Derm

Langerhan cells birbeck granules

Birbeck granules, also known asBirbeck
bodies, are rod shapedor "tennis-racket"
cytoplasmic organelles with a central linear
density and a striated appearance. They are a
characteristic microscopic finding inLangerhans
cell histiocytosis(Histiocytosis X), which is one
of a group of rare conditions collectively known
ashistiocytosis.
Formation is induced bylangerin.

Wood lamp
A Wood lamp emits ultraviolet light mainly at a wavelength of
365nm.
Blue-green fluorescence is detectable at the base of each infected
hair shaft in ectothrix and some endothrix infections.
Dermatophyte lesions of the skin (tinea corporis) do not fluoresce;
macules of tinea versicolor have a golden fluorescence under a Wood
lamp.
Erythrasma, an intertriginous infection caused by Corynebacterium
minutissimum, may fluoresce pink-orange, whereas Pseudomonas
aeruginosa is yellow-green under a Wood lamp.

 Infantile hemorrhagic edema

similar to HSP but involves face also

 Mechanics hand, shawl sign,

raccoons eyes dermatomyositis

Sweet Syndrome
Acute febrile neutrophilic dermatosis,
Sweet syndrome manifests abruptly as
tender, erythematous, edematous plaques
or nodules on any area of the skin, often
accompanied by fever, anemia, and
leukocytosis.
Diagnosis is confirmed by the presence of
a dense neutrophilic infiltrate without
evidence of vasculitis.

 Acrodermatitis chronica
atrophicans(ACA) (also known as
"Herxheimer disease"and "Primary
diffuse atrophy") is a skin rash
indicative of the third or late stage
of EuropeanLyme borreliosis.

 Necrolytic migratory erythema

glucagonoma syndrome

 Pathergy Behcets after skin

trauma various lesions like
folliculitis, purpura, pustule

 GVHD lichenoid papules

 DRESS Drug reaction, eosinophilia, systemic

symptoms
Triad fever, rash, hepatitis
exposure to certain medications, that may cause a
rash, fever, inflammation of internal organs,
lymphadenopathy, and characteristic hematologic
abnormalities such as eosinophilia,thrombocytopenia,
and atypical lymphocytosis.
Common drugs - phenobarbital,carbamazepine,
phenytoin, lamotrigine,minocycline,sulfonamides,
allopurinol,modafinilanddapsone. It has been
associated withHHV6

 Topical NSAIDs tacrolimus risk of

lymphoma
Transient neonatal pustular
melanosis PMN leucocyte

 Bilateral acromial skin dimples are usually an isolated finding,

but they are also seen in association with deletion of the long
arm of chromosome 18
Dimples tend to occur over the patella in congenital rubella
over the lateral aspects of the knees and elbows in prunebelly syndrome
pretibial surface in campomelic dwarfs
in the shape of an H on the chin in whistling-face syndrome.

 Pre auricular pits branchio oto renal

dysplasia
Accessory tragus oculo auriculo
vertebral dysplasia (goldenhars
syndrome)
Aplasia cutis congenita + blistering +
nail deformity epidermolysis
bullosa

 Setleis syndrome bitemporal

scarring
Focal dermal hypoplasia is also
known as Goltz syndrome or GoltzGorlin syndrome Osteopathia
striata are fine parallel vertical
stripes noted on radiographs in the
metaphyses of long bones of patients
with this disorder

Dyskeratosis Congenita (ZinsserEngman-Cole Syndrome)

triad of reticulated
hyperpigmentation of the skin
dystrophic nails
mucous membrane leukoplakia
in association with immunologic and
hematologic abnormalities.

Anhydrotic ectodermal
dysplasia
Sweat glands absent
Pegged teeth
Hypotrichosis

Association with
dysgammaglobulinemia
X linked

Hydrotic Ectodermal Dysplasia

(Clouston Syndrome)
autosomal dominant disorder
hidrotic ED are dystrophic,
hypoplastic, or absent nails; sparse
hair; and hyperkeratosis of the palms
and soles.

