A 35-year-old woman consulted a dermatologist due to a persistent facial rash. Physical examination revealed an erythematous rash, without blistering or ulceration, involving both cheeks and the nose, with the nasolabial folds relatively spared. The dermatologist also noted scattered erythematous, firm, maculopapular lesions on the face, neck, upper chest, and elbows, as well as focal alopecia on the scalp. The patient reported that the rash had been present for approximately six months, with exacerbation upon exposure to sunlight. Which autoimmune disease would MOST likely produce this patient's skin problems?
Q122
All are true about erythema multiforme except which of the following?
Q123
Lupus pernio is a characteristic skin manifestation of which condition?
Q124
Gluten-free diet is beneficial in:
Autoimmune Skin Diseases Indian Medical PG Practice Questions and MCQs
Question 121: A 35-year-old woman consulted a dermatologist due to a persistent facial rash. Physical examination revealed an erythematous rash, without blistering or ulceration, involving both cheeks and the nose, with the nasolabial folds relatively spared. The dermatologist also noted scattered erythematous, firm, maculopapular lesions on the face, neck, upper chest, and elbows, as well as focal alopecia on the scalp. The patient reported that the rash had been present for approximately six months, with exacerbation upon exposure to sunlight. Which autoimmune disease would MOST likely produce this patient's skin problems?
A. Dermatomyositis
B. Progressive systemic sclerosis
C. Systemic lupus erythematosus (Correct Answer)
D. Rheumatoid arthritis
Explanation: ***Systemic lupus erythematosus***
- The **malar rash** (sparing the nasolabial folds) and photosensitivity are classic dermatological findings in **systemic lupus erythematosus (SLE)**.
- **Focal alopecia** and other **maculopapular lesions** are also characteristic skin manifestations of SLE.
*Dermatomyositis*
- While dermatomyositis can also present with photosensitive rashes, the typical facial involvement includes **heliotrope rash** around the eyes or **Gottron's papules** over bony prominences.
- The description of a malar rash sparing nasal folds and scattered maculopapular lesions is less consistent with dermatomyositis.
*Progressive systemic sclerosis*
- This condition is primarily characterized by **skin thickening and hardening** (scleroderma), often starting in the extremities and face.
- The described **erythematous rash** with separate maculopapular lesions and alopecia is not typical for progressive systemic sclerosis.
*Rheumatoid arthritis*
- Rheumatoid arthritis is a chronic inflammatory joint disease and does **not typically present with primary dermatological manifestations** like the facial rash, photosensitivity, or alopecia described.
- While some skin findings can occur (e.g., rheumatoid nodules), they are not the prominent features described.
Question 122: All are true about erythema multiforme except which of the following?
A. Associated with HSV
B. Does not involve mucosa (Correct Answer)
C. Target lesion
D. Extensor involvement
Explanation: ***Does not involve mucosa***
- Erythema multiforme often presents with **mucosal involvement**, particularly in the oral cavity, which can range from mild erosions to severe blistering.
- The presence of mucosal lesions, especially oral, ocular, or genital, is a key feature distinguishing more severe forms like **erythema multiforme major**.
*Target lesion*
- The **target lesion** (or iris lesion) is the hallmark dermatological finding in erythema multiforme, characterized by concentric rings of different colors.
- This classic lesion is crucial for the clinical diagnosis of erythema multiforme.
*Associated with HSV*
- **Herpes Simplex Virus (HSV) infection** is the most common precipitating factor for erythema multiforme, especially for recurrent episodes.
- The onset of lesions typically follows an HSV outbreak by several days to weeks.
*Extensor involvement*
- The rash of erythema multiforme commonly affects the **extensor surfaces of the extremities**, such as the dorsal hands, forearms, and shins.
- While it can appear elsewhere, this distribution is a characteristic pattern.
Question 123: Lupus pernio is a characteristic skin manifestation of which condition?
A. Sarcoidosis (Correct Answer)
B. Tuberculosis
C. Carcinoid syndrome
D. Lymphoma
Explanation: ***Sarcoidosis***
- **Lupus pernio** is considered a **pathognomonic** and chronic cutaneous manifestation of sarcoidosis, characterized by violaceous plaques on the nose, cheeks, lips, and ears.
- Its presence often indicates a **more severe and chronic course** of sarcoidosis, frequently associated with systemic involvement, particularly in the respiratory tract.
*Tuberculosis*
- While tuberculosis can cause various skin manifestations, such as **lupus vulgaris** (a form of cutaneous tuberculosis), it does not typically present as lupus pernio.
- **Lupus vulgaris** involves granulomatous lesions, but their appearance and distribution differ from lupus pernio.
*Carcinoid syndrome*
- Carcinoid syndrome is characterized by symptoms like **flushing**, diarrhea, and bronchospasm, primarily due to the release of vasoactive substances like serotonin.
- It does not present with **lupus pernio** or similar skin lesions of a granulomatous nature.
*Lymphoma*
- Cutaneous lymphomas can manifest as various skin lesions, including **plaques, nodules, or tumors**, depending on the specific type of lymphoma.
- However, **lupus pernio** with its characteristic violaceous color and location is not a typical presentation of lymphoma.
Question 124: Gluten-free diet is beneficial in:
A. Exfoliative dermatitis
B. Psoriasis
C. Dermatitis herpetiformis (Correct Answer)
D. Pemphigoid
Explanation: ***Dermatitis herpetiformis***
- This condition is a **cutaneous manifestation of celiac disease**, presenting with intensely itchy, vesicular lesions.
- A strict **gluten-free diet** is the cornerstone of treatment, leading to improvement in both skin lesions and underlying enteropathy.
*Psoriasis*
- While some research explores a potential link between diet and psoriasis, a **gluten-free diet is not a primary or universally recognized treatment** for psoriasis.
- Psoriasis is primarily an **immune-mediated inflammatory skin disease** with various treatment modalities, but not specifically gluten restriction.
*Exfoliative dermatitis*
- Also known as **erythroderma**, this is a severe inflammatory skin condition characterized by generalized redness and scaling of the skin.
- It has diverse causes including other dermatoses, drug reactions, and lymphoma, but is **not linked to gluten sensitivity** or improved by a gluten-free diet.
*Pemphigoid*
- **Bullous pemphigoid** is an autoimmune blistering skin disease caused by antibodies targeting components of the basement membrane.
- The treatment typically involves **corticosteroids and immunosuppressants**, with no established role for a gluten-free diet.
