1. Auspitz sign refers to pinpoint bleeding seen when removing the last layer of scale in psoriasis, reflecting elongated dermal blood vessels. 2. Knuckle dimple sign is seen in Albright hereditary osteodystrophy due to short fourth and fifth metacarpals, enhancing a fist. 3. McCune-Albright syndrome features polyostotic fibrous dysplasia, large cafe-au-lait macules, and precocious puberty.

1. Dr.Rula jafari
‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬

4. What is a Sign…?
Objective physical finding found by the
examiner.
Two types:
1- De novo
2- Physician induced

9. ● If the superficial silvery white scales are removed via
curettage a characteristic coherence is observed, as if one has
scratched on a wax candle (“signe de la tache de bougie”
Candle sign).
● Subsequently, a surface membrane is seen, The lesion
remains dry until this last level is reached (sign of the last
Häutchen) which will also come off as a whole.
● If the latter is removed, then a wet surface is seen with
characteristic pinpoint bleeding. This finding,is called Auspitz
sign.

10. Auspitz sign, is
the clinical
reflection of
elongated
vessels in the
dermal papillae
together with
thinning of the
suprapapillary
epidermis

14. ‫ك‬

15. - Knuckle dimple sign.
- Due to short 4th and 5th metacarpals.
- Enhanced by making a fist.
- Described by Fuller Albright .
- Found in Albright hereditary
osteodysrtrophy.

16. - Short stature.
- Obesity.
- Round face.
- Mental retardation.
- Brachydactaly
- Soft tissue ossification.
- Short 4th and 5th metacarpals.
- Pseudohypoparathyroidism (PHP):
low calcium
high phosphate
high PTH
non responding kidneys
•Some Share them the habitus of AHO
but are not resistant to PTH. The latter
group are said to have pseudo-PHP.

18. McCune Albright Syndrome Albright Hereditary Osteodystrophy
AD XLD Inheritance
Polyostotic fibrous dysplasia osteodystrophy Bony lesions
Large café –au-lait macule
(cost of Maine) with
ipsilateral bony changes.
Precocious puberty.
Short stature.
Obesity.
Round face.
Mental retardation.
Brachydactaly
Soft tissue
calcification.
Short 4th and 5th
metacarpals.
Pseudohypoparathyroidism
Other symptoms

19. McCune Albright
Syndrome

22. -
-Named after an
English surgeon
William Henry
Battle.
-Indicates fracture
base of skull at
the posterior
fossa.
- Blood dissects
through fascia
and collects at
mastoid process.

25. - The ability to invaginate the tumor/lesion into the dermal
defect with digital pressure.
- Found in neurofibromas in NF1.
- others:
- Anetoderma
- Old pigmented nevi
- syphilitic chancre

27. ●

28. ● AKA Fitzpatrick’s sign, seen in dermatofibromas.
● Lateral compression with the thumb and index finger
leads to depression of the lesion.
● This dimpling effect is secondary to the lesion being
attached to the subcutaneous fat

30. Crowe’s sign

31. ● Named after Frank W. Crowe, an American physician.He noticed that axillary freckles are present in about
20-30% of patients with neurofibromatosis, but he did not see any in patients who did not have
neurofibromatosis.
- Axillary freckling in NF-1
-Occurs at a later stage compared to the Café au lait lesions.
- Can also be found in the perenium.

36. skeletal
defects

39. - wheeling, circumscribed erythema and
localzed pruritis caused by scratching or
rubbing the lesions.
- Named after the French dermatologist :
Ferninand Jean Darier (1856-1938).
-Classically in mastocytosis. (which types ?)
--explanation ?
- Also seen in : insect bite, NF , JXG, acute
neonatal lymphoblastic leukemia.

42. - Transient piloerection and elevation or increased induration of
a lesion induced by rubbing.
- observed in congenital smooth muscle hamartomas.

45. What translocation is most likely present
within this lesion?
What are the histopathologic findings?
Identify the immunohistochemical pattern
classic to this diagnosis.
What is the recommended standard treatment
option with the highest cure rate without
recurrence?
What treatment is recommended for patients
with recurrent or metastatic lesions?
Complete surgical excision, including Mohs micrographic
surgery, is the standard treatment for DFSP
Imatinib mesylate is currently FDA-approved for adults
with unresectable, recurrent and/or metastatic DFSP (800
mg daily).

