Dermatitis and Eczema

Dermatitis and Eczema Indian Medical PG Question 1: Which of the following are treatment options for acne vulgaris?

• A. Isotretinoin
• B. All of the options (Correct Answer)
• C. Topical erythromycin
• D. Oral Minocycline

Dermatitis and Eczema Explanation: ***All of the options*** - All listed options (Isotretinoin, Topical erythromycin, and Oral Minocycline) are well-established and commonly used **treatment options for acne vulgaris**, depending on the severity and type of acne. - The choice of treatment often follows a stepped approach, starting with topical agents for mild to moderate acne and progressing to oral medications like antibiotics or isotretinoin for more severe or resistant cases. *Isotretinoin* - **Isotretinoin** is a powerful oral retinoid primarily used for **severe, recalcitrant nodular acne** that has not responded to other treatments. - It works by reducing sebum production, follicular hyperkeratinization, inflammation, and the growth of *P. acnes*. *Topical erythromycin* - **Topical erythromycin** is an **antibiotic** used to treat mild to moderate inflammatory acne by reducing the growth of *Cutibacterium acnes* (formerly *Propionibacterium acnes*) and decreasing inflammation. - It is often combined with other topical agents like benzoyl peroxide to minimize the development of **antibiotic resistance**. *Oral Minocycline* - **Oral minocycline** is a **tetracycline antibiotic** used for moderate to severe inflammatory acne. - It reduces bacterial populations on the skin and exhibits **anti-inflammatory properties**, making it effective for widespread or deeper lesions.

Dermatitis and Eczema Indian Medical PG Question 2: A person has presented with history of dog-bite on the uncovered surface of his right leg. There is a minor abrasion without bleeding. Consider the following statements about management : 1. The bite should be taken as a category I contact with suspect animal 2. The bite requires local treatment of the wound 3. The person requires immediate vaccination 4. The person requires immediate administration of rabies immunoglobulin Which of the above statements are correct ?

• A. 2 and 3 only (Correct Answer)
• B. 1 and 2
• C. 2, 3 and 4
• D. 3 and 4 only

Dermatitis and Eczema Explanation: ***2 and 3 only*** - A minor abrasion without bleeding falls under **Category II exposure** per WHO guidelines, requiring **local wound treatment** and **immediate vaccination**. - **Category II exposures** are defined as nibbling of uncovered skin, minor abrasions without bleeding, or scratches without bleeding. *1 and 2* - The bite described (minor abrasion without bleeding) is classified as **Category II exposure** by WHO, not Category I. - **Category I contact** involves touching or feeding an animal, or licks on intact skin, requiring **no post-exposure prophylaxis** as there is no breach of skin integrity. *2, 3 and 4* - While local wound treatment and vaccination are correct for Category II exposure, **rabies immunoglobulin (RIG)** is not indicated for Category II. - RIG is reserved for **Category III exposures**, which involve single or multiple transdermal bites or scratches, contamination of mucous membranes with saliva, or licks on broken skin. *3 and 4 only* - Immediate vaccination is correct, but **rabies immunoglobulin** is not necessary for a minor abrasion without bleeding (Category II exposure). - Administration of RIG is only indicated after **Category III exposures** due to the higher risk of rabies transmission.

Dermatitis and Eczema Indian Medical PG Question 3: Match the following scale types with their lesions. | Scales | Lesions | | :-- | :-- | | 1. Collarette scales | a. Pityriasis versicolour | | 2. Silvery scales | b. Pityriasis rosea | | 3. Mica-like scales | c. Psoriasis | | 4. Branny scales | d. Pityriasis lichenoides |

• A. 1-d, 2-c, 3-a, 4-b
• B. 1-c, 2-b, 3-d, 4-a
• C. 1-a, 2-b, 3-d, 4-c
• D. 1-b, 2-c, 3-d, 4-a (Correct Answer)

Dermatitis and Eczema Explanation: ***1-b, 2-c, 3-d, 4-a*** - **Collarette scales** are pathognomonic of **Pityriasis rosea**, appearing as fine, trailing scales around the periphery of oval lesions in a "Christmas tree" distribution. - **Silvery scales** are the classic hallmark of **Psoriasis**, presenting as thick, adherent, silvery-white scales overlying well-demarcated erythematous plaques. - **Mica-like scales** are characteristic of **Pityriasis lichenoides**, appearing as thick, shiny, adherent scales that can be peeled off like mica sheets. - **Branny scales** are typical of **Pityriasis versicolor**, presenting as fine, powdery scales caused by **Malassezia** yeast overgrowth. *1-d, 2-c, 3-a, 4-b* - Incorrectly matches **collarette scales with Pityriasis lichenoides**, which typically presents with mica-like scales, not collarette scales. - Misassociates **mica-like scales with Pityriasis versicolor**, which characteristically has branny (fine, powdery) scales. *1-c, 2-b, 3-d, 4-a* - Wrongly pairs **collarette scales with Psoriasis**, which is known for thick silvery scales, not peripheral collarette scales. - Incorrectly matches **silvery scales with Pityriasis rosea**, which has collarette scales at lesion periphery, not silvery scales. *1-a, 2-b, 3-d, 4-c* - Falsely associates **collarette scales with Pityriasis versicolor**, which has branny scales from yeast infection, not collarette scales. - Mismatches **branny scales with Psoriasis**, which has characteristic thick silvery scales, not fine powdery scales.

