Autoimmune Skin Diseases — MCQs

Autoimmune Skin Diseases Indian Medical PG Practice Questions and MCQs

Question 111: Which of the following is not a feature of dermatomyositis?

A. Poikiloderma
B. 'V' sign
C. Holster sign
D. Groove sign (Correct Answer)

Explanation: ***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).

Question 112: Which of the following statements about lichen planus is true?

A. Lichen planus can heal spontaneously.
B. Lichen planus can cause scarring alopecia.
C. Oral lichen planus has a small risk of malignancy. (Correct Answer)
D. Ocular pterygium is a feature of lichen planus.

Explanation: ***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.

Question 113: Heliotrope sign is seen in?

A. Scleroderma (skin hardening condition)
B. Vitiligo (patchy skin color loss)
C. Photodermatitis (sun-induced skin reaction)
D. Dermatomyositis (inflammatory muscle and skin disease) (Correct Answer)

Explanation: ***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.

Question 114: What condition is associated with Gottron's sign?

A. None of the options.
B. Dermatomyositis (Correct Answer)
C. Herpes infection
D. Bacterial infection

Explanation: ***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.

Question 115: Pathergy test is used for which condition?

A. Lichen planus
B. Atopic dermatitis
C. Behçet's syndrome (Correct Answer)
D. Reiter's syndrome

Explanation: ***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.

Question 116: Treatment of dermatitis herpetiformis:

A. Dapsone
B. Sulfonamide
C. Gluten-free diet
D. All of the options (Correct Answer)

Explanation: ***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.

Question 117: What is the treatment of choice for lichen planus?

A. Topical corticosteroids (Correct Answer)
B. Systemic corticosteroids
C. Antihistamines
D. Acitretin

Explanation: ***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.

Question 118: Which of the following is NOT a characteristic of pemphigus vulgaris?

A. Oral erosions
B. Tzanck smear showing acantholytic cells
C. Positive Nikolsky’s sign
D. Subepidermal bulla (Correct Answer)

Explanation: ***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.

Question 119: Which of the following is not a feature of dermatomyositis?

A. Salmon Patch (Correct Answer)
B. Periungual telangiectasias
C. Gottron's patch
D. Mechanic's hands

Explanation: ***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.

Question 120: Which of the following is the most characteristic feature of erythema marginatum?

A. Rash is transient and may appear and disappear.
B. Lesions are serpiginous and non-itchy. (Correct Answer)
C. Rash is itchy.
D. Rash does not improve with cold application.

Explanation: ***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.

Practice by Chapter

Lupus Erythematosus: Cutaneous Forms

Practice Questions

Lupus Erythematosus: Systemic with Skin Manifestations

Practice Questions

Dermatomyositis

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Scleroderma and Morphea

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Mixed Connective Tissue Disease

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Sjögren's Syndrome: Cutaneous Manifestations

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Relapsing Polychondritis

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Autoimmune Thyroid Disease and the Skin

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Immunobullous Disorders

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Vasculitis

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Diagnostic Methods in Autoimmune Dermatoses

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Management of Autoimmune Skin Diseases

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