PSORIASIS VULGARIS LICHEN PLANUS PITYRIASIS ROSEA

dusky red erythematous plaque + silvery white lamellar scale site: - extensor surface (elbow/knee) histopatho: 1. parakeratosis 2. absent stratum granulosum 3. test tube acanthosis 4. dilated capillary 5. elevated dermal papillae other types: - ps. vulgaris - pustular ps - eryhtrodermic (>80% of body) - arthropathic tyoe - linear/zosteriform - palmoplantar ps. - flexular ps. - circinate ps. - guttate ps. *Auspitz sign = on removal of scales bleeding point 3 topical Rx: - emollient (Vaseline) - keratolytic (salicylic acid) - Vit D analogue - steroid in localized case - PUVA *topical steroid may cause relapse + pustular psoriasis 3 systemic Rx: - methotraxate - cyclosporine - syst retinoid (acetritine) - systemic PUVA (etamercept) *phototherapy - UVB (narrow band, broad band) - UVA (topical, systemic PUVA)

- well defined, flat topped violaceous papules - central umbilication *Wickhams striae site: - flexors of UL (WRIST!) - inner aspect of thigh - genitalia - face & around the neck - in scalp causing cicatricial alopecia histopatho: 1. hyperkeratosis 2. wedge shape/irregular hypergranulosis 3. saw tooth acanthosis 4. liquefactive necrosis of basal cell layer 4. band like mononuclear infiltration 5. melanophages clinical types: 1. LP of the nail (pterygium) 2. lichenplanopilaris (follicular) 3. oral mucosal LP - reticular type (most common) - erosive type 4. annular 5. photosensitive 6. hyperkeratotic (palm & sole) associated oral lesion: - reticular *benign - ulcerative/erosive *malignant associated systemic disease: - Hep C - autoimmune disease Rx: 1. topival anti-histaminic 2. antibiotic for septic focus 3. topical & systemic steroid 4. calcicotriol 5. keratolytic *steroid in LP : - acute guttate LP - generalized

etio: reactivation of Human Herpes Virus (HHV) 6,7 initial lesion: Herald patch - central caf au lair - collarete scales - erythematous margin prognosis/course : self limited in 6 weeks Rx: - anti-histamine (itching) - keratolytic (scaling) DDx - 2ry syphilis *most serious - pityriform eruption - acute LP

ACNE VULGARIS PEMPHIGUS VULGARIS PEMPHIGUS FILACIOUS

*Area of large sebaceous gland + fine hair pathogenesis: 1. follicular hyperkeratinisation 2. sebum production 3. Pripioni bacterial proliferation 4. inflammation 5. androgen i) non-inflammatory = comedone open (black heads) closed (white heads) Rx: (acne vulgaris) topical retinoid ii)inflammatory = pustules/ nodular cystic /erythematous papules Rx of mild (topical) 1. topical retinoid 2. benzoyl peroxide 3. antibiotic (clindamycin, erythromycin) 4. azeleic acid Rx of NODULAR CYSTIC ACNE - systemic retinoid (isotretinoin) *of choice! - systemic antibiotic (deoxycycline, tetracycline, clindamycin, erythromycin) complications of inflammatory acne: - scar - post eruptive hyperpigmentation Rx of scar: - dermal abrasion - peeling - laser

= flaccid vesicles, easily rupture, leaving raw area histopatho: suprabasal acantholysis antibodies against desmoglial 3 initial lesion : bullous eruption *Nilkolsky sign: Rx: 1. high dose steroid 1-1.5 mg/kg/day PO 2. other immunosuppressive: - aziothioprine - cyclosphosphamide 3. syst antibiotic to prevent 2ry bacterial infection 4. water fluid replacement complications: - 2ry bacterial infection - septic shock - sepsis - water loss electrolyte imbalance - protein loss edema (complication of steroid) - Cushinoid face - DM, HTN

- intraepidermal subgranular acantholysis

EPIDERMOLYSIS BULLOSA XERODERMA PIGMENTOSA ICTHYOSIS

hemorrhagic bullae at extremeties types: - simplex - junctional - atrophic?? Rx: - prevention of trauma - smooth dressing

- RNA enuclease complication: - malignant Rx: - sun protection

- polygonal translucent scale - attached at centre - detached at periphery etio : fillagrin gene mutation

CRUSTED IMPETIGO BULLOUS IMPETIGO ULCERATIVE IMPETIGO

(ECTHYMA) ERYTHRASMA

etio : strep/staph site : periorificial complications : - ASPGN - eczematisation - cellulitis/erysipelas - 3septicaemia Rx: - K permanganate compression - dry with gentian violet - topical antibiotic

etio : staph complications: - 2ry eczematisation - sepsis - disseminated bacterial infection (erysipelas, 4s syndrome)

etio : strep shin of tibia complications: scarring

etio : corynebacterium minutissumum flexural area Woods light : coral red Rx: - topical azole - systemic erythromycin

CRUSTED ULCERATIVE

- yellowish - brownish (hemorrhagic)