 Port wine pulsed dye LASER

MC tumor of infancy hemangioma
(GLUT 1 +)
Hemangioma beard distribution

Syndromes associated with

hemangiomas
PHACES (posterior fossa brain defects such as DandyWalker malformation or cerebellar hypoplasia, large
plaquelike facial hemangioma, arterial cerebrovascular
abnormalities such as aneurysms and stroke, coarctation
of the aorta, eye abnormalities, and sternal raphe
defects such as pits, scars, or supraumbilical raphe)
Gorham (cutaneous hemangiomas with massive
osteolysis)
Bannayan-Riley-Ruvalcaba (macrocephaly lipomas,
hemangiomas of autosomal dominant inheritance).

 Cannon ball like tufts of dermal blood

vessels tufted angioma
Kassabach Merritt - rapidly enlarging
tufted angioma or kaposiform
hemangioendothelioma,
thrombocytopenia, microangiopathic
hemolytic anemia, and an acute or
chronic consumption coagulopathy.

 Maffuci nodular enchondroma +

vascular lesion
Ataxia telangiectasia louis bar syndrome
Fabry angiokeratoma corporis diffusum
Large congenital melanocytic nevus
suspect leptomeningeal involvement

 LAMB syndrome (Carney complex), a multiple

endocrine neoplasia syndrome, consists of
lentigines of the face and vulva, atrial myxoma,
mucocutaneous myxomas, and blue nevi
Multiple lentigines in LEOPARD (lentigines in
association with electrocardiogram abnormalities,
ocular hypertelorism, pulmonary stenosis,
abnormal genitals [cryptorchidism, hypogonadism,
hypospadias], growth retardation, and
sensorineural deafness) syndrome.

 Crowes sign multiple axillary

freckling due to multiple caf au
lait macules

 Incontinentia pigmenti (Bloch Sulzberger) Xlinked dominant gene that is lethal in males (IKKgamma/NEMO gene)
1st stage erythematous linear streaks
2nd stage eosinophil filled vesicles verrucous
plaques
3rd stage pigmentary phase
4th stage - hairless, anhidrotic, hypopigmented
patches or streaks occur as a late manifestation

 Oculocutaneous albinism:
OCA1 Tyrosinase
OCA2 P protein MC assoc with
Angelman, Prader
OCA3 TRP-1
OCA3 (rufous albinism)

 Cross-McKusick-Breen syndrome consists of

tyrosinase-positive albinism with ocular abnormalities,
retardation, spasticity, and athetosis.
Hermansky-Pudlak syndrome
oculocutaneous albinism, ceroid accumulation in
lysosomes, and prolonged bleeding time
Chediak-Higashi syndrome - dysfunction of
lysosome-related organelles. hypopigmentation of
the skin, eyes, and hair; prolonged bleeding times and
easy bruising; recurrent infections; abnormal natural
killer cell function; and peripheral neuropathy.
mutations in the CHS1/LYST gene

Waardenburg Syndrome
localized areas of depigmented skin and hair.
Waardenburg type 1 - white forelock, depigmented
skin, Deafness, heterochromia irides, unibrow
(synophrys), Dystopia canthorum (i.e., telecanthus)
Waardenburg type 2 lack dystopia canthorum
Waardenburg type 3 - limb abnormalities - also called
the Klein-Waardenburg syndrome.
Waardenburg type 4 - Shah-Waardenburg syndrome have Hirschsprung disease

Hypomelanosis of Ito
cutaneous condition characterized by
various patterns of bilateral or
unilateral hypopigmentation
following thelines of Blaschko.
Associated with neurological
symptoms - mental retardation,
seizures, microcephaly.

 Vogt-Koyanagi-Harada syndrome
is vitiligo associated with uveitis,
dysacusia, meningoencephalitis, and
depigmentation of the skin, scalp
hair, eyebrows, and eyelashes.
In the Alezzandrini syndrome,
vitiligo is associated with
tapetoretinal degeneration and
deafness.

 Erythema multiforme iris or bulls

eye lesions; can be due to HSV
Steven johnson 2 or more mucosal
surfaces; M. pneumoniae is infectious
cause
TEN > 30 %

Melanobullous disorders
3 major headings with multiple subgroupings:
epidermolysis bullosa simplex (EBS)
junctional epidermolysis bullosa (JEB)
dystrophic epidermolysis bullosa (DEB)
Kindler syndrome (Kindlin-1 gene), which includes
poikiloderma and photosensitivity as well as easy
blistering, is also considered a separate form of EB.

