Dermatitis and Eczema Practice Questions

Q: Which of the following is a minor clinical feature in the diagnosis of atopic dermatitis?

Pruritus. To master Atopic Dermatitis (AD) for NEET-PG, it is essential to understand the **Hanifin and Rajka Diagnostic Criteria**, which divide features into Major and Minor categories. ### **Explanation of the Correct Answer** **Pruritus (Option B)** is a **Major Criterion**. In fact, it is the hallmark of atopic dermatitis—often described as "the itch that rashes." According to Hanifin and Rajka, a patient must meet at least **3 out of 4 Major Criteria** for a diagnosis: 1. **Pruritus** (The most essential feature). 2. **Typical morphology and distribution** (Facial/extensor involvement in infants; flexural lichenification in adults). 3. **Chronic or chronically relapsing dermatitis.** 4. **Personal or family history of atopy** (Asthma, allergic rhinitis, or AD). ### **Analysis of Incorrect Options** The other options are **Minor Criteria**. To satisfy the diagnosis, a patient needs **3 or more** of these (out of 23 possible features): * **Dry skin (Xerosis) (Option A):** A very common but non-specific minor feature. * **Morgagnian fold (Dennie-Morgan fold) (Option C):** An extra fold of skin under the lower eyelid due to chronic edema/rubbing. * **Pityriasis alba (Option D):** Hypopigmented, slightly scaly patches commonly seen on the face of children. ### **High-Yield Clinical Pearls for NEET-PG** * **Filaggrin (FLG) Mutation:** The most common genetic defect leading to skin barrier dysfunction in AD. * **Hertoghe’s Sign:** Thinning of the lateral third of the eyebrows (a minor criterion). * **Keratosis Pilaris:** "Chicken skin" appearance on outer arms/thighs; also a minor criterion. * **Serum IgE:** Often elevated in AD, but it is a minor criterion, not a major one. * **Treatment Gold Standard:** Topical Corticosteroids for flares; Topical Calcineurin Inhibitors (Tacrolimus) for maintenance.

Q: A child presents with itchy skin lesions on the elbows and other extensor surfaces. The mother reports a history of bronchial asthma. What is the most likely diagnosis?

Atopic dermatitis. ### Explanation **Correct Answer: A. Atopic dermatitis** The diagnosis is based on the **Atopic Triad** and the age-specific distribution of lesions. Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense pruritus. * **The Clinical Clue:** The presence of **bronchial asthma** in the patient (or family) is a major diagnostic criterion according to Hanifin and Rajka. This association between asthma, allergic rhinitis, and dermatitis is known as **atopy**. * **Distribution:** In **infants and young children**, AD typically involves the **extensor surfaces** (elbows, knees) and the face. As the child grows into adolescence/adulthood, the distribution shifts to the flexural surfaces (antecubital and popliteal fossae). --- ### Why the other options are incorrect: * **B. Airborne contact dermatitis:** Usually affects exposed areas like the eyelids and face (Parthenium dermatitis); it does not typically correlate with a personal history of asthma. * **C. Scabies:** Characterized by nocturnal itching and lesions in web spaces, genitals, and wrists. While it is itchy, it lacks the atopic association. * **D. Allergic contact dermatitis:** A Type IV hypersensitivity reaction occurring at the site of allergen contact (e.g., nickel, leather). It is less common in young children and does not follow the extensor-to-flexor progression. --- ### NEET-PG High-Yield Pearls: * **Major Criteria (Hanifin & Rajka):** Pruritus, Typical morphology/distribution, Chronic/relapsing course, Personal/Family history of atopy. * **Dennie-Morgan Fold:** An extra fold of skin under the lower eyelid, a classic sign of AD. * **Filaggrin (FLG) Gene:** Mutations in this gene lead to skin barrier defects, a primary cause of AD. * **Treatment of Choice:** Topical corticosteroids for flares; Topical Calcineurin Inhibitors (Tacrolimus) for maintenance.

Q: The day after playing in the high grasses of a neighbour's fields, an 8-year-old boy develops a weeping, vesicular, erythematous, and itchy rash on his arms, legs, and neck. Which of the following best describes this inflammatory response?

