thea Cats o © OD problet hak (virus) Seaip her ~~ warts: New warts / molluscum / in Green_on Wood's Lamp ~malluscum seratch Lineeee 2. Erythrasma Groin Lesion. aia SW. > Cord Red Color we In indian skin - Broun calouris see nat red Cause - Cornyn bacterium Hinutissimum 3. Vitiligo ~ more white ~ Early faint patches becomes ‘more white under WL & re easily seen 4, Ash Leaf Macule ~ Faint Hypoplomented at birth In Tuberous Sclerosis CConmision becomes ore wife on WL HR 5. Porphyria urine pink / red on WL 6 Pityriasis Verscoour (Fungal) - yellow on WL 7. Burrow in Scabies - Green on WL Eni point of Scabies mite into skin NEUTROPHILIC DERMATOSES 18:40 emis Pleniy of Neutrophils ‘Benaogy > mistcken police (molecular mimicry) ‘Ag (Some whee else) } Derma nfammation Oe dedrophits “Molecular mieiery ‘Re: Remove Trigger Ag+ Remove derma. Neutrophils = Dapsone, ~ Colchicine = Steroids [A Pyoderma Gangrenosum - Inter tigger -IbD Hematology Hatigrancy CIF = painfl leg ces with prple margineee 2% ©. Behcet's Syndrome > Recurrent Ore-geitalaphtous leer Undermined ¥ 5 Round mouth / Genital, painful ulcers B. Sweet's Syndrome Orererses ‘Aka: ete febrile Nectrophii dermatosis > Thrombosis / aneurysm > Uveitis CPF Inflammatory popules / Nodes REITER’S DISEASE 31:40 oe adrone meee > New Name [CANT SEE - Uveitis |CAN'T PEE - Urethrits [CAN'T CLIMB A TREE - Arthritiseee Ehology > CNamydi Trackomatis ¥ v Salmonella Senual = H/C Shigella v Yersinia urethra discharge / urethritis Carnpylobocter Ditres or 4. Arthritis - Large, weight bearing joints Uke, knee Tooke g eoneu® ue Fascia altach ment point Inflammation - = a/c HAB2 = al Enthesitis Heel pan 2. Uveths / Conynctivitis 3, Skin Lesions -cirinate bolanits > Glans |-Kerato / Derma /bleno / raga vue Skin Pus o2ing Herd Keratinon sle UCHEN NITIDUS. 4450 C/F: Pinpoint papules on dorsum of hands & genitals Lesion are asymptomatic & do not need treatment eb H/P ~ Chtehing he bl appearance oR “Clow & Bal” appearanceeee ” ete go doun & curve inwards ike adas Lymphocytes look tke a ballwee = Hair Diseases-TB-Erythema Nodosum = —_ TELOGEN EFFLUVIUM 16:20 ay Tt ScALP Mam eveLe 02:30 [a Anoger| [oeTeloge Vv v Growth pose Resting phase ‘@years) (3 months) ‘ea Anagen pushes out the Telogen Teg Wha Efflvium (shnormal Loss) Telogen effluvism —Anagen Efflevium | zachary > 100 lost/day > tlost/éay Non-Scarring Normal | 8% [1% Fever | 0% | 100% (3 (Covi, months) Typhoid, NA 060 Malaria) >| ud months v Conver back fo Anogen (00%) acute Telogen «flusand™ ~Sudden Loss U ag apter. 3 man Of peut) Labour Chronic Telagen Effluvim ~ Chronic Telogen Loss Nutritional Anemia Deficiency HypothyroidismHAIR DISE CUTANEOUS TB 26:43 Exogenaus oie Hatherin Daughter on Skin Organs (stent) (cncally seen) (GSSSSSSSSS | 41) Exogenous Tb Poor Immunity 60d immunity v ‘To “chance” sO “cer wolf Wc © Healing with central scarring © Progressive leson Fie (2) of pus wig Descopy > Pressing with side iz ‘Apple ely Nodule (Yellow Brown Module) 2) Endogenous Eg: Scrofuladerma v Non Hectng sinus from underlying To focus Infected Lymph Node 3) Tuberailids Tubercut ud v v other in organs daughter in skin 3 types of fberculd depending on sizeof daughter onskin: Tuberaiid: 1) Hicropoplar (Lichen Serofuosorum)® 2) Popular (PaponecroticTuberaid)HAIR DISE 3) Naddar(Gazin's Disease /Erythema Induratum) Preys REY | os EnyTwema