Essentials in Dermatology

(with Multiple Choice Questions)

Essentials in Dermatology
(with Multiple Choice Questions)

Second Edition

Devinder M Thappa

MD, DHA, MNAMS, FIMSA

Professor and Head

Department of Dermatology and STD
Jawaharlal Institute of Postgraduate Medical Education and Research
(JIPMER)
Pondicherry, India

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Essentials in Dermatology (with Multiple Choice Questions)

2009, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any
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of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all
legal matters are to be settled under Delhi jurisdiction only.

First Edition: 2003

Second Edition: 2009
ISBN 978-81-8448-558-5

Typeset at JPBMP typesetting unit

Printed at Ajanta

Preface to the Second Edition

The second edition of Essentials in Dermatology (with Multiple Choice Questions) is being published
6 years after the appearance of the first edition. The encouraging response to the first edition prompted
me to revise the book, keeping in view the comments received, and changing trends in the field of
dermatology.
This new edition incorporates differential diagnosis for each entity or group of entities to further
understand the subject critically. Three new chaptersSkin in Systemic Diseases, Skin Changes of
Pregnancy and Old Age, and Antiretroviral Therapy (ART) have been added. The existing chapters
have been updated and treatment guidelines revised. Newer entities have been included under
various chapters, but not at the cost of brevity and conciseness. For better understanding of the text,
better photographs and clinical illustrations have been incorporated.
The section on multiple choice questions has been considerably expanded, and this section has
been divided into twofor PG entrance examinations and for postgraduates in dermatology.
Additional mnemonics have been included in the useful medical mnemonics section.
The objective of this edition remains the sameto serve as an aid for beginners in dermatology
and those aspiring for PG entrance examinations.
The making of the revised edition of this book involved a number of people besides myself.
Many of the chapters were revised with inputs from my senior residents Dr Rashmi Kumari,
Dr Amiya Kumar Nath and Dr Abarna Devi and junior residents Dr Nidhi Singh, Dr Abhijit
Chougule, Dr Kishan Kumar Agarwal, Dr Balaji Adityan, Dr Sowmya Kaimal and Dr Sakthi Kandan.
The photographs utilized in the book have been possible due to the Medical Illustration Department
of the hospital, and the digital cameras of my postgraduates, making the new edition a colorful
experience. My laboratory technician Mr Samsudeen deserves a mention for his skill in the staining
and preparation of laboratory material for photomicrography. The final making of this edition has
involved the support and cooperation of all my esteemed colleagues, patients and the forgotten
names of residents (who worked for the first edition of the book).
As always, this edition is open to constructive criticism and suggestions for its further
improvement.
Devinder M Thappa

Preface to the First Edition

Dermatology, the science of the skin, was one of the many specialties, which evolved from general
internal medicine during the course of the nineteenth century. In India, recognition of dermatology
as a specialty distinct from internal medicine is recent; it has still not grown to its full stature in
practice and teaching. In spite of having some share in the curriculum, dermatology remains a
neglected subject because of its non-inclusion in the qualifying examination at MBBS level. There
has been an explosion of knowledgeeasily documented by the size of standard dermatology
textbooks, whose length has increased from an average of 1000 pages to the most recent editions of
Fitzpatrick and of Rook, which are more than 3000 and 3600 pages, respectively. Expansion has
been greater on the surgical and cosmetic side of the specialty, which barely existed 50 years ago.
Such vast knowledge is difficult to grasp in 3 years course of MD dermatology, venereology and
leprology, sometimes may be at the cost of another. So there was need for a short textbook for
postgraduates who have just joined the specialty to have the glimpse of the subject and understand
the basic dermatology before venturing for detailed standard textbooks. There is lack of simple but
up to date book for undergraduates who are preparing for Postgraduate Entrance Examination.
Though market is flooded with a number of books, many of them are not even framed by dermatology
specialty individuals and lack correct and appropriate information. This prompted me to write this
book to fulfill the needs of students aspiring for entering in postgraduate courses in reputed institutes
of India. The material in this book is based on the standard textbooks and latest information from
specialty journals. Introduction to MCQs is a unique section in this book to guide the students. The
multiple choice questions are taken from a number of sources to sensitize the student to know
certain subject areas in this specialty thoroughly and accordingly the book section gives relevant
points highlighted for quick revision of facts. The suggestions and healthy critical remarks will be
very much appreciated to improve this book.
Devinder M Thappa

Acknowledgements
I would like to thank those who helped me to update chapters
1. Dr Balaji Adityan for updating
Principles of Diagnosis in Dermatology
Bacterial Infections
Viral Infections
Fungal Infections
Skin Changes in Pregnancy and Old Age
2. Dr Sakthi Kandan for
Infestations
Disorders of Hair and Nails
Metabolic and Nutritional Disorders
Skin in Systemic Diseases
3. Dr Sowmya Kaimal for
Pediatric Dermatology
Human Immunodeficiency Virus Infection (HIV) and Acquired Immunodeficiency Syndrome
(AIDS)
4. Dr Amiya Kumar Nath for
Eczema
Connective Tissue Disorders
Genetics and Genodermatoses
5. Dr Abhijit Chougule for
Differential Diagnosis for Leprosy
Treatment of Leprosy
6. Dr Kishan Kumar Agarwal for
Urticaria, Angioedema and Pruritus
Disorders of Sebaceous, Eccrine and Apocrine Glands
7. Dr Nidhi Singh for
Cutaneous Tuberculosis and Atypical Mycobacterial Infections
Vesiculobullous Disorders
Pigmentary Disorders
Following residents helped in framing MCQs for postgraduates
1. Dermatology Basics
Dr Abhijit Chougule
Dr Kishan Kumar Agarwal
2. Clinical Dermatology Part -I
Dr Rashmi Kumari