Spongiotic dermatitis. **Explanation:** The clinical presentation describes a classic case of **Acute Allergic Contact Dermatitis (ACD)**, likely triggered by plants (e.g., Poison Ivy or similar vegetation) found in the fields. This is a **Type IV (Delayed) Hypersensitivity reaction**. **1. Why Spongiotic Dermatitis is Correct:** Histologically, the hallmark of acute eczema/dermatitis is **Spongiosis**. This refers to intercellular edema within the epidermis, which stretches the desmosomes (intercellular bridges) apart. Clinically, this manifests as the "weeping" and "vesicular" lesions described in the question. "Spongiotic dermatitis" is the pathological umbrella term for various forms of eczema, including contact dermatitis. **2. Why the Other Options are Incorrect:** * **Erythema Nodosum:** This is a form of septal panniculitis (inflammation of subcutaneous fat). It presents as painful, tender, erythematous nodules, typically on the shins, rather than itchy, weeping vesicles on the arms and neck. * **Pemphigus:** This is an autoimmune blistering disease caused by IgG antibodies against desmogleins. It results in **acantholysis** (loss of intercellular connections), not spongiosis. It is usually chronic and involves oral mucosa. * **Psoriasis:** This is a chronic inflammatory condition characterized histologically by **Acanthosis** (epidermal thickening), parakeratosis, and Munro’s microabscesses. Clinically, it presents as silvery-white scales on erythematous plaques, not acute weeping vesicles. **Clinical Pearls for NEET-PG:** * **Linearity:** If the rash appears in a linear pattern (due to brushing against plant leaves), it is termed **Phytophotodermatitis** or "Linear Dermatitis." * **Histology Sequence:** Acute Dermatitis = Spongiosis; Chronic Dermatitis = Acanthosis and Hyperkeratosis. * **Common Trigger:** Nickel is the most common cause of ACD worldwide; Urushiol is the allergen in plants like Poison Ivy.

Q: A 36-year-old farmer presented to the dermatology department with pruritic erythematous lesions on the arms, forearms, face, and retroauricular area after removing weeds in his farm. A diagnosis of phytodermatitis was made. What is the most likely plant responsible for this condition?

Parthenium hysterophorus. ### Explanation **Correct Option: A. Parthenium hysterophorus** The clinical presentation describes **Parthenium Dermatitis**, a common form of **Airborne Contact Dermatitis (ABCD)** in India. *Parthenium hysterophorus* (Congress grass/Gajar Ghas) contains **Sesquiterpene lactones**, which act as haptens. * **Mechanism:** It is a Type IV (Delayed) Hypersensitivity reaction. * **Distribution:** The "Airborne" pattern typically involves exposed areas like the face, neck, V-area of the chest, flexures (antecubital/popliteal fossae), and the **retroauricular area** (a classic diagnostic site that helps differentiate it from photodermatitis, which usually spares the retroauricular shadow). **Incorrect Options:** * **B. Urtica dioica (Stinging Nettle):** Causes **Contact Urticaria** (Type I Hypersensitivity/Immediate) via mechanical stings that release histamine and acetylcholine. It presents with immediate wheals rather than chronic eczematous lesions. * **C. Alstroemeria (Peruvian Lily):** A common cause of **Tulip finger** (allergic contact dermatitis) in florists, typically affecting the fingertips. * **D. Melaleuca alternifolia (Tea Tree Oil):** Known for causing allergic contact dermatitis due to oxidized terpenoids, but it is not associated with the specific airborne/weed-clearing pattern described. **Clinical Pearls for NEET-PG:** 1. **Diagnostic Test:** Patch testing with the **Sesquiterpene Lactone mix** or Parthenium leaf. 2. **Clinical Sign:** The **"Spare-part" sign** (sparing of the skin folds) is sometimes seen, though Parthenium is notorious for involving the folds in later stages. 3. **Differential Diagnosis:** Must be distinguished from **Chronic Actinic Dermatitis (CAD)**; however, Parthenium dermatitis involves the skin folds and retroauricular area, which are usually spared in CAD. 4. **Seasonality:** Often flares during the rainy season when the weed grows abundantly.

