DIMS Lectures Dermatology PDF

Here is the complete pdf lecture of dermatology by Dr. Tahir Malik

Introduction to Clinical Dermatology

Dermatology is the branch of medicine that focuses on skin, hair, and nail disorders, ranging from common conditions like acne to life-threatening diseases like melanoma. Skin is the largest organ of the body and plays a crucial role in protection, sensation, and immune response.

Common Dermatological Conditions

1. Acne Vulgaris

• Definition: A chronic inflammatory skin condition affecting the pilosebaceous unit.
• Causes:
  • Increased sebum production (hormonal influence).
  • Propionibacterium acnes (bacterial involvement).
  • Follicular hyperkeratinization leading to clogged pores.
  • Inflammation due to immune response.
• Clinical Features:
  • Comedones (blackheads and whiteheads).
  • Papules, pustules, nodules, cysts (inflammatory acne).
  • Post-inflammatory hyperpigmentation and scarring in severe cases.
• Management:
  • Mild: Topical retinoids, benzoyl peroxide.
  • Moderate: Oral antibiotics (Doxycycline, Minocycline), hormonal therapy.
  • Severe: Isotretinoin (systemic retinoid).

2. Psoriasis

• Definition: A chronic autoimmune skin disease characterized by hyperproliferation of keratinocytes.
• Types:
  • Plaque Psoriasis: Most common, silvery scales over erythematous plaques.
  • Guttate Psoriasis: Small drop-like lesions, triggered by infections.
  • Inverse Psoriasis: Affects skin folds (axillae, groin).
  • Erythrodermic Psoriasis: Severe, life-threatening form with widespread redness.
• Clinical Features:
  • Well-demarcated plaques with silvery scales.
  • Auspitz sign (bleeding when scale is removed).
  • Koebner phenomenon (lesions at sites of trauma).
• Management:
  • Topical corticosteroids, Vitamin D analogs (Calcipotriol).
  • Systemic agents for severe cases (Methotrexate, Biologics like Infliximab).

3. Eczema (Atopic Dermatitis)

• Definition: A chronic inflammatory skin condition with a defective skin barrier.
• Triggers:
  • Allergens, irritants, climate, genetic predisposition.
• Clinical Features:
  • Dry, itchy, red patches (commonly on flexural surfaces).
  • Lichenification (thickened skin due to scratching).
  • Dennie-Morgan folds (infraorbital skin folds in chronic eczema).
• Management:
  • Emollients and moisturizers (first-line therapy).
  • Topical corticosteroids (mild to moderate).
  • Calcineurin inhibitors (Tacrolimus, Pimecrolimus) in sensitive areas.

4. Urticaria (Hives)

• Definition: A transient allergic reaction causing wheal formation and itching.
• Causes:
  • Allergens (foods, drugs, insect bites).
  • Infections, physical stimuli (cold, pressure).
  • Autoimmune diseases.
• Clinical Features:
  • Erythematous, raised, pruritic wheals.
  • Angioedema in severe cases (swelling of lips, eyelids, throat).
• Management:
  • Antihistamines (Cetirizine, Loratadine).
  • Epinephrine for anaphylaxis.
  • Corticosteroids for persistent symptoms.

5. Fungal Skin Infections

• Definition: Superficial infections caused by dermatophytes, yeasts, or molds.
• Types:
  • Tinea Corporis (Ringworm): Annular, scaly plaques with central clearing.
  • Tinea Capitis: Scalp infection, leading to hair loss.
  • Tinea Pedis (Athlete’s Foot): Scaling and fissures between toes.
  • Tinea Versicolor: Hypopigmented patches due to Malassezia furfur.
• Diagnosis:
  • KOH (Potassium Hydroxide) Preparation (microscopic examination of fungi).
• Management:
  • Topical antifungals (Clotrimazole, Terbinafine) for mild cases.
  • Oral antifungals (Griseofulvin, Itraconazole) for extensive infections.

6. Skin Cancers

• Types:
  • Basal Cell Carcinoma (BCC): Most common, slow-growing, pearly nodule.
  • Squamous Cell Carcinoma (SCC): Scaly lesion, may ulcerate, sun-exposed areas.
  • Melanoma: Most aggressive, pigmented lesion with asymmetry, border irregularity.
• Diagnosis:
  • Dermoscopy, Biopsy (Excisional preferred for melanoma).
• Management:
  • BCC & SCC: Mohs surgery, excision.
  • Melanoma: Wide excision, lymph node evaluation.

7. Bacterial Skin Infections

• Impetigo: Honey-colored crusted lesions (Staphylococcus, Streptococcus).
• Cellulitis: Painful, erythematous swelling with systemic symptoms.
• Necrotizing Fasciitis: Rapidly spreading infection, requires emergency surgery.

8. Autoimmune Skin Diseases

• Systemic Lupus Erythematosus (SLE): Butterfly rash, photosensitivity.

• Pemphigus Vulgaris: Flaccid blisters, positive Nikolsky’s sign.

• Bullous Pemphigoid: Tense bullae, negative Nikolsky’s sign.

Case Example: A 10-Year-Old with Widespread Itching

1.A 10-year-old boy presents with itchy red patches on flexural areas (elbows, knees) for 6 months. Examination shows lichenified plaques and excoriation marks.

2.A 7-year-old child from a low-income area presents with easy bruising, swollen gums, and pinpoint skin hemorrhages on the legs. His diet mainly consists of bread and tea, with minimal fruit and vegetables. Examination reveals perifollicular hemorrhages, corkscrew hairs, and gingival bleeding.

3.A 10-year-old boy presents to the dermatology clinic with intense itching, especially at night, for the past 2 weeks. His younger siblings have similar complaints. Examination reveals multiple excoriated papules and burrows in the interdigital spaces, wrists, axillae, and genital area.

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1.Diagnosis: Atopic Dermatitis

2.Diagnosis: Scurvy (Vitamin C Deficiency)

3.Diagnosis: Scabies (Sarcoptes scabiei Infestation)

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