npoosum 40:05 Red Node CCAP Red, tender nodules on skin Pathe- ———— fii Sept pannialtis (eatropis enter sept) a8 T Lebulor panniculitis Helealar ery oe Deep seated rode below skin Cases of EN [No -No Cause, Netropilic, Dermatoses \Gchoets deat, Svet’s Syndrome) 'b~Drugs (Sulfonamides) 0-0cP 3 Sarccidosis U= Ulcerative citi (aso crchn's) Ht Hicrobes (Strepto, Tb), Hoternity, «MalignancyLEPRC | BPBSsszszissescsses i040 nS=saisrasissessea Leprosy Ce] Hea WaNSeNS DISEASE mise err Cosltkin + Marve v Swpericl [utnor, fc] v Thi papablet rea tans oO vw Noleprosy Lessbacli Hany bac (He) (pau Sealary] Firstnerve Only Nerve — Nerve Bx for v v Dx ‘Then skin Ne shin v v (Pure Neurol Tobe purely SkinBx for Dx Hansen) sensory nerve = Rade cutaneous sural ‘© Hie internal organ - Tests (col temp) v ‘Gynecomastia ‘© Earliest sensation Lass ~ Thermal > pain ‘© Sensations not lost - proprioception, vibration © Hic deformity claw hond ‘© Organs no involved ~ CNS, Uterus. Wineled boil ¥ skin dermal macrophage @ ms we L Bee oe @ oe ek ne eek ete Sire ee 1 a a a ide doping ossification Nenve policemanLEPROSY TT HaNsens es pe. B cell anti 4 Silent obsenven conto XK foam cals ‘Tuberculoid Grandoma virechow's cell ¥ In & oround the nerve irre 8 gronsione som _/t0% nae TR dex denis uw ae a erect ©Oo yee 4 + niin oe fen ieee “3 No Grenama { Gronulema Foam calls / Virchow cells /Lepra cll = No Foam v calleo TPE 1 LepRA 3847 © Typevs: pein stein ic te] 1 wards 1 ‘Om 14 ™ ANALOGY + Bread analogy Living bead mot mo ao lon? Ag oo on Ag ft J SOunitsof =» “000unitsof Immunity am Imanity Aiypersensitvty) v Severe inflammation ¥ Lepra Reaction After WOT Nenve Type Towards TT “Towards v v v v T Cells ‘Type tlepraReaction / Type -2Lepra Reaction apgroding / Reversal (EN. - Erythema reaction, Nodosum Lepresum)LEPROSY TPE — 2 LepRA 43:00 46% Analagy: Police surrounded the thet from all sdes. ree ir Tne oer 99 ss ypersenstity -F Aneogy > prison enlogy + Sometimes upto 3 skin lesions (arly) Tors TT Towards UL v v Type nts, Type3s er {aka type A epra) (ka Type 2epra) omer ay 0 ~ Neuritis > steroids - Vasculitis: aay = Nerve abscess > | & (Immune complex deposit i v D ‘on vessel endothetium) n eer = wt ‘SKIN HANSEN FEATURES 48:13, - anaes ee ‘eros |» | tSetcen SP |r | | reat , any, oe pee aa ar in pet p Co @e."r Redness * on Existing Lesions of Leprosy (No New “chee Leer) iia] bathed Than Sn fer aes fant] tlaeye Neveco oy Tu + Uncnte © Symmetry of Lesions 44 Almost symmetrical lesions + Symmetry of thick Nerves 40 + Almas symmetrical nerves + Serston improves verted saucer + setinprow + dr ® “7 e C3 nts) eid ae a a 1200 * pepeiesg ne Re tipopgnentaton No seatng se ) Nera seston Diffuse Lesion [No border} v ‘Asymptomatic [Because 10-30 Lesions ' i ‘hereto grander wa 48° Andogy UL = Tolibon in Afgon Ear Lobe infiltration > President's Houseeo Nodular LL = Leanne = Poinless Node © Non Nodular = ua eprosy (Beautfa Leprosy © Histoid Leprosy > type of UL with dapsone Resistance v (0 Skinin between papules / Nodes Voy “Thick Nerve Peripheral Neuropathy (tore stocking anesthesia v Poinless / Tropic / Neuropathic Ulcer © NeET HAY 22 Deetoracdnere Only eopsone Invent v 2. Multiple Hypatsthetc, Hpopigmented macule with Sur Karat ‘Numerous ocidFast boc is indiativ of v SO Dry corel ders am 7 © legepthdnans 2u 3.87 wo vG. Apthient comes uth few Hypoplgmented Hypoasthetic ploques on body. His ulnar nerve on Left side & Lterah popliteal on right side are enlarged. The dagnosis is? aT zu nary 4 ERYTHEMA NODOSUM LEPROSUM Lk Leprosy 01:35:38 © Tender Nodule on Extremities (eu Lesions) © Systemic features: fever © Immune complex deposits © soint pain © Uveitis (© Glomerulanephritis © Orehits 0 Hepatitis 4 Andogy > Immune Complex = Rolling Tennis bel on fire Int Nov 2022 REACTION DRUGS EMIS Meta -t Frypn-? 