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Eczema
(Dermatitis)
Defective
cement Fluid

Intercellular edema
(Spongiosis)
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5 or 14
 Slide 9- Appendage/ Adnexa

Pilo

Eccrine sweat gland Apocrine sweat gland

• Everywhere else • Axilla
• Perineum
• Areola
 Miliaria (occlusion due
to Staph. Slide 10
Epidermidis)
Hidradenitis
suppurativa

Acne vulgaris

Fordyce spots –
Ectopic sebaceous glands
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Slide 12 Hormonal acne

Inflammation

PCOD
Androgen
receptor

5-αR
DHT T
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UVA (320-400 nm) UVB (290-320 nm)

Psoralen No Psoralen
• Broad band UVB (290-320
2
nm)
hrs

UVA • Narrow band UVB (311 nm

Q)
(PUVA)
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Slide 24 Male AGA
Slide 25 Female AGA
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Chronic urticaria (>6 Weeks)
Acute urticaria (<6 wk)
1) Physical
• Food - Scratching (dermographism)
• Infections - Cold (cold urticaria )
• Drugs - Sun (solar ” )
- Water (aquagenic ” )
- Stress (adrenergic ” )
- Sweat (cholinergic ” )
2) Autoimmune urticaria
3) Idiopathic urticaria
Slide 27 DEJ
DEJ
 Basal B
Keratinocyte

Dermo- epidermal Lamina

L lucida

junction
Lamina
L densa

D
Dermis
B

Anchoring
L
filaments
L

Anchoring
D fibres
 2 Proteins in
B
anchoring
filaments
BP 1 (BP-230)
BP 2 (BP-180)
L

1 Protein in
D anchoring fibre
(Collagen 7)
• BP- bullous pemphigoid
• LIGA- linear IgA disease
• EBA- epidermolysis bullosa acquisita
 BP
B
BP, LIGA

BP 1
BP 2
L

Anchoring
D fibres
Collagen 7

EBA
Disease Ag Ab Congenital Onset Level DIF
defect

BP BP-1 Anti-BP-1 - Acq Lucida +

(Minor) Anti BP-2
BP-2 (IgG)
(Major)
LIGA BP-2 Anti-BP-2 - Acq Lucida +
(IgA)
EBA Collagen-7 Anti - Acq Dermis +
Collagen-7
(IgG)
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A) Exogenous TB
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Causes
• NO: No cause, Neutrophilic dermatoses
(Behçet’s disease, Sweet’s syndrome)
• D: Drugs (sulfonamides)
• O: OCP
• S: Sarcoidosis
• U: Ulcerative colitis(also Crohn's)
• M: Microbes (Strepto), Maternity, and
Malignancy (hematological)
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1) m/c Peripheral nerve= Ulnar (UL), Post tibial (LL)
2) ” deformity = Claw hand
3) ” Cranial nerve= Facial
4) ” Hansen in India= BT
5) ” internal organ involved= Testis
6) ” nerve for biopsy- Radial cutaneous > Sural
7) Earliest sensation lost= Thermal
8) Sensation never lost- Propioception, vibration
9) Internal organ rarely involved= Uterus/CNS
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MDT

(Hypersensitivity)
TT
T cell Hypersensitivity LL
Type 1 lepra reaction B cell Hypersensitivity
aka Reversal reaction Type 2 lepra reaction
aka Erythema nodosum leprosum
(ENL)
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Slide 38 ZN staining on SSS

S + F + G= Bacteriological index (BI)

S= Morphological index (MI)
 Slide 39 Treatment

Thickened lesions SSS

Nerves

>1 1-5 >5 Negative Positive

1

PB MB PB MB PB MB
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Slide 42 2. Condyloma lata
(Flat moist lesions- anus)

