Seborrheic Dermatitis — MCQs

10 questions

A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:

Skin biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in stratum corneum. Most likely diagnosis?

Which of the following is used in the treatment of Pityriasis versicolor?

An eleven-year-old boy has Tinea capitis on his scalp. Which of the following is the most appropriate line of treatment for this condition?

An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :

Identify the skin condition depicted in the image.

Which of the following organisms has a role to play in Seborrheic dermatitis?

Pompholyx affects:

Q10

A child presented with itchy plaques over the neck, the bilateral popliteal and cubital fossa. What could be the diagnosis?

Seborrheic Dermatitis Indian Medical PG Practice Questions and MCQs

Question 1: A child presenting with localized patches of complete hair loss with normal appearance of scalp. The diagnosis is:

A. Tinea capitis
B. Cradle cap
C. Alopecia areata (Correct Answer)
D. Telogen effluvium

Explanation: ***Alopecia areata*** - This condition is characterized by **localized, well-demarcated patches of complete hair loss** on the scalp. - The underlying skin typically appears **normal, smooth, and healthy**, without inflammation or scaling. *Tinea capitis* - This fungal infection usually presents with **scaly patches**, inflammation, pustules, or "black dots" where hairs have broken off. - The scalp appearance is typically **abnormal** due to scaling and inflammation, unlike the normal scalp seen here. *Cradle cap* - Also known as **seborrheic dermatitis in infants**, it presents as greasy, yellowish, scaly patches on the scalp. - It does not cause **complete hair loss** in localized patches, but rather diffuse scaling and sometimes mild thinning. *Telogen effluvium* - This condition involves **diffuse hair shedding** (increased number of hairs falling out), often triggered by stress, illness, or medications. - It does not present as **localized patches of complete hair loss**, and the hair thinning is generally widespread.

Question 2: Match the following scale types with their lesions. | Scales | Lesions | | :-- | :-- | | 1. Collarette scales | a. Pityriasis versicolour | | 2. Silvery scales | b. Pityriasis rosea | | 3. Mica-like scales | c. Psoriasis | | 4. Branny scales | d. Pityriasis lichenoides |

A. 1-d, 2-c, 3-a, 4-b
B. 1-c, 2-b, 3-d, 4-a
C. 1-a, 2-b, 3-d, 4-c
D. 1-b, 2-c, 3-d, 4-a (Correct Answer)

Explanation: ***1-b, 2-c, 3-d, 4-a*** - **Collarette scales** are pathognomonic of **Pityriasis rosea**, appearing as fine, trailing scales around the periphery of oval lesions in a "Christmas tree" distribution. - **Silvery scales** are the classic hallmark of **Psoriasis**, presenting as thick, adherent, silvery-white scales overlying well-demarcated erythematous plaques. - **Mica-like scales** are characteristic of **Pityriasis lichenoides**, appearing as thick, shiny, adherent scales that can be peeled off like mica sheets. - **Branny scales** are typical of **Pityriasis versicolor**, presenting as fine, powdery scales caused by **Malassezia** yeast overgrowth. *1-d, 2-c, 3-a, 4-b* - Incorrectly matches **collarette scales with Pityriasis lichenoides**, which typically presents with mica-like scales, not collarette scales. - Misassociates **mica-like scales with Pityriasis versicolor**, which characteristically has branny (fine, powdery) scales. *1-c, 2-b, 3-d, 4-a* - Wrongly pairs **collarette scales with Psoriasis**, which is known for thick silvery scales, not peripheral collarette scales. - Incorrectly matches **silvery scales with Pityriasis rosea**, which has collarette scales at lesion periphery, not silvery scales. *1-a, 2-b, 3-d, 4-c* - Falsely associates **collarette scales with Pityriasis versicolor**, which has branny scales from yeast infection, not collarette scales. - Mismatches **branny scales with Psoriasis**, which has characteristic thick silvery scales, not fine powdery scales.

Question 3: Skin biopsy shows psoriasiform hyperplasia with neutrophilic microabscesses in stratum corneum. Most likely diagnosis?

A. Psoriasis (Correct Answer)
B. Seborrheic dermatitis
C. Pityriasis rosea
D. Lichen planus

Explanation: ***Psoriasis*** - **Psoriasiform hyperplasia**, characterized by regular epidermal acanthosis and elongated rete ridges, is a classic histological feature of psoriasis. - The presence of **neutrophilic microabscesses (Munro microabscesses)** in the stratum corneum is a pathognomonic finding for psoriasis. *Seborrheic dermatitis* - Histologically, seborrheic dermatitis typically shows **irregular acanthosis** with parakeratosis and a **perivascular lymphocytic infiltrate**, but not regular psoriasiform hyperplasia or Munro microabscesses. - There may be *spongiosis* and neutrophils in the stratum corneum, but not the distinct microabscesses seen in psoriasis. *Pityriasis rosea* - Pityriasis rosea histology often reveals **focal parakeratosis**, **spongiosis**, and a **perivascular lymphocytic infiltrate** with extravasated red blood cells. - It does not demonstrate the characteristic regular psoriasiform hyperplasia or neutrophilic microabscesses of psoriasis. *Lichen planus* - Lichen planus is characterized by a **"sawtooth" rete ridge pattern**, a **band-like lymphocytic infiltrate** at the dermo-epidermal junction, and **colloid bodies (Civatte bodies)**. - It does not exhibit psoriasiform hyperplasia or neutrophilic microabscesses in the stratum corneum.