 EBS generalized Koebner

EBS localized- Weber Cockayne
EBS herpetiformis - HSV Dowling
Meara

 JEB Herlitz
JEB Non Herlitz associated with
pyloric atresia
Pseudosyndactyly, amitten
deformityof thehand
recessivedystrophic
epidermolysis bullosa(EB) /
Hallopeau-Siemens

 Gluten sensitive enteropathy

associated dermatitis herpetiformis
Linear Ig A dermatosis chronic
bullous dermatoses of childhood
Irritative contact dermatitis saliva
irritant

 Vesicular Hand and Foot Dermatitis (Dyshidrotic Eczema,

Dyshidrosis, Pompholyx)
Cockayne syndrome dwarfism, MR, photosensitivity
Cradle cap malazzesia furfur seborrheic dermatitis
result from cutaneous histiocytic infiltrates in infants with
Langerhans cell histiocytosis.
Seborrheic dermatitis is a common cutaneous
manifestation of AIDS

Rothmund-Thomson
syndrome
poikiloderma congenitale
Mutations in the RECQL4 gene
Plaques of erythema and edema replaced gradually
by reticulated, atrophic, hyperpigmented, telangiectatic
plaques.
Light sensitivity
Short stature; small hands and feet; sparse eyebrows,
eyelashes, and pubic and axillary hair, and sparse, fine,
prematurely gray scalp hair or alopecia; bony defects;
and hypogenitalism are common.
Assocn with osteosarcoma

 Guttate psoriasis strep

Keratosis follicularis Dariers
Collodion baby
Rx: oral retinoids

 CHILD (congenital hemidysplasia with

ichthyosiform erythroderma and limb defects)
CHIME (colobomas of the eyes, heart defects,
ichthyosiform dermatosis, mental retardation,
and ear abnormalities) syndrome
keratitis with ichthyosis and deafness (KID
syndrome, connexin 26 gene)

 X linked Ichthyosis corneal opacities,

cryptorchidism

contiguous gene deletion syndromes.

Kallmann syndrome (KAL1 gene), which
consists of hypogonadotrophic
hypogonadism and anosmia, X-linked
chondroplasia punctata (ARSE gene),
short stature, and ocular albinism.

Chondrodysplasia Punctata
X-linked dominant CPD, also known as Conradi-H?nermann
syndrome
X-linked recessive
also be caused by maternal vitamin K deficiency or warfarin
teratogenicity.
ichthyosis and bone changes - generalized erythema and scaling
to mild hyperkeratosis.
Rhizomelic chondrodysplasia punctata is associated with
cataracts, hypertelorism, optic nerve atrophy, disproportionate
shortening of the proximal extremities, psychomotor retardation,
failure to thrive, and spasticity
The pathognomonic defect, termed chondrodysplasia
punctata, is stippled epiphyses in the cartilaginous skeleton.

Netherton syndrome
ichthyosisassociated with mutations
in theSPINK5gene
hair shaft defect (trichorrhexis
invaginata), also known as "bamboo
hair".
high susceptibility toinfectionand
allergy
ichthyosis linearis circumflexa

 Glistening dots in fovea Sjogren larsson

DM granuloma annulare, necrobiosis
lipoidica
SCARF skeletal, cutis laxa, ambiguous
genitalia, retardation, facial abnormalities
Ehler Danlos fibrillar collagen

 Pebbly plucked chicken skin pseudoxanthoma

elasticum
Urticaria pigmentosa MC form of mastocytosis
Chilblains - pernioandperniosis- is a
medical condition that is often confused with
frostbiteandtrench foot. Chilblains are a tissue
injury that occurs when a predisposed
individual is exposed to cold and humidity.

 Alopecia areata in downs ophiasis pattern

Hippocratic nails clubbing

Uncombable hair syndrome, Spunglass hairandCheveux incoiffablesis a
rare structural anomaly of thehairwith a
variable degree of effect.