46. Darier-Roussy subcutaneous
sarcoidosis

50. - Central depression surrounded by an elevated skin
rim.
- Seen in scleromyxedema.
- On the extended proximal intelphalenges.

51. What stains would you use for a skin biopsy of
a scleromyxedema case?

54. ● Symmetric confluent violacous erythema
over the knuckles, wrists, knees is called
Gottron’s sign
●Violaceous papules over MP joints
(Gottron’s papules)

55. What are the other features
of dermatomyositis?

56. Photodistributed
poikiloderma
involving the “V” of the
chest and the upper
back is often referred to
as the “shawl sign”
(Samitz sign)
cuticular dystrophy and nail fold
telangiectasias.
The cuticles are “ragged” and within the
proximal nail fold,
dilated capillary loops alternate with
vessel dropout
Heliotrope sign
(most characteristic)

58. Holster sign

59. CALCINOSIS CUTIS

60. • BLEOMYCIN treatment
•Adult -onset Still's
disease
• Shiitake mushroom
dermatitis.

62. .Juvenille DM vs adult DM – list 5 clinical differences
Juvenile Adult
Calcinosis cutis No calcinosis
No malignancy Malignancy (ovarian)
No sex predominance F:M = 2-7:1
10% overlap with other CTD 20% overlap with other CTD
More vasculitis Less vasculitis
what is in adults but not children ?
malignancy (12% vs 0%)
serology in adults not in children ?
anti-synthetase ab (Jo-1)

63. Two medications can induce DM
Statin – type lipid lowering agents.
Hydroxyurea
Two important clinical features differ lesion
of DM from LE
Violaceouse hue
Pruritus

66. - After the English surgeon George Grey Turner ( 1877 – 1951 ).
- Induration and brusing of skin over the costovertebral angel
secondary to the spread of blood from the anterior pararenal
space.
- Commonly with acute hemorrhagic pancereatitis.
- Can be with any other causes of retroperitoneal hemorrhage.

67. What other signs are seen in acute
hemorrhagic pancereatitis ?

68. - Cullen's sign :
hemorrhagic discoloration
of the umbilicus.

71. - Around 20% of lymphogranuloma venereum.
- Caused by a mass of femoral and inguinal nodes
separated by the femoral ligament.

72. LYMPHOGRANULOMA VENEREUM
Incubation
Period ??
3-21 days
Chlamydia
trachomatis L1, L2, or
L3
Ccc
histology??
Gamna-Favre bodies -
Basophilic inclusion bodies
located in the cytoplasm of
endothelial cells
Doxycycline 100 mg PO bid
for 21 d
Erythromycin base 500 mg
PO qid for 21 d

75. - A cutaneous sign of neural tube defect on the scalp.
- Coarse dark hair surrounding the underlying defect.
- Can be seen in : aplasia cutus congenita, encephalocele,
meningocele, ectopic brain tissue.

76. Aplasia Cutis Congenita (ACC )
• Onset before birth; localized defect in epidermis, dermis and/or
fat; variable appearance, typically along midline
• Presents with erosion, ulceration, scar, or membranous defect
(ovoid lesion covered by an epithelial membrane)
• Hair collar sign

77. IV

78. Group Main criterion Associations
1
Scalp: ACC without or with only isolated
anomalies
CLP, CMTC, PDA, tracheoesophageal fistula
2 Scalp ACC with limb reduction defect Adams-Oliver syndrome
3 Scalp ACC with associated epidermal nevi Sebaceous nevus , nevus verrucosus
4 ACC with underlying embryonic malformations
Encephalocele, meningocele, spina bifida,
omphalocele
5 ACC associated with fetus papyraceus
Scalp, chest, flanks, axillae and/ or extremities
Multiple, symmetric
Stellate/angulated configuration
6 ACC with epidermolysis bullosa
Lower extremities (“Bart syndrome”) or large areas of the trunk and
extremities
7 ACC in the extremities
Pretibial areas, extensor forearms, dorsal hands and feet
Radial dysplasia (associated with ACC on the extensor forearm)
8 ACC in conjunction with specific teratogens
Methimazole, Misoprostol, Low-molecular-
weight heparin ,Valproic acid
Maternal antiphospholipid syndrome
intrauterine HSV or VZV infection
9
ACC in conjunction with Malformations

83. - Loss of lateral third of eye brow.
-Seen in a list of diseses:
-AA, trichotelemania, leprosy, ectodermal dysplasia, syphilis, KP,
alopecia mucinosa, systemic sclerosis and hypothyroidism.

