Autoimmune Skin Diseases Practice Questions

Q: Which of the following is not a feature of dermatomyositis?

Groove sign. ***Groove sign*** - The **Groove sign** (referring to prominent **longitudinal ridging and grooves** in the nails) is NOT a typical feature of dermatomyositis. - This nail manifestation is characteristically seen in **lichen planus** and other conditions, but not in classic dermatomyositis. - In dermatomyositis, nail changes include **periungual telangiectasias**, **ragged cuticles**, and **nail fold capillary changes**, but not prominent nail grooves. *'V' sign* - The **'V' sign** is a characteristic cutaneous finding in dermatomyositis, presenting as **photodistributed erythema** on the anterior neck and upper chest in a 'V' shape. - This distribution corresponds to sun-exposed areas and is a common manifestation of the disease. *Holster sign* - The **Holster sign** refers to **poikilodermatous changes** located on the lateral aspects of the thighs, resembling the area where a holster would be worn. - It is a specific cutaneous manifestation of dermatomyositis, often indicating chronic photodamage in the disease. *Poikiloderma* - **Poikiloderma** is a combination of **atrophy**, **telangiectasias**, and **dyspigmentation** (both hypo- and hyperpigmentation) of the skin. - Poikiloderma is a prominent feature in dermatomyositis, especially in photodistributed areas like the neck (V-sign), upper back (Shawl sign), and lateral thighs (Holster sign).

Q: Which of the following statements about lichen planus is true?

Oral lichen planus has a small risk of malignancy.. ***Oral lichen planus has a small risk of malignancy.*** - **Oral lichen planus (OLP)** is classified by WHO as an **oral potentially malignant disorder (OPMD)** with a documented malignant transformation rate of approximately **0.4-1.5%**. - The risk is highest in **erosive and atrophic forms**, particularly affecting the tongue and buccal mucosa. - **Regular monitoring** with biopsy of suspicious lesions is recommended due to this small but clinically significant **risk of squamous cell carcinoma**. - Among all the options presented, this represents the most clinically important statement requiring awareness in medical practice. *Lichen planus can heal spontaneously.* - This statement is **medically accurate** - cutaneous lichen planus can resolve spontaneously in 50-75% of cases within 1-2 years. - However, **oral and erosive forms** tend to be chronic and persistent, often requiring treatment. - While true, this is less clinically significant than recognizing the malignancy risk of oral lesions. *Lichen planus can cause scarring alopecia.* - This statement is also **medically accurate** - **lichen planopilaris (LPP)** is a follicular variant that causes **permanent scarring alopecia**. - LPP leads to irreversible hair loss due to follicular destruction and scarring. - However, this affects only the follicular variant, not classic lichen planus, making it a more limited statement. *Ocular pterygium is a feature of lichen planus.* - This is **incorrect** - **ocular pterygium** is a conjunctival growth extending onto the cornea, typically caused by **UV exposure**, not lichen planus. - Lichen planus does affect nails (causing thinning, ridging, pterygium formation in nails, or nail loss) but does **not** cause ocular pterygium.

Q: Heliotrope sign is seen in?

Dermatomyositis (inflammatory muscle and skin disease). ***Dermatomyositis*** - The **heliotrope sign** is a classic cutaneous manifestation of **dermatomyositis**, presenting as a violaceous or purplish discoloration of the eyelids. - This symptom, often accompanied by **periorbital edema**, is a key diagnostic indicator for the condition. *Scleroderma (skin hardening condition)* - **Scleroderma** is characterized by **skin thickening and hardening**, Raynaud's phenomenon, and internal organ involvement, not periorbital discoloration. - While it can cause changes in skin appearance, the **heliotrope sign** is not associated with this condition. *Vitiligo (patchy skin color loss)* - **Vitiligo** is an autoimmune condition resulting in **depigmented macules** and patches due to melanocyte destruction. - It involves a loss of skin color, which is distinct from the erythematous-violaceous coloration of the heliotrope sign. *Photodermatitis (sun-induced skin reaction)* - **Photodermatitis** is an inflammatory skin reaction triggered by **sun exposure**, presenting with erythema, edema, and sometimes blistering in sun-exposed areas. - While it affects sun-exposed skin, it does not specifically manifest as a violaceous discoloration of the eyelids like the heliotrope sign.