01:39:20 tds First 2 Episodes After 2 Episodes } v “Recurrent EN.” Steroids v [loteaimine SVE: Red Broun pigmentationLEPROSY Thalidomide > Not approved by WHO due to Risk of (for EN) We iN Phacomelia _Periphera. Neuropathy Grenz 2one [one of clearing in upper dermis without foam cel] Investigation > (SSS) SLit ~ skin - smear > Hoke a Blade Nikon es On Eor ‘Skin sions ee -@X ao v ee eutcen a ae Le i IN “an on sssO__ Be ! ej “eg wan. ‘S#F4G = Bacteriological index (Bi) > Remains +ve after Treatment 'S = morphologic. Index (HI) > Becomes -ve offer ‘Treatment LEPROMIN SKIN TEST 01:51:00 © Infradermal Test to assess Immune stous‘© Prognosis test, not dagnostc test Test ® oO v v (00 person, TT'Side Touré side Innov 22 \to CRITERIA FoR LePRosy Any ove of = 41. Skinesions consistent with Leprosy + sensory Loss. ‘Thickened Nerves 2. Positive shin smears (SSS) Treatment Wewred | sine as oo}c4 ra Beg 2 ae i 1 | er 0 mann = uperied | on unsupervised Daily For PB > 6 months Rx. [Finish in Hax 4 months) For HB > 12 months Rx [Finish in Hax 18 months) INICET Nov2t INDETERMINATE HANSEN 02:00:50 a (NDE Leprosy Thre is eprosy bac n Confused | skin ~ But 90 less thon full. symptoms have nat Ned sreaton core Nera Sweat Hypopigmentedon cheek (child)eo AD res eine “em. IF H/o post fever + Black skin > S/o PKDL (Not Leprosy) + De Gemsa stn - To lok for LD Body + Rx Ora Miltefesne Very Less Bact After 6 months ‘© Immunity may be able to i this baci > Normal. Rarely Less ‘© Bacill > Divided & cause full blown leprosy with symptoms. v Re with HOT. D/4-> post hla ear Derma Leishmaniasis (PKOL) Leishmaniasis by sandfly in Bib / UP After many years of kala Azar -> PADL = InPROL © Hypopigmented > Resembles 8 ©. Nedules > Resembles LLGeNrrat uLceRs o1as Bacterial ¥ curable Vit > Net curable (Recurrent) v HSV-2[K, Gentais) et sn 9-90 days v a _rhannut Pri ‘chancre (ulcer) 2|opme cope Single = Serous discharge {No blood) Primary chance Inv Not to do Blood Test v Better todo ulcer smear v ork Ground lumination [D6] led =e ms = Enlarged tN pense painless LN STD Primary Syphilis W Not Re Goes into Blood > Secondary Syphilis ia Tenayime Immune Assay] ¥ > Comes ct3vks after incalation sweat us Screening Test inte primary Syphilis v Some Abdo start f form SECONDARY SYPHILIS, suas 1) Rash Non thy > mare on he pln & sle > ‘era Rash / Peripheral Rash > Allover the body > Sealy, zymptomati > Great imtatr psoriasis] v DexpDeral Tenderness @v Deep pressure uith blunt cbject on palm / sole v Pain due to underlying vessel inflammation > Never get blisters in secondary syphilis ae 2) Condyloma Lata > "EET ~ flat v Flat, most lesions onthe onal area v Full of spirochetes 3) Mucous patch / Snail Track ulcer > Unear uleer on tongue Looking Uke snail track 4) Moth Eaten Alopecia (Nen- Scarring) 10¢ for secondory syphilis > VDRL If secondary syphilis Not Rx - Latent Syphilis v Hidden v Ptbecomes