Q: Which of the following materials used to make jewelry will commonly cause contact dermatitis in sensitive individuals?

Nickel/chromium. **Explanation:** **1. Why Nickel/Chromium is Correct:** Nickel is the **most common cause of Allergic Contact Dermatitis (ACD)** worldwide. It is a **Type IV (delayed-type) hypersensitivity reaction** mediated by T-cells. In jewelry, nickel is frequently used as a base metal or alloy to provide hardness and luster. Chromium (often found in leather tanning and cement) is also a potent sensitizer. When these metals come into contact with sweat, metal ions are released, which act as **haptens**. These haptens bind to skin proteins to form a complete antigen, triggering an inflammatory response in sensitized individuals. **2. Why Other Options are Incorrect:** * **Sapphire:** This is a gemstone (corundum). Gemstones are chemically inert and do not release ions that penetrate the skin; therefore, they do not cause ACD. * **Silver:** Pure silver is generally non-allergenic. While some "sterling silver" contains copper or trace nickel that might cause a reaction, pure silver itself is considered safe. * **Gold:** Pure 24k gold is highly inert. While gold sodium thiosulfate is a known allergen, clinical dermatitis from gold jewelry is significantly rarer than nickel allergy. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dimethylglyoxime Test:** A bedside chemical test used to detect the presence of nickel in jewelry (turns pink in the presence of nickel). * **Patch Test:** The gold standard investigation for diagnosing Allergic Contact Dermatitis. * **Common Sites:** Earlobes (earrings), wrists (watch straps), and infra-umbilical region (jeans buttons/belt buckles). * **Cross-reactivity:** Patients allergic to nickel often show cross-reactivity with **Cobalt**.

Q: A 55-year-old male, with uncontrolled diabetes mellitus and hypertension, developed severe airborne contact dermatitis. What is the most appropriate drug for his treatment?

Azathioprine. **Explanation:** The patient presents with **Airborne Contact Dermatitis (ABCD)**, most commonly caused by *Parthenium hysterophorus* in India. This condition often requires long-term immunosuppression as it is a chronic, relapsing Type IV hypersensitivity reaction. **Why Azathioprine is the Correct Answer:** Azathioprine is considered the **gold standard "steroid-sparing" agent** for chronic, recalcitrant ABCD. In this specific case, the patient has **uncontrolled diabetes mellitus and hypertension**. Azathioprine is preferred because it does not exacerbate glycemic levels or blood pressure, unlike systemic steroids or cyclosporine. Before starting, a Thiopurine Methyltransferase (TPMT) assay is ideally performed to prevent bone marrow toxicity. **Analysis of Incorrect Options:** * **Systemic Corticosteroids:** While effective for acute flares, they are contraindicated for long-term use in this patient due to his **uncontrolled diabetes** (causes hyperglycemia) and **hypertension** (causes fluid retention). * **Cyclosporine:** Although a potent immunosuppressant, it is avoided here because it is **nephrotoxic** and frequently causes or worsens **hypertension**, which is already uncontrolled in this patient. * **Thalidomide:** Primarily used in ENL (Leprosy) or actinic prurigo; it is not a first-line treatment for ABCD and carries a significant side-effect profile. **Clinical Pearls for NEET-PG:** * **Parthenium dermatitis** typically presents in an "airborne pattern" involving the eyelids, nasolabial folds, and retroauricular areas. * **Patch Test** is the gold standard for diagnosis. * **Steroid-sparing agents** (Azathioprine, Methotrexate) are essential for long-term management to avoid the "Cushingoid" side effects of chronic prednisone.

Q: Id reaction is associated with which of the following conditions?