Q: What condition is associated with Gottron's sign?

Dermatomyositis. ***Dermatomyositis*** - **Gottron's sign** is a pathognomonic rash associated with **dermatomyositis**, characterized by **erythematous, scaly papules** over the dorsal aspect of the interphalangeal joints. - This condition is an **inflammatory myopathy** affecting both the skin and muscles, leading to muscle weakness and characteristic skin manifestations. *Herpes infection* - Herpes infections cause **vesicular lesions** often seen in clusters, such as **cold sores** (herpes labialis) or **shingles** (herpes zoster), and do not present as Gottron's sign. - The rash is typically painful and burning, unlike the papular rash of Gottron's sign. *Bacterial infection* - Bacterial infections can cause a wide variety of skin lesions, including **abscesses**, **cellulitis**, or **pustules**, but these are distinct from the specific morphology of Gottron's sign. - They are usually accompanied by signs of local inflammation like warmth, swelling, and tenderness, and often respond to antibiotics. *None of the options.* - This option is incorrect because **Gottron's sign** is definitively associated with **dermatomyositis**, which is listed as an option. - There is a clear and well-documented medical condition directly corresponding to the described skin manifestation.

Q: Pathergy test is used for which condition?

Behçet's syndrome. ***Behçet's syndrome*** - The **pathergy test** is a diagnostic test where a sterile needle is used to prick the skin, and a positive result (erythematous papule or pustule) indicates a hyperreactivity of the skin, common in **Behçet's syndrome**. - This syndrome is a **vasculitis** characterized by recurrent oral and genital ulcers, ocular inflammation, and skin lesions, where pathergy is a characteristic feature. *Lichen planus* - This is an **inflammatory dermatosis** affecting the skin, hair, nails, and mucous membranes, characterized by "6 P's": **Pruritic, Purple, Polygonal, Planar, Papules, and Plaques**. - The pathergy test is **not used** in the diagnosis of lichen planus. *Atopic dermatitis* - Also known as **eczema**, it is a chronic, relapsing inflammatory skin condition characterized by dry, itchy skin and often associated with a personal or family history of allergies, asthma, or allergic rhinitis. - Diagnosis is primarily clinical, focusing on characteristic skin lesions and symptoms, and the **pathergy test is not applicable**. *Reiter's syndrome* - Now known as **reactive arthritis**, this condition is an autoimmune disorder that develops in response to an infection elsewhere in the body, typically genitourinary or gastrointestinal. - It classically presents with **arthritis, urethritis, and conjunctivitis** (Can't see, can't pee, can't climb a tree), and the **pathergy test is not used** for its diagnosis.

Q: Treatment of dermatitis herpetiformis:

All of the options. ***All of the options*** - **Dermatitis herpetiformis (DH)** is a chronic, intensely itchy blistering skin condition associated with **celiac disease**. - Effective management involves both a **gluten-free diet** to address the underlying autoimmune process and medications like **dapsone** or **sulfonamides** for symptomatic relief. *Gluten-free diet* - A strict **gluten-free diet** is crucial for long-term management as it addresses the underlying small intestinal enteropathy associated with **celiac disease** and **dermatitis herpetiformis**. - While it may take several months to see full skin improvement, it can eventually lead to resolution of skin lesions and reduced or eliminated need for medication. *Dapsone* - **Dapsone** is a rapidly effective medication for alleviating the intense itching and rash of **dermatitis herpetiformis**, often providing relief within 24-48 hours. - It works by inhibiting neutrophil migration and inflammation, but does not treat the underlying gluten-sensitive enteropathy. *Sulfonamide* - **Sulfonamides**, such as sulfapyridine or sulfamethoxypyridazine, can be used as an alternative for patients who cannot tolerate **dapsone** or who respond inadequately to it. - Like dapsone, these medications provide symptomatic relief by reducing inflammation and neutrophil activity in the skin, but do not address the gluten-induced intestinal damage.