Essentials in Dermatology
Dr Balaji Adityan
Dr Ajay Kumar Singh
Dr Anuradha Priyadarshini
Dr Tukaram Sori
3. Clinical Dermatology Part -II
Dr Malathi
Dr Sathyamoorthy
4. Sexually Transmitted Diseases
Dr Sowmya Kaimal
Dr Rajalakshmi
5. Leprosy
Dr Abarna Devi
Dr Sakthi Kandan

Reviews
Most of the dermatology textbooks are too much voluminous for undergraduate students already
overburdened with other heavy weight subjects. Not only undergraduates, beginners at the
postgraduate level also face problem to acquire basic conception from such large books. So there is
always a need for a concise book which can provide clear basic conception and up-to-date knowledge
to the students.will be of immense help to the postgraduate entrance examinees.should be
collected in all undergraduate medical college libraries for the benefit of the students
Indian J Dermatol 2003; 48(4): 248.
The stated aim of the book is to have a short textbook for new entrants to postgraduate
studies in dermatology which could glimpse of the subject and understand basic dermatology before
venturing for detailed standard textbooks. The second aim stated is to fulfill the needs of students
aspiring for entering in postgraduate courses in reputed institutes.well written and fulfill the
stated aimsAn approach to attempting MCQs appears to be a very useful chapter.strongly
recommend this book to the new entrants in specialty training and those preparing for admission to
postgraduate courses
Indian J Dermatol Venereol Leprol 2004; 70(6): 393.

Contents

SECTION 1: DERMATOLOGY
1. Ten Most Influential People in Medicine and Dermatology .................................................... 3
2. History of Dermatology in the World ............................................................................................ 5
3. Microanatomy of the Skin ................................................................................................................ 8
4. Physiology, Biochemistry and Immunology of the Skin ......................................................... 13
5. Principles of Diagnosis in Dermatology ..................................................................................... 16
6. Bacterial Infections .......................................................................................................................... 31
7. Viral Infections ................................................................................................................................. 43
8. Fungal Infections ............................................................................................................................. 57
9. Infestations ........................................................................................................................................ 72
10. Papulosquamous Disorders ........................................................................................................... 82
11. Eczema ................................................................................................................................................ 99
12. Vesiculobullous Disorders ........................................................................................................... 114
13. Cutaneous Tuberculosis and Atypical Mycobacterial Infections ........................................ 127
14. Connective Tissue Disorders (Collagen Vascular Disorders) ............................................... 134
15. Pigmentary Disorders ................................................................................................................... 148
16. Keratinization Disorders .............................................................................................................. 156
17. Urticaria, Angioedema and Pruritus .......................................................................................... 166
18. Drug Eruptions, Erythema Multiforme, Stevens-Johnson Syndrome
and Toxic Epidermal Necrolysis ................................................................................................. 172
19. Disorders of Sebaceous, Eccrine and Apocrine Glands ......................................................... 180
20. Disorders of Hair and Nails ......................................................................................................... 189
21. Metabolic and Nutritional Disorders ......................................................................................... 198
22. Genetics and Genodermatoses .................................................................................................... 210
23. Skin in Systemic Diseases ............................................................................................................ 222

xiv

Essentials in Dermatology
24. Skin Changes of Pregnancy and Old Age ................................................................................. 237
25. Pediatric Dermatology .................................................................................................................. 240
26. Benign, Pre-malignant and Malignant Tumors of the Skin .................................................. 246
27. Topical Formulary and Key Systemic Drugs ............................................................................ 257
28. Dermatosurgical Procedures ........................................................................................................ 272

SECTION 2: SEXUALLY TRANSMITTED DISEASES AND HIV INFECTION

29. Historical Milestones in Sexually Transmitted Diseases ...................................................... 279
30. History Taking and Examination in Sexually Transmitted Diseases (STDs) .................... 282
31. Sexually Transmitted Diseases ................................................................................................... 288
32. Human Immunodeficiency Virus Infection (HIV) and Acquired
Immunodeficiency Syndrome (AIDS) ....................................................................................... 309
33. Antiretroviral Therapy (ART) ..................................................................................................... 318

SECTION 3: LEPROSY
34. Historical Milestones in Leprosy ................................................................................................ 327
35. History Taking and Examination in Leprosy ........................................................................... 330
36. Clinical Leprosy ............................................................................................................................. 333
Multiple Choice Questions .................................................................................................................... 351
Some Useful Medical Mnemonics ....................................................................................................... 441
Terminology ............................................................................................................................................. 447
Answers ..................................................................................................................................................... 465
Index ........................................................................................................................................................... 469