1. Rash
• Non itchy
• The great imitator
• No blisters
• Scales- Palm, sole
Secondary
stage
4. Moth eaten alopecia
(non scarring alopecia) 3. Mucosal involvement
(Mucous patches/ Snail
track ulcers)
EARLY SYPHILIS Primary Inj. Benzathine
( < 2 yrs) Secondary Penicillin 2.4 MU
Early latent im single dose

LATE SYPHILIS Late latent Inj. Benzathine

( > 2 yrs) Tertiary Penicillin 2.4 MU
im 3 doses at
weekly intervals

* Neurosyphilis- i.v.
Aqueous
Crystalline
Penicillin
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(Pund cells)
Slide 48 Urethritis
Gonococcal Non-gonococcal
• N. gonorrhea • Chlamydia/ Trichomonas/
• IP: 2-8 days mycoplasma/ ureaplasma
• Thick purulent urethral • IP: 1-3 weeks
discharge • Thin muco-purulent
• Treatment urethral discharge
- Inj. Ceftriaxone 500 mg • Treatment
im stat (preferred) - Doxy 100 mg BD for 7
Alternative days (preferred)
- Tab cefixime 800 mg stat - Tab Azithromycin 1 gm
stat
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Syndromic approaches
 Vaginal discharge
INI CET 2021
Nov

Candidal vaginitis Trichomonas vaginitis Bacterial vaginosis

 Vaginal discharge
INI CET 2021
Nov

Candidal vaginitis Trichomonas vaginitis Bacterial vaginosis

Fluconazole +
Secnidazole
Doxycycline 100 mg BD for 21 d
+
Azithromycin 1 gm stat
Blister
Lower abdominal
Pain (For PID)
 Vaginal discharge

Candidal vaginitis Trichomonas vaginitis Bacterial vaginosis

-White creamy Green frothy discharge Foul smelling discharge
minimal discharge Profuse discharge Ph > 4.5
-Itching ++ Strawberry cervix No itch
-Dysuria + Itching +
Dysuria +
Bacterial Vaginosis
 No Partner treatment Q -
• Gardenella
• Herpes
• Candida
• Sudden withdrawal of systemic steroids
• Pregnancy
• Emotional stress
• Smoking, Alcohol
• Infections- streptococcus
• Drugs (B-blockers, Lithium, Chloroquine, NSAIDS,
ACEI)
 Biologicals
• TNF inhibitors
- Infliximab
- Adalimumab
- Etanercept
• IL 12/23 inhibitors
- Ustekinumab
• IL‐17 inhibitors
- Secukinumab
Non-Inflammatory
(Non-scarring
Inflammatory
alopecia) (Scarring alopecia)

• Gray patch (scaly) • Kerion

Microsporum (Boggy swelling)
Trichophyton
Microsporum
• Black dot
Trichophyton • Favus
(Yellow Scutulum)
Trichophyton
 HSV / VZV

Acantholytic cells
Multinucleate giant cell
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Hanifin and Rajka criteria
(Any 3 out of )-
1) Itching- HALLMARK
2) Typical sites
- Extensor dermatitis in children
- Flexural dermatitis in adults
3) Personal/ family history of atopy
4) Chronic, relapsing course
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Irritant Contact Dermatitis
• Not immunological
• Due to toxic chemicals
• Memory cells not involved
• Eg:
1) Detergents (house-
wives eczema)- m/c Q
2) Acid and alkali burns
Allergic Contact Dermatitis
• Immunological Type 4
hypersensitivity
• Memory cells involved
• In predisposed persons
• Diagnosis- Patch test
• Eg:
1) Nickel – m/c overall Q
2) Para-Phenylene
Diamine (PPD) in hair dye
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Photo-
patch
closed
open

Becomes red
Remains
normal
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Level of blisters
Epidermal Dermal / DEJ

• Flaccid • Tense
• Ruptures by itself • Does not rupture by
• Does not heal itself
with scarring • Heals with scarring
• Heals with hyperpigm • Heals with hypopigm
 Hypopyon
sign
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Toxin
disseminates into
Blood
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Pathogenesis of DH

ETG