Q: What is the treatment of choice for lichen planus?

Topical corticosteroids. ***Topical corticosteroids*** - **Topical corticosteroids** are the first-line treatment for localized lichen planus due to their potent **anti-inflammatory** and **immunosuppressive** effects. - They effectively reduce **itching**, **inflammation**, and the characteristic **violaceous papules** of lichen planus. *Systemic corticosteroids* - **Systemic corticosteroids** are typically reserved for widespread, severe, or refractory cases of lichen planus, not as initial treatment. - Their use is limited by potential **systemic side effects**, such as **osteoporosis**, **hypertension**, and **diabetes**. *Antihistamines* - **Antihistamines** primarily target **itching** (pruritus) associated with lichen planus but do not address the underlying **inflammatory process** or resolve the skin lesions themselves. - They may be used as an adjunct for symptomatic relief, especially for nocturnal pruritus. *Acitretin* - **Acitretin** is a **retinoid** used for severe or refractory cases of lichen planus (including erosive, oral, and hypertrophic variants), but not as first-line treatment for localized cutaneous disease. - It carries significant **teratogenic risks** and other side effects, making it unsuitable as initial therapy when topical corticosteroids are effective.

Q: Which of the following is NOT a characteristic of pemphigus vulgaris?

Subepidermal bulla. ***Subepidermal bulla*** - Pemphigus vulgaris is characterized by **intraepidermal bullae** resulting from acantholysis (loss of cohesion between keratinocytes), not subepidermal bullae. - **Subepidermal bullae** are characteristic of conditions like **bullous pemphigoid**, where the split occurs below the epidermis. *Positive Nikolsky’s sign* - The **Nikolsky's sign** is positive in pemphigus vulgaris, indicating the fragility of the skin where gentle lateral pressure causes epidermal shearing. - This sign is a direct result of the **intraepidermal blistering** due to weakened cell-to-cell adhesion. *Oral erosions* - **Oral erosions** are a very common and often the initial manifestation of pemphigus vulgaris, frequently preceding skin lesions. - These painful erosions are persistent and heal slowly, sometimes making eating difficult. *Tzanck smear showing acantholytic cells* - A **Tzanck smear** from a fresh blister in pemphigus vulgaris typically reveals **acantholytic cells**, which are detached, rounded keratinocytes with basophilic cytoplasm. - The presence of acantholytic cells confirms the **loss of intercellular adhesion** within the epidermis, a hallmark of pemphigus.

Q: Which of the following is not a feature of dermatomyositis?

Salmon Patch. ***Salmon Patch*** - A **salmon patch** (also known as a nevus simplex or stork bite) is a common, benign vascular birthmark that presents as a flat, red or pink patch. - It is **not associated with dermatomyositis** and has no pathogenic link to the condition. *Gottron's patch* - **Gottron's patches** are a classic cutaneous manifestation of dermatomyositis, characterized by erythematous, violaceous, or dusky red papules or plaques over the **extensor surfaces of the metacarpophalangeal and interphalangeal joints**. - Their presence is highly suggestive of dermatomyositis, often preceding or co-occurring with muscle weakness. *Periungual telangiectasias* - **Periungual telangiectasias** are dilated capillaries around the nail folds and are a common skin manifestation of dermatomyositis. - They represent small vessel vasculopathy, a histological feature, and suggest microvascular damage often seen in systemic connective tissue diseases like dermatomyositis. *Mechanic's hands* - **Mechanic's hands** are a cutaneous feature seen in dermatomyositis (and other inflammatory myopathies like antisynthetase syndrome). - They are characterized by **hyperkeratosis**, fissuring, and scaling of the skin, particularly on the lateral and palmar aspects of the fingers, resembling the hands of a manual laborer.