Dermatitis and Eczema Indian Medical PG Question 4: Identify the diagnosis based on the dermatology immunofluorescence (IF) image provided.

• A. Pemphigus vulgaris
• B. Pemphigus foliaceus
• C. Bullous pemphigoid
• D. Dermatitis herpetiformis (Correct Answer)

Dermatitis and Eczema Explanation: ***Dermatitis herpetiformis*** - The immunofluorescence image shows **granular IgA deposits** at the **dermal papillae region**, which is characteristic of dermatitis herpetiformis. - This condition is strongly associated with **celiac disease** and presents with intensely pruritic papules and vesicles. *Pemphigus vulgaris* - Immunofluorescence in pemphigus vulgaris typically shows a **fishnet pattern** of IgG deposits throughout the **epidermis**, reflecting antibodies against desmoglein 3 and 1. - This pattern is an intercellular deposition, not granular at the dermal papillae. *Pemphigus foliaceus* - Similar to pemphigus vulgaris, pemphigus foliaceus also exhibits **intercellular IgG deposits** in the epidermis, but it is usually more superficial, targeting desmoglein 1. - The image does not show this intercellular epidermal staining. *Bullous pemphigoid* - Bullous pemphigoid is characterized by **linear IgG and C3 deposits along the dermal-epidermal junction** (basement membrane zone). - The image distinctly shows granular IgA, not linear IgG/C3, and specifically in the dermal papillae.

Dermatitis and Eczema Indian Medical PG Question 5: A 25-year-old patient presents with chronic itchy, erythematous skin lesions on the flexural areas that have been recurring since childhood. The patient has a family history of asthma. Which of the following is the most important diagnostic criterion for the most likely diagnosis?

• A. Personal or family history of atopy
• B. Elevated serum IgE levels
• C. Early age of onset (before 2 years)
• D. Chronic pruritic eczema with typical morphology and distribution (Correct Answer)

Dermatitis and Eczema Explanation: ***Chronic pruritic eczema with typical morphology and distribution*** - The patient presents with **chronic**, **itchy**, **erythematous lesions** on the **flexural areas** (e.g., antecubital and popliteal fossae), characteristic of **atopic dermatitis** (eczema). - The **recurrence since childhood** and the typical distribution represent the **major diagnostic criteria** based on clinical morphology and distribution. - **Clinical presentation with typical morphology** is the **primary diagnostic criterion** according to Hanifin and Rajka criteria. *Elevated serum IgE levels* - While **elevated serum IgE** is often associated with atopic dermatitis, it is a **minor criterion** and a **laboratory finding**, not a primary diagnostic feature. - It reflects an **atopic predisposition**, but **clinical morphology and distribution** remain the most important diagnostic factors. *Personal or family history of atopy* - A **family history of asthma** (an atopic condition) is a **minor criterion** that supports the diagnosis of atopic dermatitis. - However, this is a **predisposing/supporting factor**, not as important as the characteristic clinical morphology and distribution. *Early age of onset (before 2 years)* - While atopic dermatitis often begins in **infancy or early childhood**, this is a **minor criterion** in the diagnostic framework. - The question states symptoms **recurring since childhood** but onset timing is less diagnostically important than the characteristic **clinical presentation** with typical morphology and distribution.

Dermatitis and Eczema Indian Medical PG Question 6: Dermatological manifestation of which of the following diseases?

• A. Photo dermatitis
• B. Pellagra (Correct Answer)
• C. Acrodermatitis enteropathica
• D. Vitamin B deficiency

Dermatitis and Eczema Explanation: ***Pellagra*** - The image shows a classic "butterfly" rash on the face, specifically a photosensitive dermatitis, which is a hallmark of **pellagra**. - Pellagra is caused by a deficiency of **niacin (vitamin B3)**, characterized by the "3 D's": **dermatitis**, **diarrhea**, and **dementia**. *Photo dermatitis* - While pellagra often presents with photosensitive dermatitis, "photo dermatitis" is a general term for **skin inflammation caused by light exposure** and not a specific disease itself. - It could be caused by various factors, including medication, immune reactions, or other underlying conditions, but the pattern seen here is highly suggestive of pellagra. *Acrodermatitis enteropathica* - This condition is a **hereditary zinc deficiency** that typically presents with a periorificial and acral dermatitis. - The skin lesions are typically **vesicular-pustular or eczematous** and do not usually have the distinct butterfly pattern of photosensitive dermatitis seen in the image. *Vitamin B deficiency* - While pellagra is a vitamin B **(niacin, B3)** deficiency, this option is too broad. - Other vitamin B deficiencies, such as **riboflavin (B2)** or **pyridoxine (B6)** deficiency, have different dermatological manifestations like angular cheilitis, glossitis, or seborrheic dermatitis, but not the characteristic facial rash seen here.