Normal but VDRL stl aly Lotent mn ewe Tertiary Syphilis v Spirachetes go nto deep tissues J v ns. cys Skin v v ‘Neurosyphiis ‘Gummatous Syphilis Cardiovascular Syphilis CLASSIFICATION OF SYPHILIS 26:26 “0 Early Syphilis fe 2 yrs] > Primary Secondary nj Benzathine peniclin 24 HU Early Latent IM Single dose2) Late Syphitis > 2 yrs] > Frist Secondary stage (Early C5) Lote Latent v Jn. Benzathinepenclin 24 HU Later ~ Tertiary stage (Later C3) Tertory 7 1H3 doses of weekly interval *Neurosyphils Iv Aqueous __[ Early Congenital Syphis | Late Congenital Syphilis crystinepenicilin | Shuffles (Rhinitis) Hutchinson’ Triad Pre forlest BHC sign fpeilln dlergy © Blisters [Sypiiiic | Interstiti Keratits (pemphigus) + piphysts Ostecchondrits butchinsons 8 egnont Pregnancy a aa parclysis > de to if . bone pain bby des peer ee rat meve Doxyeyalne Decensitcaton |e Condjlomalta 284-Lale Syphilis Syphilis in pregnancy -> same as in non - pregnant CChancre Redx - 5/0 arly Relapsing Syphilis Dxof Congenital Syphi v Hother “Recurrence” sve 8 ae Alaays cross placenta, a Mees peT, tang VR vor ® / mode Congenital Syphilis (5): rk eh Blood of mother > Goby > First sagen Baby Paired VOR Baby's Ab titer > others Titer [4 times] Secondary stage i )— (1) v v vor. © No chanere inbobyTESTING PROTOCOL 43:56 v ‘Anchogy Airport Security Screening " vot) ° ® v ¥ Not Syphilis Confirmation Test (TPPA/TPHA) Primary chncre (First 4s) ° ® False +¥e VOR x for Syphilis {ot Syphitis) Marker of Rx Effectiveness Von Her BP er atc (1:68) reduction (1:46) becomes -ve Isefore ed CHAN ROID 48:16 (rg: Hemophitusdu-reyl fry {do ery in pind 1P:3 = 0 days leer - is opposite features to syphilis Sake Inflamed > Bub (UIL) Kissing cers = dw to auto Inoculation ‘bx: Smear (Gramstain) Paithromycin stot oR Inj, Ceftriaxone 250mg im statDONOVANOSIS 56:40 Gronuloma Inguincle -> No LN invlved (rg: Calymmato bacterium aka Klebsiella > Granuloratis 1:8 to 80 days Organism creates granuloma in inguin region Red lcer ¥ LN > Do not ell ta Bubo [cat pseudo bubol in [Donovan Bodies) Lov Pover Hil over O @ Histocytes (pun cells) x Aaithromycin preferred) v 1g / eek 08 500mg deity « f Terie Doxy 100mg 8 Lev 01:02:40 Lympho > Chiomydia Trachomats > Lymphatic cbstracton of gents abo > Secondary Stage — resenting stage Transient eer /poinless v “cer not seen by pi” v Primary Genital Stage * Inflormation of LN > Scarring / Fibrosis,v CObstrection to Lymph v Tertiary Stage - Genito Lymphedema v Elephontisis © ~ Oo x ~ Dory 100 mg 8D for 24 days enPes centraLis oxo7:at > HSV-2>45V-4 Grouped vesides pn. Grouped ees pani so? fe ace Reactivation spontaneously Partner Treatment > Not done in Herpes [case is due to reactivation) URETHRAL DISCHARGE 01:14:00 Pathology -Urethrits Gonecocea. en — Gonocoeca 1. Gonnorrhea ‘CHamydia/ Trichomonas 1 snycopasma / urea plasma 2-8 days 1P-1-3 ves ‘Thick purulent urethral | Thin muco-purdent discharge urethral discharge Treatment - Treatment - Inj. Ceftriaxone 500 mg_| Dory 00 mg 0 for > IM stat prefer) ays (preferred) oR = Tob Aathremyein 4g “Tob Cefixime Boomg stot | stat (Syndromic approach)SYNDROMIC APPROACH 01:17:37 1) Urethral discharge Goh CChiamydia v v Cefteime + attire Goyal > een 2) Vagina discharge, Canddavagintis + \ + Bactel vaginosis Trchomohes vaginitis een ree et Nort YesPT NPT Partner treatment not done in ‘Herpes 