Candidiasis. **Explanation:** **Id reaction**, also known as **Auto-eczematization**, is a secondary immunological response occurring in a site distant from the primary inflammatory or infectious focus. It is a **Type IV hypersensitivity reaction** triggered by circulating antigens (fungal, bacterial, or parasitic) rather than the spread of the organism itself. **Why Candidiasis is the correct answer:** Candidiasis is a classic cause of an Id reaction (specifically called a **Candidid**). When a primary infection (like vulvovaginal candidiasis or intertrigo) becomes acute or is treated aggressively, fungal antigens enter the bloodstream. This triggers a symmetrical, pruritic, papulovesicular eruption, typically on the hands or trunk. Other common triggers include dermatophytosis (Tinea pedis causing a 'Dermatophytid' on the hands) and stasis dermatitis. **Analysis of Incorrect Options:** * **Aphthous ulcer:** These are localized inflammatory ulcers of the oral mucosa. They are not associated with systemic hypersensitivity reactions like auto-eczematization. * **Herpetic stomatitis:** While viral infections can cause erythema multiforme, they are not typically associated with the classic "Id reaction" pattern seen in eczematous dermatology. * **Syphilis:** Secondary syphilis presents with a generalized rash, but this is due to the **direct hematogenous spread of *Treponema pallidum*** itself, not a sterile hypersensitivity reaction to distant antigens. **High-Yield Clinical Pearls for NEET-PG:** * **Key Feature:** The Id reaction is **sterile** (culture from the secondary site will be negative). * **Commonest trigger:** Tinea pedis (causing vesicles on the sides of fingers). * **Treatment:** The primary focus of infection must be treated for the Id reaction to resolve. Topical steroids are used for symptomatic relief of the secondary rash. * **Other triggers:** *Mycobacterium tuberculosis* (Lichen scrofulosorum) and *Staphylococcus aureus*.

Q: A 25-year-old male presents with multiple erythematous annular plaques with peripheral collarette of scales arranged predominantly over the trunk. What is the most probable diagnosis?

Pityriasis rosea. **Explanation:** The clinical presentation of **Pityriasis Rosea (PR)** is classic in this scenario. PR is a self-limiting, inflammatory skin disease, likely viral in origin (HHV-6 or HHV-7). The hallmark lesion is an **erythematous annular plaque** with a characteristic **"collarette of scales"**—where the scale is attached at the periphery and free towards the center. These lesions typically follow the lines of cleavage (Langer’s lines), creating a **"Christmas Tree" distribution** on the trunk. **Why the other options are incorrect:** * **Pityriasis versicolor:** Presents as hypo- or hyperpigmented macules with fine, "branny" (furfuraceous) scales, usually caused by *Malassezia* species. It lacks the inflammatory annular morphology and collarette scaling. * **Pityriasis rubra pilaris (PRP):** Characterized by follicular papules on an erythematous base, "islands of sparing," and orange-red palmoplantar keratoderma. It does not typically present with isolated annular plaques and collarette scales. * **Pityriasis lichenoides chronica (PLC):** Presents with asymptomatic, brownish-pink papules with a "frosted glass" or "wafer-like" scale that can be lifted off entirely. It lacks the specific annular arrangement seen in PR. **NEET-PG High-Yield Pearls:** * **Herald Patch:** The first lesion to appear (larger, 2–10 cm) in 50–90% of cases, usually preceding the generalized eruption by 1–2 weeks. * **Hanging Curtain Sign:** On stretching the lesion, the scales fold inwards (characteristic of PR). * **Differential Diagnosis:** Always rule out **Secondary Syphilis**, which also involves the palms and soles (PR spares them). * **Treatment:** Reassurance; it is self-limiting (6–8 weeks). Severe cases may benefit from acyclovir or UVB therapy.

Q: A 5-year-old boy presents with a small hypopigmented scaly macule on his cheek. Some of his classmates also have similar lesions. What is the most probable diagnosis?