Question 4: Which of the following is used in the treatment of Pityriasis versicolor?

A. Itraconazole (Correct Answer)
B. Griseofulvin
C. Terbinafine
D. All of the options

Explanation: ***Itraconazole*** - **Itraconazole** is an effective oral antifungal agent commonly used to treat Pityriasis versicolor, particularly in widespread or recurrent cases. - It works by inhibiting fungal cytochrome P450-dependent 14α-lanosterol demethylase, thereby disrupting ergosterol synthesis and fungal cell membrane integrity. - Standard regimen: 200 mg once daily for 5-7 days or 200 mg twice daily for 1 day. *Griseofulvin* - **Griseofulvin** is an oral antifungal primarily used for dermatophyte infections (e.g., tinea capitis, tinea corporis), not Pityriasis versicolor, which is caused by *Malassezia* species (a yeast). - It acts by disrupting fungal mitosis and is concentrated in keratinocytes, but has **no activity against yeasts** like *Malassezia*. *Terbinafine* - **Terbinafine** is an allylamin antifungal that primarily targets dermatophytes by inhibiting squalene epoxidase, an enzyme involved in ergosterol synthesis. - While it has **limited activity** against *Malassezia* species, it is not considered a first-line or preferred systemic treatment for Pityriasis versicolor. - Azoles (itraconazole, fluconazole) are far more effective for this condition. *All of the options* - This option is incorrect because **griseofulvin** has no antifungal activity against *Malassezia* species and **terbinafine** is not a preferred treatment. - Only **itraconazole** among the listed options is an appropriate and effective systemic treatment for Pityriasis versicolor.

Question 5: An eleven-year-old boy has Tinea capitis on his scalp. Which of the following is the most appropriate line of treatment for this condition?

A. Shaving of the scalp
B. Topical griseofulvin therapy
C. Oral griseofulvin therapy (Correct Answer)
D. Selenium sulphide shampoo

Explanation: ***Oral griseofulvin therapy*** - **Systemic antifungal agents** are essential for treating **Tinea capitis**, as the fungal infection is deep within the hair follicles and cannot be reached effectively by topical treatments alone. - **Griseofulvin** is a well-established and effective oral antifungal for **Tinea capitis** in children. *Shaving of the scalp* - While shaving the scalp might reduce some fungal load and facilitate topical treatment, it is **not a definitive treatment** for **Tinea capitis** on its own, as the infection remains deep in the hair follicles. - It does not address the underlying systemic nature of the infection within the hair shaft. *Topical griseofulvin therapy* - **Topical griseofulvin** is generally **ineffective** for **Tinea capitis** because the fungus resides deep within the hair follicle and hair shaft, where topical preparations cannot penetrate sufficiently. - **Systemic absorption** is required to deliver adequate drug concentrations to the site of infection. *Selenium sulphide shampoo* - **Selenium sulfide shampoo** can be used as an **adjunctive therapy** to reduce shedding of spores and prevent spread, but it is **not curative** for **Tinea capitis**. - It helps to reduce skin scaling and fungal burden on the surface but does not eradicate the infection deep within the hair follicles.

Question 6: An 8-year-old child has localized non-cicatricial alopecia over scalp with itching and scales. The diagnosis is :

A. Lichen planus
B. Tinea Capitis (Correct Answer)
C. Tinea Barbae
D. Alopecia areata

Explanation: ***Tinea Capitis*** - **Tinea capitis** typically presents as **localized, non-cicatricial alopecia** with features like **scaling**, **itching**, and broken hairs, which are consistent with the child's symptoms. - It's a common **dermatophyte infection** of the scalp, particularly in children, caused by fungi like *Trichophyton* or *Microsporum*. *Lichen planus* - **Lichen planus** can cause alopecia, but it is typically a **cicatricial (scarring)** alopecia, unlike the non-cicatricial finding described. - It is more commonly associated with **purplish, polygonal, pruritic papules** on the skin and mucous membranes. *Tinea Barbae* - **Tinea barbae** specifically affects the **beard and mustache area** in adult males and would not present as alopecia on the scalp in an 8-year-old child. - It usually involves deep follicular inflammation with **pustules and nodules**. *Alopecia areata* - **Alopecia areata** is characterized by **smooth, circular patches of non-scarring hair loss** without associated scaling or significant itching. - The presence of **scaling and itching** in this case makes alopecia areata less likely.

Question 7: Identify the skin condition depicted in the image.

