GRANULOCYTIC DERMATITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Subcorneal Pustular Dermatosis
2. Sweet's Syndrome
3. Eosinophilic Cellulitis
4. Pyoderma Gnagrenosum
5. Pustular Folliculitis
6. Hidradenitis Suppurativa
7. Arthropod Reaction

VASCULITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Leukocytoclastic Vasculitis
2. Lymphocytic Vasculitis
3. Perniosis
4. Atrophie Blanche
5. PAN
6. Nodular Vasculitis (+lobular panniculitis)
7. Angiolymphoid Hyperplasia with Eosinophilia

GRANULOMATOUS DERMATITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Foreign Body Granuloma
2. Sarcoidosis
3. Granuloma Annulare
4. Rheumatoid Nodule
5. Necrobiosis Lipoidica Diabeticorum
6. Leprosy
7. Rosacea
8. Atypical Mycobacterial Infection

VESICULOBULLOUS DERMATITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Pemphigus
2. Bullous Pemphigoid
3. Epidermolysis Bullosa (Weber-Cockayne)
4. Epidermolysis Bullosa Simplex
5. Epidermolysis Bullosa Acquisita
6. Darier's Disease
7. Dermatitis Herpetiformis
8. Grover's Disease
9. Hailey Hailey Disease

SPONGIOTIC DERMATITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Spongiotic Dermatitis / Eczema
2. Allergic Contact Dermatitis
3. Pityriasis Rosea
4. Miliaria
5. Spongiosis associated with other pattern like erythema multiforme

PSORIASIFORM DERMATITIS

COMMONLY BIOPSIED LESIONS IN MALAYSIA

1. Psoriasis
2. Picker's Nodule
3. Lichen Simplex Chronicus
4. Prurigo Nodularis
5. Pityriasis Rubra Pillaris
6. Pityriasis Rosea
7. Mycosis Fungoides

LICHENOID DERMATITIS

COMMONLY BIOPSIED LESION IN MALAYSIA

1. Erythema Multiforme
2. Pityriasis Lichenoides Chronicum
3. PLEVA
4. Lupus Erythematosus
5. Lichen Planus
6. Lichen Nitidus
7. Lichenoid Drug Eruption
8. Lichen Planopilaris

MAJOR TISSUE REACTIONS

1. Lichenoid Dermatitis
2. Psoriasiform Dermatitis
3. Spongiotic Dermatitis
4. Vesicobullous Dermatitis
5. Granulomatous Dermatitis
6. Vasculitis
7. Panniculitis
8. Granulocytic Dermatitis (Neutrophilic / eosinophilic)

DRUG INDUCED LE

PASCHA ALI

Penicillamine, Procainamide
Antihypertensives (ACE-I., Atenolol)
Sulfonamides
Chlorpromazine
Hydralazine
Antibiotics (Griseofulvin, Sulfa)
Anticonvulsants (Phenytoin, Phenobarbital)
Lithium
Isoniazid

CAUSES OF PERIPHERAL EOSINOPHILIA

CHINA

Connective tissue disease (SLE, DM, Sjogren's, CSS)
Helminths (All worms, parasites, Giardia)
Idiopathic hypereosinophilic syndrome
Neoplasms (Leukaemia)
Allergies, Asthma

SCARRING ALOPECIA

ALOPECIAS

Autoimmune (DLE, Morphea, Cicatricial pemphigoid)
Lichen Planus (Lichen planopilaris)
pseudOpelada de Brocq
Physical damage (chemicals, trauma, radiation)
Epidermal Nevus and Neoplasms (BCC, SCC, metastases)
Congenital (Aplasia cutis)
Infectious (Bacterial, Fungal, Viral - Herpes zoster)
Alopecia mucinosa (Sometimes associated with mycosis fungoides)
Sarcoidosis

DRUG INDUCED PEMPHIGUS

CRAP

Captopril
Rifampicin
ACE Inhibitor
Piroxicam; Penicillamine

CAUSES OF BLUE SCLERA

A POEM

Anaemia
Pseudoxanthoma elasticum
Osteogenesis imperfect
Ehlers Danlos syndrome
Marfan syndrome

GENERALIZED SKIN HYPERPIGMENTATION

"Generalized mean none of the skin is SPARED"

Sunlight
Pregnancy
Addison's Disease
Renal failure
Excess iron (haemochromatosis)
Drugs (e.g. amiodarone, minocycline)

HENOCH-SCHONLEIN PURPURA

NAPA

Nephritis
Arthritis, arthralgias
Purpura, palpable (especially on lower extremities)
Abdominal pain (intussusception to be ruled out)

INCONTINENTIA PIGMENTI (BLOCH-SULZBERGER'S DISEASE)

BLOCH

Bony abnormalities; Bullae/vesicles (I)
Loss or dystrophy of hair, nails or teeth
Ocular (blindness, strabismus, cataracts)
Central Nervous System (seizures, mental retardation)
Heart malformations (uncommon);

Stages:

Bullae/vesicles (I),
Hyperkeratotic plaques (II),
Hyperpigmentation (III),
Hypopigmentation- (IV)