84. ● Symmetric, prominent horizontal fold(s) (single or double) just
beneath the margin of the lower lid, originating at or near the inner
canthus and extending one-half to two-thirds the width of the lid

85. ● Peri oral pallor due to
cheilitis ( inflammation of
the skin around the lips)
Periorbital darkening (“allergic
shiners”)
• Skin around the eyes appears
gray to violet–brown, while the
rest of the facial skin is rather
pale
• Periorbital edema and
lichenification may also be seen

86. ● Refers to reticulate pigmentation of the neck
seen in patients with chronic atopic dermatitis.
● The condition was described in 1987 by two
different groups, Manabe and colleagues and
Colver and colleagues.
● The label ‘‘dirty neck’’ was given because of
the resemblance to the appearance of
unwashed skin, with the anterolateral aspects
of the neck typically affected.
● The pigmentary changes are secondary to
melanin incontinence

87. Can you remember the criteria to dx atopic
dermatitis ???

88. MAJOR FEATURES (3 OF 4 PRESENT)
• Pruritus
• Typical morphology and
distribution of skin lesions
• Chronic or chronically
relapsing dermatitis
• Personal or family history of
atopy
MINOR FEATURES (3 OF 23 PRESENT)
• Xerosis
• Ichthyosis/palmar hyperlinearity/keratosis pilaris
• Immediate (type I) skin test reactivity
• Elevated serum IgE
• Early age of onset
• Tendency toward cutaneous infections/impaired cell-
mediated immunity
• Tendency toward nonspecific hand or foot dermatitis
• Nipple eczema
• Cheilitis
• Recurrent conjunctivitis
• Dennie–Morgan infraorbital fold
• Keratoconus
• Anterior subcapsular cataract
• Orbital darkening
• Facial pallor/erythema
• Pityriasis alba
• Anterior neck folds
• Pruritus when sweating
• Intolerance to wool and lipid solvents
• Perifollicular accentuation
• Food intolerance
• Course influenced by environmental/emotional factors
• White dermographism/delayed blanch

90. ● It is seen in
keratosis pilaris in
which individual
follicles show a
long strand of
keratin glinting
when examined in
tangentially
incident light

95. -Almost a certain sign of subungual malignant
melanoma.
The possibility of melanoma should be considered for
all pigmented nail bands in fair-skinned individuals,
especially if they are
● darkly pigmented,
● have irregular pigmentation and/or
● have a width ≥3 mm.

96. What other “ hutchinsosns” do you know ?

97. - In congenital syphilis:
Hutchinsons teeth
Eighth nerve palsy
Keratistis

98. ● (V1; ~10–15% of zoster patients)
● Hutchinson’s sign refers to increased
risk of ocular involvement if skin
lesions are in the distribution of the
nasociliary branch, which supplies the
nasal tip, dorsum and root of the nose
and the medial canthus as well as the
cornea
● ~50% of patients have ocular
involvement, which can include
conjunctivitis, (epi)scleritis, keratitis,
uveitis, acute retinal necrosis and
optic neuritis
● May lead to ocular scarring and visual
loss
Herpes zoster Ophthalmic
division of the trigeminal nerve

100. Other “Hutchinsons

102. Hutchinson’s
summer

103. ● Severe form common in Native Americans , often with cheilitis
and conjunctivitis
● Can occur in all races, including Caucasians
● Childhood onset; often resolution by adolescence, but can
persist indefinitely
● Intensely pruritic, crusted papules or nodules in sun-exposed
sites
● Strong association with HLA-DR4 (DRB1*0401) and subtype
DRB1*0407
● Management: photoprotection, NB-UVB, PUVA, thalidomide,
topical calcineurin inhibitors

106. ●Deck-chair sign
● Classically described in Papulo-erythroderma of Ofuji, wherein
there is flat-topped red papules that become generalized
erythrodermic plaques without the involvement of abdominal skin
folds

109. - After the European surgeon Edmund Leser
( 1853 – 1916 ).
● Rapid appearance or growth of multiple seborrheic keratoses;
● Often these patients have acanthosis nigricans and generalized
pruritus.
● Adenocarcinomas are typically reported, particularly of the
stomach and colon but also of the breast, uterus, esophagus, and
pancreas
● Eruptive seborrheic keratoses can also develop in erythrodermic
patients who do not have an underlying malignancy