Dermatitis and Eczema Indian Medical PG Question 7: The burrow in scabies is in

• A. S. corneum (Correct Answer)
• B. Malpighian layer
• C. S. germinatum
• D. S. granulosum

Dermatitis and Eczema Explanation: ***S. corneum*** - The **burrow** created by the *Sarcoptes scabiei* mite is specifically found within the **stratum corneum** of the epidermis. - This superficial location allows the mite to feed on **keratinocytes** and deposit eggs, leading to the characteristic rash and intense itching. - The burrow appears as a **serpiginous tract** and is a pathognomonic finding in scabies. *Malpighian layer* - The **Malpighian layer** encompasses the **stratum basale** and **stratum spinosum**, which are deeper layers of the epidermis. - The scabies mite does not burrow into these deeper, metabolically active layers. *S. germinatum* - **Stratum germinativum** is another term for the **stratum basale**, the deepest epidermal layer responsible for cell division. - The scabies mite creates burrows at a much more superficial level in the stratum corneum. *S. granulosum* - The **stratum granulosum** lies between the stratum spinosum and stratum corneum. - While closer to the surface than the Malpighian layer, scabies burrows are specifically located in the more superficial **stratum corneum**, not the granulosum layer.

Dermatitis and Eczema Indian Medical PG Question 8: The skin condition shown in the image is associated with?

• A. Diabetes mellitus (Correct Answer)
• B. Hypothyroidism
• C. Hyperthyroidism
• D. Sarcoidosis

Dermatitis and Eczema Explanation: ***Diabetes mellitus*** - The image shows **diabetic dermopathy** (also known as "shin spots"), which presents as hyperpigmented, atrophic macules or papules, usually on the shins. This condition is a common cutaneous manifestation of **diabetes mellitus**. - Other dermatological conditions associated with diabetes include **necrobiosis lipoidica diabeticorum**, **acanthosis nigricans**, and **erythrasma**, which are important to recognize in patients with diabetes. *Hypothyroidism* - Hypothyroidism is associated with **myxedema**, which typically manifests as non-pitting edema, dry and coarse skin, and hair loss. - While it can cause skin changes, it does not typically present with the pigmented, atrophic lesions seen in the image. *Hyperthyroidism* - Hyperthyroidism can cause skin changes such as **pretibial myxedema** (a specific form of localized skin thickening, typically on the shins, that is often associated with Graves' disease) and warm, moist skin due to increased metabolism. - The lesions shown in the image are not consistent with the typical presentation of pretibial myxedema or other hyperthyroid skin manifestations. *Sarcoidosis* - Sarcoidosis can present with various skin lesions, including **erythema nodosum**, lupus pernio, plaques, and papules. - The skin changes seen in the image, characterized by small, atrophic, hyperpigmented macules, do not fit the typical pattern of cutaneous sarcoidosis.

Dermatitis and Eczema Indian Medical PG Question 9: A patient presents with the skin lesions shown in the image. All of the following are routinely indicated for the treatment of this condition EXCEPT:

• A. Rituximab (Correct Answer)
• B. Topical vitamin D
• C. Cyclosporine
• D. Acitretin

Dermatitis and Eczema Explanation: ***Rituximab*** - The image displays **plaque psoriasis**, characterized by erythematous plaques with silvery scales. Rituximab, an anti-CD20 monoclonal antibody, targets B-cells and is primarily used in conditions like **lymphoma, leukemia, and rheumatoid arthritis**, not typically for psoriasis. - While some off-label uses or investigational studies might explore its role, it is **not routinely indicated** for the treatment of psoriasis. *Topical vitamin D* - **Topical vitamin D analogs** (e.g., calcipotriene, calcitriol) are a common first-line treatment for mild to moderate plaque psoriasis. They work by **inhibiting keratinocyte proliferation** and promoting their differentiation. - These agents are often used alone or in combination with topical corticosteroids to reduce inflammation and scaling. *Cyclosporine* - **Cyclosporine** is a calcineurin inhibitor used as a systemic treatment for severe psoriasis, especially in cases that are refractory to topical therapies or phototherapy. - It works by **suppressing the immune system**, thereby reducing the inflammation and rapid cell turnover seen in psoriasis. *Acitretin* - **Acitretin** is an oral retinoid indicated for severe psoriasis, particularly **pustular and erythrodermic psoriasis**, and in some cases of chronic plaque psoriasis. - It normalizes epidermal cell growth and differentiation, effective for extensive or difficult-to-treat forms of the disease.