- friable, easily removed - adherent, diff to remove

- eroded skin after removal - ulcer after removal

- peri-oral - shin of tibia, bony prominence

- any child

needs predisposing factors - iron-def anaemia - recurrent trauma - parasitic dis (scabies,pediculosis)

- heals by normal skin heals by scar

SCABIES PEDICULOSIS ACUTE ANTERIOR

GONOCOCCAL URETHRITIS ERYTHEMA

MULTIFORME

polymorphic eruption - excoriated papule - scratch marks site: - finger web - flexor of rist - ulnar border of arm - under axilla - around umbilicus - genitalia - groin - breast cause : adule female Sarcoptes Scabii antiscabitic Rx: 1. malathion0.5 % 2. benzyl benzoate 10% 3. crotamiton 10% 4. gamma benzene hexachloride 1% 5. pyrethrin 5% *systemic = ivermectin Number of mites/case = 12 complications: - 2ry infection - eczematisation

- urticaria - acarophobia

lice : pediculus humanus capitis complications : - lymphadenopathy - 2ry bact infection - urticaria - lichen eczema rx: - malathion 0.5%

cause : Niesseria Gonorrhea - gram stain : gram ve - intrecellullar - kidney shaped - diplococcic *Thayer Martin culture * test : oxidase, fermentation Rx: ceftriaxone250mg IM single dose non-gonococcal cause: -chlamydia - mycoplasma -

initial lesion : target lesion - - - * herpes iris etio: 1. drugs - NSAID - anti-epileptic 2. post-infection (HSV) 3. malignant subtypes: - macula-papular - vesiculo-bullous - Steven-Johnson - Rx:

TINEA CAPITIS

NON-INFLAMMATORY INFLAMMATORY FAVUS

GREY PATCH BLACK DOTS KERION CELSI

etio: black dots = Trychophyton violeceum grey patch = Microsporum inv: - scrapping & KOH

black dots grey patch

endothrix ectothrix

No hair stumps w hair stumps scales

- culture - Woods light DDx of non-cicatricial alopecia: - alopecia areata - 2nd stage syphilis - trichotillomania - trichocryptomania Rx of choice: Griseofulvin 12.5mg/kg/day for 6 wks other Rx: - itraconazole - terbenafine *TOPICAL antifungal has NO role in T.capitis & onychomycosis

= boggy swelling w/ multiple oozing point etio: Microsporum canis complications : - cicatricial alopecia - 2ry bacterial infection inv: - scrapping & KOH - culture w/ seborrheic dextrose - Woods light DDx of cicatricial alopecia: - kerion selci - discoid lupus - severe trauma - 3rd stage syphilis - LP pilaris Rx: (all SYSTEMIC) 1. antifungal - ultragriseofulvin 10mg/kg/day - azole group (flucoazole/itraconazole) - terbenafine 2. systemic antibiotic 3. systemic steroid

etio: trichophyta sconlei initial lesion : scutulum

TINEA CORPORIS (CIRCINATA)

EROSIVE INTERDIGITALIS ONYCHOMYCOSIS PITYRIASIS VERSICOLOR

well defined circinate patch - scaly patch - healing centre - active margin other types: - t. facii - t. pedia & manuum - t. corporis - t. circinata T. Pedis subtypes: - vesiculo-bullous/eczematous - hyperkeratotic - toe web maceration (athletic foot) - circinate type 2 topical Rx: 1. anti-fungal 2. DDx of other circinate lesions: - - -

etio: 1. fungal - dematophytes - candida 2. bacteria - gram ve - pseudomonas 3. mixed 4. physical factors (hyperhydrosis, trauma) Predisposing factors: - DM - hyperhydrosis - fitting shoes/socks

hypo/hyperpigmented macules + fine branny scales etio : yeast-mycelial shift of commensal pitysporum ovale, orbiculare into malessezia furfur site : seborrheic area - neck, chest, upper back, upper extremeties inv: 1. scrappig & KOH = spaghetti & meat ball app 2. culture 3. Woods light = golden yellow Rx: 1. topical anti-fungal (main) 2. systemic anti-fungal - fluconazole - itraconazole 3

CHICKEN POX HERPES ZOSTER HERPES LABIALIS

- discrete vesicle on erythematous base cause: = 1ry infection of Varicella Zoster virus MOT: = droplet infection - in groups, discrete - pleomorphic (vesicles + papules + crust) *NOT monomorphic (6entrip-vesicular urticaria)/polymorphic (scabies) distribution : 6entripetal complications: 1. 2ry bacterial infection 2. scar 3. viral pneumonia 4. encephalitis 5. hemorrhagic chicken pox Rx: 1. Anti-histamine 2. Soothing agent 3. Topical antibiotics to prevent 2ry bact infection.