2. Candido Not STI 3. Bacterial vaginosis Candido > Tob fluccnaaote 150 mg stat ‘Trichomonas -> Tob metroniacale 2g stator tb Sceridezle 2g stat aréenella > Tab Hetronidazle 500 mg 8D for 7 ays a or > Tob Tiidsacle 2g 00 for 2 dys cy REO > Teb Secnidazole 2g stat 3) Cervical discharge Gore ‘Chamyda UL ___,__J rey Kit fey we Depends on pr speeum seen it J intn 4 Ingint Biko Chancroid Lsv v v Aaithromycin tg stot + Dory (100) BD for 21 days ‘lack packet > was5) Genitol Ulcer v Blister Herpes Syphilis Choroid_Dafglon ¥ Aeydoir —Benaathine + Aattromycin [ed Kit] peniciin dlerg) White Kit m (46) + Aethromyein nee 6) Lover Abdonjpa pin [P10] oho 6@ Anerabe so Cefixime v Hetronidzale ocToR’s aPrRoncH o1es26 Vaginal Discharge ‘Candida ‘Trichomonas. Bacteriol. veg | gig | veges Sate) | Gen \ | Fak aneling creany/\|traty | dederge ary | asderg || >pures rinina || > eroise | > noieh deere / | dere || ea Voge Itching ++ | > Strauberry/ | Gram Stain yams [cari 7) | ecboaas > & Sehinge | pes — PS be Epithelil cell ce at eat mount / ran Senor Aine for / fy [whiff test]Soriasis ‘© Autoimmune process ~ T-cell mediated NORMAL, + Grane [rome ] PatwotocY PSoRIRsis Unknown ®— self i Tal tn o [F Bacto | snopper epidermis Teal N FTaule ‘© Avoid systemic steroids, topical steroids permittedInfermitfent pn point bleed (spite sign) mmunroe, = esc mere abscess a ee Ihr Psotiasis > Tome our of estes ‘ite episerns Re REG IAT: a © eyToKINeS (HCA) Wr] aa + inflammation ‘= Auspite demonstrated after srapping 1. (grattage test) 123_| Removed by biologicals + Drugs ending in “mabFORMS OF PSORIASIS. infer Sudden stopping systemic : wed oe | Stress. Smoke/dechol Pregnancy Unstable ~ Sader many neesions ~ Pastor proiosis ~Erythrodermic pores erythrederma (90% imalvement) HEN ‘TYPES OF PSORIASIS 1. Psoriasis vulgaris * HC ‘© Onextensor ~elbou/hnee = Slvery scales © Chronic } 2. GUTTATE PSORIASIS Rain drops fg ~ streptococcus (pharynx) fx Antibiotic3, ERY THRODERMIC PSORIASIS. © Aka exfalitive dermatitis, #908 redness, sealing Rx methotrexate, cylosporine | | SfE-hepatotoxic $/E-nephrotoxocity 4, FLEXURAL (INVERSE) PSORIASIS © No scaling © Due tofriction 4) Flexural = No'caing = teres HEN PLANUS 5, SEBOPSORIASIS D/A for scales on scalp ‘Sebopsorisis (5) © Shey sedes Dry ety + shampoo of ‘pica stersids ‘pice ctor ‘peak caleipotriot ‘Seborrheic dermatitis (9D) (sebum is yellow) ‘Yellow, greasy Oly, fey Coused by imdasezzia Rxchatoconaale ine pyritrione Copirox Selerium sulhide HCQ— Spin infants > cradle capHEN Impetigo herpetiformis 6. GENERALISED PUSTULAR PSORIASIS (6PP) @ (Pinal ver bec ath aris 7. PSORIASIS ARTHRITIS. inflanmaton& fever lassen -» DP + Sterepus + AuHtaez? + Entei Sa EJ ‘Gat * [er £ ¥ Non pregnant (Von || Pregnant Cmpetign 2umbseh) apelin) + Sealing on ard/oot fachctretn 1 + iy S/E~Teratogenic ra Hf ready DH-+ ioLo«icat aves cyclosporine + Tot inhibitors = infix = Aliana = etanercept + 112/23 inhibitors = Ustekinumab© a7 inhibitors = Seeukinumd COMPLICATIONS OF PSORIASIS ‘© Hetobolic syndrome (isin resistance)ungal Infection PrrvRiasis versicator 0:32 + diagnosis 7 fi 4. Woods lamp > yellow or sven 2. Scrapping of scales and stain with KOH Powdery Sees varlous eilour 1 (branny sees) -—-—— “Spaghetti meatball” Fine scales [typo | | Hyper “Bonana grape” ‘+ Usly on chestbock ‘© Typiedly around hair folie ‘+ Organism > Helassezia — commnensoh AS - pink GHS - green © Rx *Aaole” group of drugs Canoroiasis 08:32 © Organism: C albicans t “alba - whiteFECT ‘© Calbicans + commensal = nets t Opportunistic Fungus cama baton resree ‘Gans inflammation prepucial inflammation ‘© CIF fissure on prepuce skin — phimosis ALORAL CANDIDIASIS © Often with uncontrolled DH DH moisture. poor immunity D. CANDIDAL INTER/TRIGO cargpett inbeken shine enh +g inframammary/qrin/toe bs eee + edoriite B.CANDIDAL BALANITIS ‘© Balanitis > glans inflammation ‘© Redaess, itch on glans “© Often due to over washingWER (RINGWORM) ‘Anmudar lesion itchy Edge scale Central deoring Worm -> wrong name Organism: Dermatophytes L Keratophilic (skin hair, nai) Dermatophyte (3 species) it Hand = Tanai — Foot — T.pedis/Athlete foot ster nodes tna Teanga ! Tinea | exes nar Trichophy Eplermopyo an lon Hicrospora Har |G) @ Skin Nit @) @ @ w Groin — Tcruris/Jock teh Body + Tcorporis Face + TFacei Scalp ~T. capitis w4 1 4+ Tne of na -+OnyebonyenssCTanguum) CAF yellow nat = thid na oe drgused >| cidonrox_| Rx topical antifungal fo nal ‘We use nail lacquer | Net Sane c = =a q Petchy hairlossit Endewex tome G j (os By Aricent CLASSIFICATION OF T.CAPITIS, ‘Non- inflammatory Inflammatory |_on-scaring dopecis) | (Scarring dopecta) ‘© Gray patch (scaly) | ® Kerion Hicrasporum (Boggy swelling) Good prognosis “Trichophyton Hicrosporum Bod prognosis © Black dot + Favs “Trichophyton (yellow scuttum) ood progress “Trichophyton od prognosis Crust 1 Hicrosporum canis rem || Ora griseofulvin 6) | Foraloter teas, (part from Tap) ] Organism & 4 1 TRubram —al rat THentagrophyte. olonies_||| terblnafi Ora itraconaz oleSPOROTRICHOSIS 4458 IICET Nov 21,1 Nov 2022 ‘© Organism: Sporothrix 4 In soit ‘+ In formers/gordens (after thorn prick) Sie fe tan rel S Subeutomeones rupert (cp) lynn a Nodules along tywwbatics tee How Sinus "along lyrpitn of Ur [ee © Dr-Blopsy 1 Splendore- Hoel phenomenon (asteroid bovies) - NEET Hoy 22 hex ts Key \] ‘ter causes of infections along yrphatics (Ist Nov-22) ‘+ Hycobacerium marina fish tank granu) aka summing poe grandoa Nocardia MYCETONA, 50:17 ‘© Not along bymphaties rom pata SI former. oS Deep most © Mnemonic = 6.$.T, = SirusEumycetoma (adurels mycetomats) 1 Dark grains 1 Px Orek troconazale potassium ldide Actinamycotic CCHROMOBLASTOMYCOSIS 54:07 INI NOV 2022 © Chrome-color © Former ‘= Prick on foot Caulflaver mass - > a sins, no grains a A ‘Hos dork coloured fungal spores (don't require ‘any stain tobe seen)SUMMARY ‘Subcutaneous fing infection Svelng | soa Grai “Sporotricho- 2 Hyeetoma ‘3.Chromeblast o-myeosis sfsfs——————— © Aka dermatitis, 4 Inflaryation ‘thawte || 2chronc = Couse: 4. Exogenous ‘Skin becomes thicker dve to constant scratch troura 2. Endogenous © Albeceema 1 Spongiosis > intercellular edema 1 ‘Thick skin Look black (lichenificaton) 1 Black (+) increased skin markings 3 ae Seen in early ecoema stage 28 | Co2ing (early fsa eT ae Sticky fd after © Hchscratch cyte of chronic Eczema Hebing Have itch — nal seratch 1 4 ‘After scratching for many months (chronic eczema) t bel com fo skin 1 Rowshin } HL Increase inflammations Microbes enter (Staph) eae) 1 Foruncles (bit)© types of Eczema “1. Atophic dermatitis (AD) — endogenous 2. Contact dermatitis (CD) + exogenous ATOPHIC DERMATITIS (AD) 161 + Chronic eczema © Pishme “Atopy” Genetic (x) enviconment