111. ● Pseudo sign of Leser Trelat
(Patton et al J. Drugs
dermatology 3:565, 2OO4):
● Increase in size of seborrheic
keratosis which can be seen
after the use of cytarabene for
the the treatment of acute
myelogenous leukemia.
● Cytarabene causes inflammation
of existing seborrheic keratosises

113. 1)Both conditions began simultaneously (neoplasia and paraneoplasia)
2) Development of a parallel course *
3) The skin lesion is not associated with a genetic syndrome
4) There is a specific type of neoplasia that occurs with paraneoplasia
5) The dermatosis is rare in the general population
6) There is a high frequency of association between both conditions
* Treatment of the neoplasia results in regression of the skin lesion;
recurrence of the neoplasia implies recurrence of the skin lesion.

115. Association with adenocarcinoma of the stomach
or other sites within the GI or GU tracts
How do you know its
MALIGNANT acanthosis
nigricans ?
•If it is :
• Sudden onset
• With constitutional symptoms and
weight loss
• Extensive and involves sites such
as the palms and soles and mucous
membaranes .
• With other paraneoplastic features

116. ● Tripe palms :
● Ridged velvety lesions on the palms with
prominence of dermatoglyphics
● adenocarcinoma of the gastrointestinal tract.
● squamous cell carcinoma of the lung
Florid cutaneous papillomatosis
(gastric adenocarcinoma)
Dermatoglyphics are absent/hypoplastic in
what genodermatoses ?
• Dermatopathia pigmentosa reticularis
•Naegeli–Franceschetti–Jadassohn syndrome
•Profuse congenital familial milia with
absent dermatoglyphics (Basan's
Syndrome)

117. Paraneoplastic
Pemphigus (PNP)
• Associated with
•Non-Hodgkin’s
lymphoma (most
common),
•Chronic lymphocytic
leukemia,
•Castleman’s
disease,
•Thymoma ,
•Waldenström
macroglobulinemia ,
•Sarcoma
Benign
Autoantigen : various
desmosomal proteins
including
•desmoglein 3,
•periplakin,
•envoplakin,
• desmoplakin 1/2,
•BPAG1,
•plectin,
•170 kDa Ag,
•rarely desmoglein 1

119. Bazex syndrome (acrokeratosis
paraneoplastica)
•Acral psoriasiform plaques, typically
with involvement of the nose and
helices; often the lesions are
violaceous .
• Longitudinal and horizontal ridging of
the nails occurs in 75% of patients
•By definition, this condition is linked to
malignancy, generally occurring in the
upper aerodigestive tract (pharynx,
larynx or esophagus)

120. Erythema gyratum repens
Variable sites and types of malignancy

121. Glucagonoma syndrome
(Necrolytic migratory erythema),
•With angular cheilitis, glossitis
•Due to a glucagon-secreting tumor of the pancreas.
•Patients are often treated for intertrigo before the syndrome is
diagnosed.
•Weight loss and diabetes mellitus accompany the dermatosis

122. Don’t mix between
Necrolytic MIGRATORY erythema ( paraneoplastic )
with
Necrolytic ACRAL erythema ( associated with HCV and
zinc def )

123. Acquired hypertrichosis
lanuginosa
(malignant down)
•Growth of fine lanugo
hairs in a generalized
distribution or
•localized to the face.
With time, these hairs
may become
coarser
•Associated with a
variety of internal
malignancies, most
often carcinoma of the
lung, colon or breast

124. Acquired ichthyosis
Resembles ichthyosis vulgaris; most often
located on the legs
Lymphoma typically predates the diagnosis of
the ichthyosis

125. Sister Mary Joseph sign, refers to a palpable nodule
bulging into the umbilicus as a result of metastasis of a
malignant cancer in the pelvis or abdomen.
Gastrointestinal malignancies account for about half of
underlying sources (most commonly gastric
cancer, colonic cancer or pancreatic cancer,

126. Pitryasis rotunda
associated with HCC
(in type 1)

127. Sweet’s syndrome
● Associated with hematologic
malignancies (10–20% of
cases), in particular acute
myelogenous leukemia; solid
tumors, e.g. carcinoma of
the genitourinary tract,
breast and colon.