Q: Which of the following is the most characteristic feature of erythema marginatum?

Lesions are serpiginous and non-itchy.. ***Lesions are serpiginous and non-itchy.*** - **Erythema marginatum** is best characterized by its distinctive **serpiginous (snake-like)** morphology with **pink or red macules** that have pale centers. - The **non-pruritic (non-itchy)** nature is a key diagnostic feature that distinguishes it from other cutaneous manifestations in **rheumatic fever**. *Rash is transient and may appear and disappear.* - While this statement is factually correct, as erythema marginatum lesions do **migrate rapidly** and can **appear and disappear**, it is less diagnostically specific. - The **morphological features** (serpiginous pattern) and **symptomatic characteristics** (non-itchy) are more clinically useful for diagnosis than behavioral patterns. *Rash is itchy.* - This is incorrect; **erythema marginatum** is characteristically **non-pruritic**. - The presence of itching would suggest alternative dermatological conditions such as **urticaria** or **allergic dermatitis**. *Rash does not improve with cold application.* - This statement lacks clinical relevance as **cold application** is not a standard diagnostic test for erythema marginatum. - The diagnosis relies on **morphological appearance** and **clinical context** (association with rheumatic fever), not response to temperature changes.

Question 1

Which of the following is not a feature of dermatomyositis?

Accepted Answer

Groove sign

Answer

Poikiloderma

Answer

'V' sign

Answer

Holster sign

Question 2

Which of the following statements about lichen planus is true?

Accepted Answer

Oral lichen planus has a small risk of malignancy.

Answer

Lichen planus can heal spontaneously.

Answer

Lichen planus can cause scarring alopecia.

Answer

Ocular pterygium is a feature of lichen planus.

Question 3

Heliotrope sign is seen in?

Accepted Answer

Dermatomyositis (inflammatory muscle and skin disease)

Answer

Scleroderma (skin hardening condition)

Answer

Vitiligo (patchy skin color loss)

Answer

Photodermatitis (sun-induced skin reaction)

Question 4

What condition is associated with Gottron's sign?

Accepted Answer

Dermatomyositis

Answer

None of the options.

Answer

Herpes infection

Answer

Bacterial infection

Question 5

Pathergy test is used for which condition?

Accepted Answer

Behçet's syndrome

Answer

Lichen planus

Answer

Atopic dermatitis

Answer

Reiter's syndrome

Question 6

Treatment of dermatitis herpetiformis:

Accepted Answer

All of the options

Answer

Dapsone

Answer

Sulfonamide

Answer

Gluten-free diet

Question 7

What is the treatment of choice for lichen planus?

Accepted Answer

Topical corticosteroids

Answer

Systemic corticosteroids

Answer

Antihistamines

Answer

Acitretin

Question 8

Which of the following is NOT a characteristic of pemphigus vulgaris?

Accepted Answer

Subepidermal bulla

Answer

Oral erosions

Answer

Tzanck smear showing acantholytic cells

Answer

Positive Nikolsky’s sign

Question 9

Which of the following is not a feature of dermatomyositis?

Accepted Answer

Salmon Patch

Answer

Periungual telangiectasias

Answer

Gottron's patch

Answer

Mechanic's hands

Question 10

Which of the following is the most characteristic feature of erythema marginatum?

Accepted Answer

Lesions are serpiginous and non-itchy.

Answer

Rash is transient and may appear and disappear.

Answer

Rash is itchy.

Answer

Rash does not improve with cold application.

Autoimmune Skin Diseases — MCQs

Autoimmune Skin Diseases — MCQs

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