Dermatitis and Eczema Indian Medical PG Question 10: A 22-year-old female presents with dry papules in the seborrheic areas, especially in the summer. Her father also has a history of similar lesions. What is the most probable diagnosis?

• A. Pemphigus foliaceus
• B. Keratosis pilaris
• C. Darier's disease (Correct Answer)
• D. Seborrheic dermatitis

Dermatitis and Eczema Explanation: ### Explanation **Correct Answer: C. Darier’s Disease** **Why it is correct:** Darier’s disease (Keratosis Follicularis) is an autosomal dominant genodermatosis caused by a mutation in the **ATP2A2 gene**, which encodes the **SERCA2 calcium pump**. This defect leads to a loss of cell-to-cell adhesion (acantholysis) and abnormal keratinization. * **Clinical Presentation:** It typically manifests as greasy, crusted, "dirty-looking" **malodorous papules** in a **seborrheic distribution** (chest, back, forehead, and scalp). * **Exacerbating Factors:** A classic hallmark is **photo-exacerbation**; lesions characteristically flare up during the **summer** due to heat, humidity, and UV exposure. The positive family history in this case further supports an inherited condition. **Why the other options are incorrect:** * **A. Pemphigus foliaceus:** While it involves acantholysis and affects seborrheic areas, it presents with superficial blisters and erosions rather than persistent keratotic papules, and it lacks a strong genetic/hereditary pattern. * **B. Keratosis pilaris:** Presents as "goose-flesh" papules on the extensor surfaces of arms and thighs. It is not typically found in seborrheic areas and does not flare specifically with summer heat. * **D. Seborrheic dermatitis:** Though it occurs in the same distribution, it presents as erythematous plaques with greasy yellow scales (dandruff-like) rather than discrete keratotic papules, and it usually improves or remains stable in summer rather than worsening. **High-Yield Clinical Pearls for NEET-PG:** * **Nail Findings:** Pathognomonic **"V-shaped" nicking** at the distal margin and longitudinal red/white bands. * **Mucosal Findings:** "Cobblestone" appearance of the oral mucosa. * **Histopathology:** Look for **"Corps ronds"** (in the stratum spinosum) and **"Grains"** (in the stratum corneum). * **Hand Findings:** Palmar pits and punctate keratosis.

Dermatitis and Eczema Flashcard 1 of 10

Question: Pityriasis alba is often a manifestation of _____

Answer: atopic eczema

Dermatitis and Eczema Flashcard 2 of 10

Question: _____ is the only recommended systemic therapy for chronic hand eczema.

Answer: Alitretinoin

Dermatitis and Eczema Flashcard 3 of 10

Question: _____ eczema is primarily caused by microorganisms or their products.

Answer: Infective

Dermatitis and Eczema Flashcard 4 of 10

Question: What kind of dermatitis is seen in Eczema?_____

Answer: Spongiotic

Dermatitis and Eczema Flashcard 5 of 10

Question: Atopic dermatitis in _____ most commonly involves the flexor aspects (wrists, ankle) and neck

Answer: children

Dermatitis and Eczema Flashcard 6 of 10

Question: Chlamydia trachomatis

Answer:

Extra Information: reactive arthritis, conjunctivitis, urethritis, PIDazithromycin or doxycycline

Dermatitis and Eczema Flashcard 7 of 10

Question: Campylobacter jejuni

Answer: -

Extra Information: comma shapedgrows at 42° C mnemonic: Campy likes a hot campfire +dysentery, Guillain-Barre, reactive arthritispoultry, puppies, undercooked meat, unpastuerized dairy

Dermatitis and Eczema Flashcard 8 of 10

Question: Pseudomonas aeruginosa

Answer: -

Extra Information: bacilliaerobic-+pneumonia, otitis externa, UTI, osteomyelitis, folliculitisaminoglycoside + wide spectrum penicillinexotoxin A

Dermatitis and Eczema Flashcard 9 of 10

Question: Neisseria gonorrhoeae

Answer: -

Extra Information: diplococciyes, polysaccharide capsule-gonorrhea, septic arthritis, neonatal conjunctivitis, PID, Fitz-Hugh-Cutris syndromeceftriaxone + (azithromycin or doxycycline for potential chlaymidia coinfection)

Dermatitis and Eczema Flashcard 10 of 10

Question: Peyronie's disease

Answer: fibrotic tissue formation in penis shaft

Extra Information: non-painful, bent penis