128. Trousseau syndrome
Migratory superficial thrombophlebitis’
with Pancreatic cancer

132. - Hyperpigmentation of the neck occurring in pellagra
patients.
What is deficient in pellagra ????????????
Niacin

135. - Blue sclera.
-Seen in multiple cases:
● Osteogenesis imperfecta,
● Ehler danlos syndrome,
● nevus of Ota,
● argyria and
● Alkaptinuria.

136. What are the other features of Alkaptinuria ??

137. It is a rare condition in which a person's urine turns a
dark brownish-black color when exposed to air
defect : Homogenestic acid oxidase deficiency.
- AKA : endogenous Ochranosis.
- AR.
● Osler sign,
● blue pigment in the skin,
● cartilage destruction ( ears),
● brown sweat,
● dark urine,
● arthropathy, intervertebral disc calcification.

138. Features that may present
early in life include :
brownish discoloration
of diapers (due to the
dark urine) and cerumen
that is more brown to
black in color than
normal

141. Slight rubbing of the skin results in exfoliation
of the outermost layer.
- Seen in :
●Autoimmune condition (pemphigus vulgaris).
●Bacterial infection ( scalded skin syndrome).
- Negative in BP.

143. ● Seen in Steven Johnson syndrome, toxic epidermal
necrolysis and in some cases of burns and bullous
icthyosiform erythroderma.
● The underlying mechanism here is the necrosis of epidermal
cells and not acantholysis, as seen in true Nikolskiy's sign.
● It is elicited the same way as the true sign. However, unlike
Nikolskiy's sign, pseudo-Nikolskiy's sign is elicited only on
clinically involved or erythematous areas.

144. What is the name of the sign positive in BP?

145. - Named for Gustav Asboe-Hansen (1917–1989),
Danish physician.
- AKA "indirect Nikolsky sign" or "Nikolsky II sign“.
- Extension of a blister to adjacent unblistered skin
when pressure is put on the top of the bulla.

149. - The new blisters arises around the
old leasions forming linear
sequential lesions.
- Seen in CBDC.
•Target antigen:
•9 7 kDa Ag ( LAD-1 or LABD97 ):
cleaved ectodomain of
BPAG2
Treatment of choice ???

150. IgG staining IgA staining
linear deposition of IgA along the BMZ

153. Direct IF
(DIF) :
Detects in
vivo
antibodies
bound to
tissue
antigens in
perilesional
skin

154. Indirect IF (IIF)
Detects circulating
serum antibodies
(substrate
sections react with
serially diluted serum
from
patient → incubated
with anti-IgG or other
specific
fluorescent dye-
tagged antibody)
Best substrate :
monkey esophagus
(PV), guinea
pig esophagus (PF),
transitional rat
bladder

155. Salt-split-skin (SSS) Technique
● Variant of IIF allowing distinction between different subepidermal
blistering conditions with similar DIF findings;
● Normal human skin incubated in 1 M NaCl for 48–72 h resulting in
split at lamina lucida level; location of antibody binding to split (
epidermal or dermal side ) distinguishes different diseases

156. B- Bullous
pemphigoid

161. - A diagonal ear lobe crease extending diagonally
from the tragus across the lobule to the rear
edge of the auricle.
- It has been hypothesized that Frank's sign is
indicative of cardiovascular disease and/or
diabetes.
- have no predictive value in Native American
Indian and Asian patients.

164. ● Sometimes used for scale crust of pemphigus foliaceous.
● Cornflake sign seen in Flegel's disease is characterized
by 2-3 mm keratotic scaly papules with discrete
irregular margins.
● The scale separates from many lesions, leaving a non-
exudative red base.

165. What other types of scale do you know?

166. .

167. Ichthyosiform scale
Describes large,
polygonal scales - as
in fish scales.
Example: Ichthyosis
vulgaris.

169. Thin adherent mica-like scale attached at the center of a lichenoid firm
reddish brown papule and free at the periphery. Example: Pityriasis
lichenoides chronica.

170. In clear cell acanthoma, wafer-like scale is seen
adherent at the periphery, which leaves a moist
or bleeding surface when removed.