cause (combined) ust Noe are i clothes = allergens gf ue in bhood (Atopic due) Atopy. [of tn nose = Allerg rin (3) : a InskineAp || Inlung = Asthma (2) o / Seencrio > (1) + (2) + (3) Scenorio 2—+ ether of them Scenario 3 ~+ one after the other CRITERIA FOR RD + Harifn ard aj criteria Any 3 out of) 4. Hhching~ HELLA 2. Typied. sites ~ Extensor dermatitis in children = Flexural dermatitis nots 3. Personal/family history of atopy 4. Chronic, relapsing couese © HC sites involved in ods = Antecubital fossa Cront of etbou) ~ Popliteal Fossa © HC in eh ~ Extensor of Us ~ Cheeks Ind, soph enters through und (chronic steph aureus carer) [inerier] [net] OTHER FEATURES FOR AD 4. Dannie Horgon fold © Extra creases on lover eyelidPiya aba_| Pigmented Tent | cbsk pats Fine sing (on srt) ‘© Usually reselves on ts oun ‘+ b/d Indeterminate Hansen (LH) Padbe Hypopigmented patch wth scaling W/0 atopy scding Hypoplgmented patch uitout H/0 endemic area mentioned (Ginar/¥P) mentioned 5. White dermagraphism + Vasoconstriction vite Unes on scratch Refor AD 4. Ps with AD have dryness/Iehthyosis > Tish” ike skin | ‘Apply Lat of moisturisers (ceramide containing smeisturizer) 2. Immunosippressves 4 Reduce inflammation (TH2 calls) Str ptt Aeathieprine HycxphenolteHotetit|| Systemic ydsporine Phototheropy Toerolimus ~topiea CONTACT DERMATITIS. 44:28 ‘© Chemical touch -» Dermatitis+ 2hypes of cD —[ auerge o (0) Irritant > CD) te Irion ouchng skin 10) — og Acia/Aeat soap eit, ti Parnnfn, a buster Iebing scaling © No participation of Longerhans cell = Nen-immunelogy ACD aA @—® Aerio my Tulle Nice (eellery) Hai ye (para-phenylenediamine-PPD) © Immunologieat {ICD — wl happen fo everyone exposed to Irvitont ‘ACD - Only happens in predisposed people Diagnosis of ACD ‘© Potch test — type # hypersensitivity fest 7 ‘+ Protocol for patch test term Rone Bodh ee Deyo oy 2 Day Day 7 Put ” 2 ” patch || reading || reading || reating ‘Specie type of CD ~» ABCD ‘= Airborne contact dermatitis‘© Aka phyto-photo dermatitis Parftenium plants (seeds) © Chronic disease ‘© fAg from plant + UV ight CChronic eczema in farmer on sun-exposed areas © Dx for ABCD > photo-patch test ‘= Rx for ABCD — Sterols Azathioprine(wuceT Nov 2022) FIXED DRUG ERUPTION (FOE) 00:30 ‘© Comman rugs = Anti-dorrhoed. (Hetrordiazle/Tnidazsle/Ornidazole) ~ Painkiller Sulfonamides 4 te erythema, then dermal pigrenttion(bue/purpe) 4 Then subsides 1 But return at seme spot wth drug eexposure rug Reaction Bullous PDE 4 Blister on FOE lesion ‘© Hoy be seen on genitals [Recurrent cenit blisters — | —_ H genitals © Growped veside + No pigments. thm on hecking © Seu exposureERYTHEMA MULTIFORME (EM) © Torget lesion (3 zones) Red Black 08:46 © Causes 1HSV-1 HC 2. Drugs ~ eg: Sulgha Lethernia dopathic © types of BH EH minor EH Hajor 1 4 Targets without || Targets wth rmucosdulcers | mucosal ulcers CC/F targets on acro-facial location 14 ‘ordh Fece 4 Pam, Sole IG RE ION +B thlipe targets ‘© D/é for torgetis ECM 1 Tickbites 1 Single forgets = Erythema hronicam ‘migrans 1 Lorge, single ‘© Rx for EH + Remove case EPIDERMAL NECROLYSIS (© Mainly drug induced © Epldermal/Necro/lyss 1 t 14:40 EpldermisION © Cbse Teall functong cll Norma cell Fas @ dosed > functioning cll a Oo @ oe ers Inte at Sere gee deron owe + Drug — premature opening oF good alls + InEn 2 Zone fort eins 1+ Pathogenesis