Pityriasis alba. **Explanation:** The correct diagnosis is **Pityriasis alba**. This is a common, benign condition primarily seen in children (3–16 years). It is considered a manifestation of **atopic dermatitis**. The classic presentation involves ill-defined, hypopigmented, slightly scaly macules or patches, most commonly located on the face (cheeks). The "epidemic" mention of classmates having similar lesions often points to shared environmental triggers like sun exposure or dry skin, rather than contagion. **Distinguishing the Options:** * **Pityriasis rosea:** Characterized by a "Herald patch" followed by a "Christmas tree" distribution of erythematous, scaly plaques on the trunk. It is not typically localized to a single facial macule. * **Pityriasis versicolor:** Caused by *Malassezia furfur*. While it causes hypopigmented scaly macules, it predominantly affects the chest and back (seborrheic areas) and is rare in young children. Diagnosis is confirmed by a "spaghetti and meatballs" appearance on KOH mount. * **Indeterminate leprosy:** Presents as a solitary, hypopigmented, non-scaly macule with **loss of sensation** and/or loss of hair. The presence of scales in the question points away from leprosy. **NEET-PG High-Yield Pearls:** * **Etiology:** Low-grade eczematous dermatitis; often associated with xerosis and sun exposure. * **Clinical Stages:** Starts as pink erythema $\rightarrow$ progresses to hypopigmented scaly patches $\rightarrow$ ends as smooth hypopigmented macules. * **Treatment:** Reassurance, emollients, and sun protection. * **Key Differentiator:** Unlike Vitiligo, Pityriasis alba has **ill-defined borders** and **fine scaling**.

Question 1

Which of the following is a minor clinical feature in the diagnosis of atopic dermatitis?

Accepted Answer

Pruritus

Answer

Dry skin

Answer

Morgagnian fold

Answer

Pityriasis alba

Question 2

A child presents with itchy skin lesions on the elbows and other extensor surfaces. The mother reports a history of bronchial asthma. What is the most likely diagnosis?

Accepted Answer

Atopic dermatitis

Answer

Airborne contact dermatitis

Answer

Scabies

Answer

Allergic contact dermatitis

Question 3

The day after playing in the high grasses of a neighbour's fields, an 8-year-old boy develops a weeping, vesicular, erythematous, and itchy rash on his arms, legs, and neck. Which of the following best describes this inflammatory response?

Accepted Answer

Spongiotic dermatitis

Answer

Erythema nodosum

Answer

Pemphigus

Answer

Psoriasis

Question 4

A 36-year-old farmer presented to the dermatology department with pruritic erythematous lesions on the arms, forearms, face, and retroauricular area after removing weeds in his farm. A diagnosis of phytodermatitis was made. What is the most likely plant responsible for this condition?

Accepted Answer

Parthenium hysterophorus

Answer

Urtica dioica

Answer

Alstroemeria

Answer

Melaleuca alternifolia

Question 5

Which of the following materials used to make jewelry will commonly cause contact dermatitis in sensitive individuals?

Accepted Answer

Nickel/chromium

Answer

Sapphire

Answer

Silver

Answer

Gold

Question 6

A patient presents with a rash. There is a family history of asthma. What is the most probable diagnosis?

Accepted Answer

Allergic contact dermatitis

Answer

Seborrheic dermatitis

Answer

Atopic dermatitis

Answer

Erysipelas

Question 7

A 55-year-old male, with uncontrolled diabetes mellitus and hypertension, developed severe airborne contact dermatitis. What is the most appropriate drug for his treatment?

Accepted Answer

Azathioprine

Answer

Systemic corticosteroids

Answer

Thalidomide

Answer

Cyclosporine

Question 8

Id reaction is associated with which of the following conditions?

Accepted Answer

Candidiasis

Answer

Aphthous ulcer

Answer

Herpetic stomatitis

Answer

Syphilis

Question 9

A 25-year-old male presents with multiple erythematous annular plaques with peripheral collarette of scales arranged predominantly over the trunk. What is the most probable diagnosis?

Accepted Answer

Pityriasis rosea

Answer

Pityriasis versicolor

Answer

Pityriasis rubra pilaris

Answer

Pityriasis lichenoides chronica

Question 10

A 5-year-old boy presents with a small hypopigmented scaly macule on his cheek. Some of his classmates also have similar lesions. What is the most probable diagnosis?

Accepted Answer

Pityriasis alba

Answer

Pityriasis rosea

Answer

Pityriasis versicolor

Answer

Indeterminate leprosy

Dermatitis and Eczema — MCQs

Dermatitis and Eczema — MCQs

On this page

Practice by Chapter

Want unlimited practice?