LEUKOCYTOCLASTIC VASCULITIS

VASCULITIS

Viral hepatitis B, C
Anaphylactoid purpura, Autoimmune (SLE, PSS, DM)
Systemic lupus & other autoimmune Disease, Staph/Strep Sepsis
Cryoglobulins
Urticarial Vasculitis, ulcerative colitis
Lymphoproliferative Disease (Hairy Cell leukemia)
Idiopathic
Thiazides, PhenoThiazines, Lasix
Immune Sera, & Iodides
Sulfa (& other antibiotics)

Hair shaft abnormalities

1) Increased fragility - monilethrix, pili torti,trichorrhexis invaginata, trichorrhexis nodosa, trichoschisis
2) Without fragility - pili annulati, uncombable hair, loose anagen hair



Pili torti - twisting of hair, flattened hair with rotation of 180 degree around long axis at irregular interval
eg. Menkes' syndrome, Bjornstard syndrome
Trichorrhexis nodosa is the fraying of hair ends so that the resemble a "broom-stick" or "paint brush".
eg. argininosuccinic aciduria

Trichoschisis or clean fracture of the hair shaft.
eg. Tay's syndrome is also known as trichothiodystrophy

Trichorrhexis invaginata or bamboo hair.
eg. Netherton's syndrome

Monilethrix means beading of hairs, it is an Autosomal Dominant condition.
Abnormality is in gene coding for human hair keratins hHb1 and hHb6.
Pili Annulati is the alternating light and dark bands secondary to air-spaces seen in normal light and has been associated with alopecia areata.

CLASSIFICATION OF HYPERSENSITIVITY REACTION

ACID

A = Type 1 Anaphylactic
C = Type 2 Cytotoxic
I = Type 3 Immune complex
D = Type 4 Delayed

Modified sebaceous glands

Fordyce spots = lips
Montgomery's tubecles = nipples
Meibomian glands = eyelids
Tyson glands = genitalia

KOEBNER'S PHENOMENON

Very Low Density Lipo-ProteinS

V = Vitiligo; Viral wart
L = Lichen planus / Lichen striatus
D = DLE
L = Molluscum contagiosum
P = Psoriasis
S = Sarcoidosis

LICHEN PLANUS

"7P"

Pruritic, Papules, Plaques, Purple, Polygonal, Plain top, Peripheral

LYMPHOGRANULOMA VENEREUM

ABCDEFG

A = Asymptomatic in early stage
B = Bilateral buboes
C = Causative organism Chlamydia trachomatis
D = Drug of choice doxycycline
E = Estheomine
F = Frei's test
G = Groove's sign

Important HPV types

Plantar warts 1,2
Common warts 1,2
Flat warts 3,10
Butcher's warts 7
Epidermodysplasia verruciformis 5,8,9
Condyloma acuminatum (CA) 6,11
Bushke Lowenstein tumour (Giant CA) 6,11
Focal epithelial hyperplasia of Heck 13,32
Bowenoid papulosis 16
Intraepithelial neoplasias 11,16,31,33

Classification of cutaneous TB

1.Exogenous
- Primary inoculation TB (nonsensitized)
- TB verrucosa cutis (sensitized)

2.Endogenous
- Lupus vulgaris
- Scrofuloderma
- Metastatic TB abscess
- Acute miliary TB
- Orificial TB

3.Tuberculid
- Erythema induratum
- Papulonecrotic tuberculid
- Lichen scrofulosorum

Blueberry Muffin spots

Causes:
Prenatal infections (e.g. TORCH)
Severe anemia (e.g. Hemolytic Disease of the newborn, Hereditary spherocytosis)
Neoplastic diseases (e.g. rhabdomyosarcoma, Neuroblastoma)

Indicate extramedullary erythropoiesis

AGEP

Acute generalized Examthematous Pustulosis

Drugs: Ampicilin, cephalosporins, macrolides, Ca channel blockers, hydrochloroquine, paracetamol
Infections: Enterococcus, Parvo virus 19, CMV, Chlamydia, spider bites

MHC molecules

MHC Class I molecules are on ALL nucleated cells
MHC Class II molecules are on B cells, monocytes, dendritic cells, and are inducible on keratinocytes and endothelial cells.

TH relation of skin diseases

TH1: psoriasis, contact dermatitis, tuberculoid leprosy
TH2: atopic dermatitis, lepromatous leprosy, SLE

TH1:IL1, IL2, IL12, IL15, IL18, IL23, IFN alpha, IFN gamma, TNF alpha, TNF beta
TH2:IL4, IL5, IL6, IL9, IL10, IL13

Sutures

Absorbable: Catgut, Vicryl, Maxon, Monocryl, PDS, Dexon

Non-absorbable: Polypropylene, Nylon, Navafil, Silk

Waardenburg's syndrome gene

"pack your mittens and pack your socks"

PAX-3
MITF
SOX10

POEMS syndrome

Polyneuropathy
Organomegaly
Endocrinopathy
Monoclonal gammopathy
Skin lesions - gromeruloid hemangioma

DFSP VS Dermatofibroma

Immunohistochemistry staining

Dermatofibrosarcoma protuberans : CD34+++ Factor XIIIa +
Dermatofibroma : CD34+ Factor XIIIa+++

Acute sarcoidosis

LöfgreN syndrome
Hilar Lympadenopathy, erythema Nodosum, fever, migrating polyarthritis, acute iritis

Heerfordt syndrome
Parotid gland enlargement, fever, uveitis, and cranial (usually facial) nerve palsies