Drug attaches fo FaS Receptor on KC Xa iyeos Tas 4 aoe 4 ee ‘Nobarrier (lke burn) = Q 1 kok sign ve in EN Fd Loss sepsis.cwomesa || 10-30% asa 1 Steven Overlap of Achnson 545 and TEN = ex 4 Stpdrag 2. Re-ockFos 230% BSA 1 Toxic Epidermal necrlysis Ten) 1 ‘Aka yel's syrdrore 1 vg (itrovenos Immunoglbitn) 3. CD8 inhibitor ~ cyclosporine 4. Sterods - controversial 1 Secmise ou sgn/t sepsis (terlés may | sepsis)LEVEL oF BLISTERS EPIDERMAL, Flcald ‘+ Ruptures by itself © Does not heal wth scarring 2 Heals with byperpigm MMreTicn 00:35 Does not rupture byitself Heats with scarring Heats wth Hypopig 02:51 istering Disorders aw ‘Non bulous [impetigo cantogiosa (contagious toother cilren)] 4 Streptoctecus ‘Stophylacccaus t CAF horey coloured crust Pattern on Stph eT toxin) +"Scissor” 1 perma toxin = at Subcornel buster ‘Aka exfoliative DE-ve toxinPeMPHicus 14:40 1. PFoLIAcEous — >} Hrpepyen Sign “Foliage” + leaf Like scale presentation Ghost read ——— Subvowmall flute, ‘Auwys ere iy cerita By fll eae richer OT, pension cidasitne |) gly lon burnt child + FF -rw mere dertin halt oe oe ‘+ DG" diseases do not have mucosal involvement 6 [Pag-f-y macs in saborric aren: 4 'S85S - Noorl/ genta ulcers Th ‘Therefore PF scales are seen maintyon scalp, fc, upper trunk2, VULGARIS(PV) 3. P.VEGETANS Less flaceid than PF «Allover J body © Vegetable-ike (caiflover tke masses) Infact blister may be seen 1 ‘© Severe mucosal In flexes Uke oxlla painful cers > Variant of P.\ulgars ora ers Eye ulcers Genitl ulcers 4, PARANEOPLASTIC PEMPHIGUS ‘© als internat malignancy, mainly NE, other CLL ‘thymoma ‘© Pemphigus has +ve Nkalsky sign +e Nikalshy sign seen in + 2typesof PY een pees ee eee 1 Pemphigus Only mucosal bso 1 3. Epldermal necrolysis Only mucosal ulcers t Anf-bsg3MANAGEMENT eee eee ‘Steroid || Azathiopr || Cycloph || Hycoph je 48.17 || ine cxphamt || enolate é mofetil, ‘© New ny ituximad ‘+ BPinpregnancy + pemphigoid gestationis 1 © Rea herpes gestationis Honeclnd Ab agcnst Cb 20 receptor ‘on Bell surface al alll =) ® econ Elderly patient ** (INICET Nov 21) BP ‘ ‘oval margin Tense chy Blisters coming on ed skin or i» beyond pen mark orm skin ‘+ Urticaria like lesions os = } Pointed ’ fh extension pe DERMATITIS HERPETIFORMIS (DH) azar Herpes Grouped blisters nH reserbling Herpes t Eosinophils itch inl - blisters ‘Subepiermd blister Very very tehy || Tense 4 + Patent serach || Poplar ster ‘© Bulla spread sign (Lut sign, Asboe Hansen ony ee sign) =:we got UL eer “gh el IgA in papilla Neto in pop = pplarymirebeess “© Blister in poplla > tense in, Ighat tip of popil Cm in grnuar pattern yReatwent © Glen free diet + Dopsone (ont neutrophilic rug) LUisA/cHRONIC BULLOUS 51358 DISORDER OF CHILDHOOD (CED) © CBC > Child © UGA adit °F, SWAN Linear loot DED‘+ CIF Hehy ister ine ring 1 Cluster of jewels on String of pearls © DOC -Depsone WAILEY-HAILEY DISEASE (HHD) 54:09 ‘Weok KC rupture in fiction oeas, Uke xa t Eplermal flaccid blste forms but ruptures die fo ribbing 1 Fissures/rau oeas i axla/grcin ‘+ Bkabenign fami. pemphigus t uns infomies '* HIP brick wall appearance bls sorb iaptes ker) © Br at ge, | oreo a ie CONGENITAL EPIDERMOLYSIS BULLOSA (EB) 5750 e880 q Tense ‘Scarring EB) ro laminin DD no ‘+ Trauma indsced blisters a site of handing of bby he[ci ister ro on di ‘© Dx-electron microscopy DF ve Re + no treatment possible