 Meuhrkes nails hypoalbuminemia

Lindsay nails half-and-half nails - Renal
Terry nails. The nail bed is white with only
a narrow zone of pink at the distal end
cirrhosis
arsenic poisoning - Mees lines

 Bluish black to greenish nails pseudomonas

Onycholysis tetracycline
Onychomadesis exaggeration of Beaus lines
acrodermatitis enteropathica
Trachyonychia (20-nail Dystrophy) - Trachyonychia
is characterized by longitudinal ridging, pitting,
fragility, thinning, distal notching, and opalescent
discoloration of all the nails

 Cowden PTEN mutation multiple

hamartoma syndrome
Ecthyma gangrenosa is a necrotic
ulcer covered with a gray-black
eschar- P. aeruginosa immunosuppressed patients

Staphylococcal Scalded Skin

Syndrome
(Ritter Disease) strain 71, 55
exotoxin A and B
scarlatiniform erythema
Nikolsky +ve
Abortive type nikolsky negative

 Folliculitis, or superficial infection of the hair

follicle, is most often caused by S. aureus
(Bockhart impetigo).
Sycosis barbae is a deeper, more severe
recurrent inflammatory form of folliculitis caused
by S. aureus that involves the entire depth of the
follicle.
Hot tub folliculitis is attributable to P.
aeruginosa, predominantly serotype O-11.

 Tuberculids- tuberculoid features + no

mycobacteria
Black dot ringworm tinea tonsurans
Majocchi granuloma due to penetration of
organisms along the hair follicle to the level
of the dermis, producing a fungal folliculitis
and perifolliculitis. Usually after steroids in
ringworm in infection.

viral inclusion bodies

Intracytoplasmic eosinophilic
Negri bodiesinRabies
Guarnieri bodies inSmall pox
Henderson-Peterson bodies inMolluscum contagiosum

Intranuclear acidophilic Cowdrytype A inHerpes simplex virusandVaricella zoster virusand Torres

bodies inYellow fever
Cowdrytype B inPolio

Intranuclear basophilic Cowdry type B inAdenovirus

"owl eyes" incytomegalovirus

Both intranuclear and intracytoplasmic Warthin finkeldey bodies inMeasles

Inclusion bodies in skin

conditions:
Asteroid bodies - Sporotrichosis
Cowdry A - Herpes Simplex
Donovan bodies - Granuloma Inguinale
Dutcher bodies - Multiple Myeloma, Primary
cutaneous marginal zone lymphoma
Pustulo-ovoid bodies - Granular cell tumor

 Medlar bodies - Chromoblastomycosis

MichaelisGutmann bodies - Malakoplakia
Rocha Lima bodies - Verruga peruana
Russell bodies - Multiple myeloma
Rhinoscleroma bodies
Verocay bodies - Schwannoma
Virchow bodies - Leprosy

 Norwegian scabies- type of scabies with

deficient host immune response
Vagabonds skin Pediculosis corporis
Maculae cerulae pediculosis pubis
Pomade acne due to grey hair
preparations - along the hairline

 Acne fulminans erythema

nodosum, osteolytic bone lesions
Pilomatricomas - mutations in betacatenin
syringoma is derived from an
intraepidermal sweat gland duct

 Sea bathers eruption - The eruption

appears to be due to an allergic
hypersensitivity reaction to venom
from larvae of the thimble jellyfish
(Linuche unguiculata)

Cutis Marmorata
When a newborn infant is exposed to low
environmental temperatures, an evanescent,
lacy, reticulated red and/or blue cutaneous
vascular pattern appears over most of the body
surface.
Cutis marmorata telangiectatica congenita is
clinically similar, but the lesions are more
intense, may be segmental, are persistent, and
may be associated with loss of dermal tissue,
epidermal atrophy, and ulceration.

Impetigo

Non bullous
MC
Staph aureus GA beta hemolytic
Golden honey colored crusts

Cellulitis
Strep pyogenes, staph aureus

Necrotizing Fasciitis
Necrotizing fasciitis is a subcutaneous tissue infection that
involves the deep layer of superficial fascia but largely
spares adjacent epidermis, deep fascia, and muscle.
polymicrobial in nature, with an average of 4 different
organisms isolated.
The organisms most commonly isolated in polymicrobial
necrotizing fasciitis are S. aureus, streptococcal species,
Klebsiella species, E. coli, and anaerobic bacteria.
development of crepitance signals the presence of
Clostridium spp. or gram-negative bacilli such as E. coli,
Klebsiella, Proteus, or Aeromonas.