171. Double-edged scale
Describes erythematous, exfoliating or scaly, annular or polycyclic,
flat patch with an incomplete advancing double edge of peeling
scale. Example: Ichthyosis linearis circumflexa

172. ICHTHYOSIS HYSTRIX
descriptive term for massive hyperkeratosis that has a verrucous surface or forms protruding, porcupine-like
spines;
Observed :
• In patients with EI (most common )
•Verrucous epidermolytic nevi
•Ichthyosis hystrix Curth-Macklin
• Hystri -like ichthyosis with deafness (HID) syndrome (mutations in the GJB2 gene)

173. Mauserung desquamation
Mutations:
keratin 2 (KRT2),

174. Plate-like scale (Armor
plate)
LAMELLAR ICHTHYOSIS
Transglutaminase-1 deficiency due to deleterious mutations
in both copies of the TGM1 gene
LAMELLAR ICHTHYOSIS

178. ● This sign is diagnostic of Discoid
Lupus Erythematosus [DLE].
● Removal of an adherent scale from
a lesion of DLE reveals the
undersurface to be covered with
horny plugs [resembling carpet
tacks] overlying dilated hair
follicular openings

183. ● This is pathognomic of Congenital Syphilis.
● An irregular thickening or enlargement of the
sternal end of clavicle, usually unilateral

186. V

189. ● This is seen in Kwashiorkor and other diseases leading to
severe protein malnutrition like extensive bowel
resection, severe ulcerative colitis etc.
● Presence of alternating white and dark bands along
individual hair shafts SEEN BY NAKED EYES
● The bands are formed due to intermittent severe protein
malnutrition.

190. What else can cause this sign
???????

191. ?
Tiger tail appearance : alternating
light and dark bands under
polarizing light
Seen in Trichothiodystrophy
(autosomal recessive disorder
characterized
by sulfur-deficient hair)

193. Actinic keratosis
●alternating areas
of orthokeratosis
and parakeratosis.

196. ●It is the ability of patients of Ehlers-
Danlos syndrome to touch the tip of
the nose with the tip of their tongue.

199. ● This sign is seen in Rubella and was originally
described by Forschheimer.
● The name is given to an enanthem [mucosal rash]
that is confined to the soft palate during the
prodromal period in Rubella

203. Friar-Tuck signFriar-Tuck sign

204. ● This is seen in Trichotillomania.
● In severe forms of the disease, when the whole
scalp is involved the hair at the margins is
characteristically spared.

207. ● The bites of bed bugs (Cimex
lectularius) usually follow a
linear pathway in a group of
three to five blood meals and
are often referred to as
“Breakfast, lunch, and
dinner” or “Breakfast, lunch,
and supper” sign

208. 31+ 32

209. sign

210. Chagas–Mazza–Romaña's sign
● Chagas’ disease
(American
trypanosomiasis),
conjunctiva is the
portal of entry
for Trypanosoma
Cruzi.
● Unilateral swelling
of eyelids and orbit
after conjunctival
inoculation is called
as eye-sign or
Chagas–Mazza–
Romaña's sign or
Romaña's sign
● It is seen in early
stages of African
trypanosomiasis
caused
by Trypanosoma
brucei
rhodensiense and
Trypanosoma brucei
gambiense known
Sleeping sickness.
● Winterbottom's sign
is enlargement of
lymph nodes in the
posterior cervical
chain
Winterbottom's sign

215. ● In 1877, Heinrich Koebner described the appearance of psoriatic lesions in the
uninvolved skin of psoriatic patients as a consequence of trauma.
● In general, the interval to koebnerization is between 10 and 20 days, but may be
as short as 3 days or as long as 2 years.
● The original classification of Koebner phenomenon is :
Koebner/Isomorphic phenomenon

216. ● Reverse Koebner
phenomenon
This phenomenon is
explained, in which an area of
psoriasis clears after injury

217. ● Remote reverse
Koebner phenomenon
It is defined in vitiligo
patients, in which
spontaneous
repigmentation is seen
in distant patches after
autologous skin graft
surgery.
Punch grafting on right leg (shown with blue arrow). Spontaneous
repigmentation over left leg (shown with yellow arrow)

218. ● Pseudokoebner
phenomenon :
● Seen skin infections like
MC and warts
● Due to auto inoculation

221. Ugly duckling sign
● Refers to the observation that a nevus that does not resemble a patient’s
other nevi is more likely to represent a melanoma

223. A few other signs …..

224. Drip sign
● Found in dermatitis
artefacta produced by
corrosive liquids.
● Patterned burned
areas correspond to
the areas of dripping
of the liquid when
applied by the patient.

225. Enamel paint sign
● Seen in patients with kwashiorkor
● Sharply demarcated
hyperpigmented desquamating
patches and plaques resembling
enamel paint occur on the skin,
predominantly in areas of pressure
and irritation.
● The underlying skin is inflamed and
raw.