- grouped vesicular eruptions overlying erythematous base in dermatomal distribution cause: = reactivation of latent Varicella Zoster virus - pain (1st obvious manifestation) - vesicular eruption overlying erythema - unilateral - dermatomal/zosteriform complications: 1. post-herpetic neuralgia (most common) 2. gangrenous & hemorrhagic type 3. dissemination causing viral meningitis, viral pneumonia 4. nerve palsy systemic Rx: 1. systemic anti-viral - acyclovir - famicyclovir - valacyclovir 2. systemic antibiotic 3. systemic analgesics

cause: = reactivation of Human Simplex Virus type 1 (HSV-1) *HSV-2 genital warts Types of 1ry lesions: 1. 1ry gingivo-stomatitis 2. herpetic kerato-conjunctivitis 3. herpetic whitlow 4. Kaposi varicelliform eruption 5. 1ry genital herpes Dx : - Tzanc smear intracellular inclusion bodies

NON VENEREAL WARTS VENEREAL WART

CONDYLOMA ACUMINATA MOLLUSCUM CONTAGIOSUM

*Herpetic whitlow = infection of herpes virus around finger nail VERRUCA VULGARIS - dome shaped papules with rough mamillated surface - single/few on hands & feet cause: HPV-2 other types: - verruca plana - verruca plantaris - verruca filiform - verruca digitiform Rx 1. electrocautery 2. cryocautery 3. laser 4. chemical cautery - Trichloro acetic acid (TCA) - 25% podophyllin VERRUCA PLANA - HPV -minute, multiple flat topped papule w smooth surface - skin coloured - on the face & back of hands *may show Koebners phenomenon Rx : topical retinoid

cause: Human Papilloma Virus (HPV) malignant transformation - in HPV type 16, 18, 45, 31

C. Acuminata C. Lata

HPV 6, 11, 16,18,91 (venereal verruca)

Treponema Pallidum (2ry stage syphilis)

- cauliflower - pedunculated - foul odour - easily bleeds on touch

- sessile - flat topped - doesnt bleeds on touching

Rx by podophyllin

Rx by penicillin

Rx = destruction of the warts i) chemical cautery : podophyllin 25% *teratogenic ii) laser cautery iii) electrocautery iv) cryotherapy *of choice in pregnancy

dome-shpaed pearly white papule + central umbilication in children etio: molluscum pox virus Rx: needle transfixation + curettage DDx of umbilicated skin lesion: - - DDx of other lesion showing Koebners phenomenon: - - - - -

VERRUCA VULGARIS VERRUCA PLANTARIS

- dome shaped other types: Rx:

etio: line of Rx: other types:

VITILIGO ALOPECIA AREATA ATOPIC DERMATITIS URTICARIA

milky white depigmented macule/patch - in any site ( at the site of trauma) pathogenesis i. autocytotoxic theory (by toxic by-product produced during melanin production) ii. auto-immune destruction iii. intrinsic defect of structure & function iv. neural v. defective free radical defense clinical types: 1. localized i) segmental (dermatomal) ii) focal iii) mucosal *bad prognosis (no hair follicle) 2. generalized (>60%) - vulgaris - acrofacial 3. universal

localized area of hair loss devoid of hair stumps & scales (normal scalp) theories: - immunological (autoimmune) - genetic - precipitating factor (stress, septic focus, emotional factor) subtypes: - areata type (1/2 patch) - subtotalis (multiple patch) - totalis (all scalp) - universalis - ophiasis (occipital) bad prognostic sign: - +ve family Hx - ass w/ nail dystrophy & autoimmune disease - subcapsular cataract - ophiasis type - subtotalis/universalis - early onset *exclamation mark! 2 topical Rx 1. steroid 2. irritant althralin DDx of non-cicatricial alopecia *if beard & adult NO tinea capitis! *ANDROGENIC ALOPECIA minoxidil 2% in females 5% in males

Major criteria: - chronic relapsing course -pruritis - +ve family hx of atopy - typical distribution Associated feature (minor criteria) - pityriasis alba - increase IgE - keratoconus - subcapsular cataract Precipitating factors: - winter - exposure to allergen

infantile childhood adult

acute subacute chronic

wet oozing vesicular

dry licheni-fication

- cheek -around eye

extensor flexor

Rx: ACUTE 1. emollient 2. topical steroid 3. K permanaganate compressive 4. topical antibiotic 5. systemic antihistamine CHRONIC 1. emollient 2. keratolytic (salicylic acid) 3. topical steroid 4. topical calcineurin inhibitor (tacrolimus) .5. systemic anti-histamine *AD in adults: - flexural area - Rx : emollient + steroid

initial lesion : WHEAL - well defined erythematous edematous lesion - fading of pressing - evanescence/ migratory *chronic; > 6 wks mech: Type 1 hypersensitivity (IgE mediated) -histamine VD edemawheal Rx: - 1st gen anti-histamine - 2nd gen anti-histamine - 3rd gen anti-histamine *demographic urticaria *URTICARIAL VASCULITIS - NOT evanescent - NO itching pain & burning - biopsy vasculitis - NO response to anti-histamine dapsone *ANGIOEDEMA - loose areolar CT (lips, eyelids, larynx, ext genitalia) Rx: - SC epinephrine - short acting systemic steroid IV - systemic antihistamine

*flexural psoriasis lack scale * crusted scabies lack itching