Dermatitis and Eczema Practice Questions

Q: 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?

Darier's disease. ### 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.

Q: The UK refinement of Hannifin and Rajka criteria is used in the diagnosis of which condition?

Atopic dermatitis. **Explanation:** The **UK Refinement of the Hanifin and Rajka Criteria** is the most widely used clinical tool for diagnosing **Atopic Dermatitis (AD)** in epidemiological studies and clinical practice. While the original Hanifin and Rajka criteria (1980) are considered the gold standard, they were deemed too cumbersome for routine use. The UK Working Party simplified these into a more practical set of criteria. To meet the UK diagnostic criteria, a patient must have an **itchy skin condition (pruritus)** plus three or more of the following: 1. History of involvement of the skin creases (flexural dermatitis). 2. Personal history of asthma or hay fever (or history of atopic disease in a first-degree relative if the child is under 4). 3. History of a general dry skin in the last year. 4. Visible flexural eczema. 5. Onset under the age of 2 years. **Analysis of Incorrect Options:** * **B. Nummular Eczema:** Characterized by coin-shaped, well-demarcated plaques; diagnosis is purely clinical and does not use these specific criteria. * **C. Eczema Herpeticum:** A viral complication (HSV-1) of AD; diagnosis is clinical or via Tzanck smear/PCR. * **D. Contact Dermatitis:** Diagnosed via history and **Patch Testing**, not the UK refinement criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Hanifin & Rajka Criteria:** Consists of 4 Major and 23 Minor criteria (3 of each required for diagnosis). * **Atopic March:** The typical progression from Atopic Dermatitis → Food Allergy → Asthma → Allergic Rhinitis. * **Dennier-Morgan Fold:** An extra fold of skin under the lower eyelid, a minor criterion for AD. * **Filaggrin (FLG) Mutation:** The most common genetic association with Atopic Dermatitis.

Q: Commonest site of Atopic dermatitis is:

Ante-cubital fossa. **Explanation:** Atopic Dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by intense pruritus and a characteristic age-dependent distribution. The correct answer is **Ante-cubital fossa** because it represents the classic **flexural involvement** seen in the childhood and adult phases of the disease. **Why Ante-cubital fossa is correct:** In patients beyond infancy (children, adolescents, and adults), the morphology of AD shifts from exudative lesions to lichenified plaques. These lesions characteristically involve the flexural surfaces, specifically the **ante-cubital** and **popliteal fossae**, the neck, and the wrists. This is a hallmark diagnostic feature in the Hanifin and Rajka criteria. **Why other options are incorrect:** * **Scalp:** While the scalp can be involved in infantile AD (often confused with seborrheic dermatitis), it is not the "commonest" or most characteristic site across the broader age spectrum. * **Elbow:** The **extensor** aspect of the elbow is typically involved in **psoriasis**. In AD, extensor involvement is usually limited to the infantile phase; as the child grows, the disease "moves" to the flexures. * **Trunk:** While the trunk can be affected in severe or generalized cases (erythroderma), it is rarely the primary or most common site of localization compared to the limbs. **High-Yield Clinical Pearls for NEET-PG:** * **Infantile Phase (<2 years):** Characteristically involves the **face (cheeks)** and extensor surfaces. The diaper area is usually spared. * **Childhood/Adult Phase:** Characteristically involves **flexures** (ante-cubital/popliteal). * **Dennie-Morgan fold:** An extra fold of skin under the lower eyelid, a classic sign of atopy. * **Filaggrin (FLG) mutation:** The most common genetic defect associated with skin barrier dysfunction in AD. * **Serum IgE:** Usually elevated in the "extrinsic" type of Atopic Dermatitis.

Q: Dennie Morgan folds are seen in which of the following conditions?

Atopic dermatitis. **Explanation:** **Dennie-Morgan folds** (also known as Dennie-Morgan lines or infraorbital folds) are a characteristic clinical sign of **Atopic Dermatitis (AD)**. They are defined as single or double symmetrical folds or lines situated below the lower eyelid margin. These folds result from chronic inflammation and edema of the lower eyelid, often exacerbated by frequent rubbing of the eyes due to the intense pruritus associated with the "itch-scratch cycle" in atopic individuals. **Analysis of Options:** * **Atopic Dermatitis (Correct):** It is a chronic, relapsing inflammatory skin disease. Dennie-Morgan folds are considered a minor diagnostic criterion (Hanifin and Rajka criteria) for AD, along with other signs like xerosis, ichthyosis, and keratosis pilaris. * **Lichen Planus:** Characterized by the "6 Ps" (Planar, Purple, Polygonal, Pruritic, Papules, and Plaques) and Wickham striae. It does not typically involve infraorbital fold formation. * **Keratosis Pilaris:** While frequently associated with atopy (comorbidity), it refers specifically to keratinous plugging of hair follicles, usually on the extensor surfaces of the arms and thighs ("chicken skin"). * **Nummular Eczema:** Presents as coin-shaped, well-demarcated eczematous plaques. It lacks the systemic stigmata and specific facial signs like Dennie-Morgan folds. **Clinical Pearls for NEET-PG:** * **Hertoghe’s Sign:** Thinning or loss of the outer third of the eyebrows; also seen in Atopic Dermatitis (and Hypothyroidism). * **Pityriasis Alba:** Hypopigmented, slightly scaly patches on the face; a common minor feature of AD in children. * **Hyperlinear palms:** Increased skin markings on the palms, often seen in AD patients with associated Ichthyosis vulgaris (FLG gene mutation). * **Dermatographism:** Patients with AD often show **white dermatographism** (vasoconstriction) instead of the typical red response.

Question 1

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?

Accepted Answer

Darier's disease

Answer

Pemphigus foliaceus

Answer

Keratosis pilaris

Answer

Seborrheic dermatitis

Question 2

The UK refinement of Hannifin and Rajka criteria is used in the diagnosis of which condition?

Accepted Answer

Atopic dermatitis

Answer

Nummular Eczema

Answer

Eczema Herpeticum

Answer

Contact dermatitis

Question 3

Commonest site of Atopic dermatitis is:

Accepted Answer

Ante-cubital fossa

Answer

Scalp

Answer

Elbow

Answer

Trunk

Question 4

Dennie Morgan folds are seen in which of the following conditions?

Accepted Answer

Atopic dermatitis

Answer

Lichen planus

Answer

Keratosis pilaris

Answer

Nummular eczema

Question 5

A boy presents with erythematous scaly papules with crusting over on the antecubital fossa. He was applying a petroleum-based emollient in the shower. What is the next step in management?

Accepted Answer

Apply triamcinolone cream topically.

Answer

Decrease the frequency of petroleum-based emollient application.

Answer

Decrease the frequency of showering.

Answer

Apply mupirocin 1% topically.

Dermatitis and Eczema — MCQs

Dermatitis and Eczema — MCQs

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