226. Hoagland’s sign
● is early and transient
bilateral upper lid edema
occurring in patients with
infectious mononucleosis.
● The sign is usually present
only for the first few days
of the clinical presentation
of the illness.

228. Foot prints in
snow'
appearance in
Pseudopelade
of Brocq

229. Asbestos-like
appearance Pityriasis
amiantacea

230. Cauliflower
appearance
Relapsing
polychondritis
Cauliflower appearance
condylomata acuminata

231. Cayenne pepper appearance
Schamberg disease

232. Cigarette paper like scars
The skin in patients with Ehler-Danlos syndrome is hyperextensible which
gives rise to gaping "fish-mouth wounds" over bony prominences like the
shins, knees, and elbows following minor trauma. Such wide, thin,
papyraceous scars over the knees and elbows are also called "cigarette
paper scars."

233. cigarette paper"-like wrinkled
appearance in parapsoriasis

234. Cliff drop appearance
Atrophoderma of Pasini and Pierini

235. Cobblestone appearance
In Darier's
disease

236. In crohn's disease

237. Cowden’s disease (AD)

238. In Heck's disease
What is Hecks
disease ?
Focal epithelial hyperplasia:
papules on buccal, gingival,
labial mucosa resembling flat
warts
What is the causative
agent ?
HPV 13, 32

239. Following punch grafting for vitiligo

240. Confetti-like appearance
Amyloidosis cutis dyschromica
(Primary cutaneous amyliodosis),
‫الورق‬ ‫قصاصات‬
‫الملونة‬

241. Dyschromatosis symmetrica
hereditaria (Acropigmentation
of Dohi)
The skin findings are
characterized by hypo- and
hyperpigmented macules on
the dorsal and ventral aspects
of the hands and feet, which
may extend to the proximal
portions of the limbs (knees
and elbows). Macules appear
in the first to second decade
and are typically non-
progressive. Similar lesions
(freckle-like macules) can be
found on the face.

242. Dyschromatosis universalis hereditaria
The disease begins in early childhood and is characterized by mottled pigmentation which
originates from the hands and can progress to involve the trunk, extremities and face. The lesions
are characterized by hyperpigmented macules admixed with hypopigmented lesions and can also
involve the palms, soles and oral mucosa.

243. Tuberous Sclerosis Complex

244. Vitiligo ponctué, an unusual
clinical presentation of
vitiligo, is characterized
by multiple small (confetti-
like), discrete amelanotic
macules,
sometimes superimposed
upon a hyperpigmented
macule

245. Purse string appearance of oral aperture in a case of systemic sclerosis

246. Figure of 8/hour glass appearance of vulva in lichen
sclerosus

247. Glazed appearance
Juvenile plantar dermatosis
‫مصقول‬

248. Inverted wine bottle
appearance in
lipodermatosclerosis

249. A child with diffuse
cutaneous
mastocytosis giving a
leather grain
appearance to the
skin

250. Nutmeg grater appearance
Pityriasis rubra pilaris (PRP)

251. Pebbly appearance
Hunter syndrome
mucopolysaccharidosis II
(MPS II), is a lysosomal
storage disease caused by a
deficient (or absent) enzyme,
iduronate-2-sulfatase (I2S).
The accumulated substrates
in Hunter syndrome are
heparan sulfate and dermatan
sulfate. The syndrome has
X-linked recessive
inheritance.

252. Pseudoxanthom a
elasticum
showing the
characteristic
'plucked chicken'
appearance

253. Rippled appearance
Macular amyloidosis

254. Salt and pepper'
appearance
on upper back in a
female with
systemic sclerosis

255. Sandpaper appearanc
trachyonychia

256. Speckled appearance
Speckled lentiginous nevus

257. Tapir nose appearance
Mucocutaneous leishmaniasis caused by Leishmania braziliensis and L.
mexicana is termed as "espundia," which is characterized by mutilation of the
nasal apparatus. It spares the nasal bones. When the septum is destroyed, the
nasal bridge and tip of the nose collapse, giving the appearance of a parrot beak,
camel nose, or tapir nose appearance

258. Vermiculate
atrophoderma in a
young patient with
'worm-eaten' picture

259. Zebra-like appearance
Linear and whorled nevoid hypermelanosis

261. Thank you