A. Ichthyosis (Correct Answer)
B. Syndromic ichthyosis
C. Cutaneous sarcoidosis
D. Leprosy

Explanation: ***Ichthyosis*** - The image clearly displays widespread **dry, scaling, and thickened skin**, consistent with the characteristic presentation of ichthyosis. - This condition is characterized by a defect in **skin barrier function** leading to excessive dryness and accumulation of scales. *Syndromic ichthyosis* - While syndromic ichthyosis also involves skin scaling, it is associated with **additional systemic symptoms** or **organ involvement**, which cannot be determined from this image alone. - The term "ichthyosis" broadly covers this appearance, and without more clinical information, specifying it as syndromic is not the most direct identification. *Leprosy* - Leprosy typically presents with **hypopigmented, anesthetic skin patches** or **nodules**, which are not seen in the image. - The texture and color changes in the image are not characteristic of the primarily neurological and dermatological manifestations of leprosy. *Cutaneous sarcoidosis* - Cutaneous sarcoidosis manifests as **reddish-brown papules, plaques, or nodules**, often on the face, neck, or extremities. - The widespread, fine scaling and dryness seen in the image do not align with the typical granulomatous lesions of sarcoidosis.

Question 8: Which of the following organisms has a role to play in Seborrheic dermatitis?

A. Pityrosporum ovale (Correct Answer)
B. Propionibacterium
C. Candida albicans
D. None of the above

Explanation: ***Pityrosporum ovale*** - **Pityrosporum ovale**, now known as **Malassezia furfur**, is a lipophilic yeast that colonizes the skin and plays a significant role in the pathogenesis of **seborrheic dermatitis**. - Its presence is commonly associated with the inflammatory response seen in seborrheic dermatitis, though the exact mechanism is not fully understood. *Candida albicans* - **Candida albicans** is a common cause of **mucocutaneous candidiasis** and **intertrigo**, but it is not directly implicated in the etiology of seborrheic dermatitis. - While it can cause skin infections, its typical presentation involves erythematous, macerated rashes with satellite lesions in skin folds. *Propionibacterium* - **Propionibacterium acnes**, now known as **Cutibacterium acnes**, is primarily associated with the pathogenesis of **acne vulgaris**. - It plays a role in the inflammation and comedone formation characteristic of acne, not the scaling and erythema of seborrheic dermatitis. *None of the above* - This option is incorrect because **Pityrosporum ovale (Malassezia furfur)** is a well-recognized organism involved in seborrheic dermatitis. - The other organisms listed are associated with different dermatological conditions.

Question 9: Pompholyx affects:

A. Groin
B. Scalp
C. Trunk
D. Palms and soles (Correct Answer)

Explanation: ***Palms and soles*** - **Pompholyx**, also known as **dyshidrotic eczema**, is characterized by recurrent outbreaks of **vesicles and bullae** predominantly on the palms and soles. - These lesions are typically very **itchy** and can cause significant discomfort. *Groin* - Conditions like **tinea cruris** (jock itch) or **intertrigo** commonly affect the groin, presenting with erythema and scaling rather than vesicles. - While eczema can occur in the groin, classical pompholyx has a predilection for the acral regions. *Scalp* - The scalp is more commonly affected by conditions such as **seborrheic dermatitis** or **psoriasis**, which manifest as scaling, redness, and flaking. - Vesicular eruptions are rare on the scalp unless due to specific conditions like herpes zoster. *Trunk* - The trunk is a common site for various dermatoses, including **atopic dermatitis**, **psoriasis**, or **pityriasis rosea**, but these typically present with different morphologic features (e.g., plaques, patches). - Pompholyx is specific to palms and soles and does not usually involve the trunk.

Question 10: A child presented with itchy plaques over the neck, the bilateral popliteal and cubital fossa. What could be the diagnosis?

A. Dermatitis herpetiformis
B. Psoriasis
C. Pemphigus vegetans
D. Atopic dermatitis (Correct Answer)

Explanation: **Atopic dermatitis** - The presentation of **itchy plaques** in the anatomical locations described (neck, bilateral popliteal fossa, and cubital fossa) is highly characteristic of **atopic dermatitis** in children. - Atopic dermatitis typically involves **flexural surfaces** in older children and adults, and is characterized by **intense pruritus**. *Dermatitis herpetiformis* - This condition presents with **extremely itchy, grouped vesicles and papules**, primarily on extensor surfaces, buttocks, and scalp. - It is strongly associated with **celiac disease** and is unlikely to present as plaques in flexural areas. *Psoriasis* - Psoriasis typically presents with **well-demarcated, erythematous plaques** covered with **silvery scales**, often on extensor surfaces (knees, elbows) and the scalp. - While it can occur in flexural areas (inverse psoriasis), **itching is usually less prominent** than in atopic dermatitis, and the characteristic scaling is usually present. *Pemphigus vegetans* - Pemphigus vegetans is a rare variant of pemphigus, characterized by **verrucous, vegetative lesions** and **bullae**, often in intertriginous areas. - This condition is a chronic autoimmune blistering disease and does not typically present as simple itchy plaques in a child.

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