12. Wheal
Transitory, compressible papule or plaque of
dermal edema.
Usually rounded or flat-toped, and evanescent,
disappearing within hours.
The borders of a wheal are sharp, but not stable.
59. Tinea CapitisTinea Capitis
TypeType S.R.WS.R.W
Black dotBlack dot
R.WR.W
KerionKerion FavusFavus
OrganismOrganism
T. ViolaceumT. Violaceum
M. CanisM. Canis
T. ViolaceumT. Violaceum
Of animal originOf animal origin
eg T.eg T.
VerrucosumVerrucosum
T. shoenleiniiT. shoenleinii
LesionLesion
Patch coveredPatch covered
by grayishby grayish
scalesscales
Patch withPatch with
black dotsblack dots
Boggy $ withBoggy $ with
crustscrusts
Scutula, dryScutula, dry
yellow saucer-yellow saucer-
shaped crustsshaped crusts
HairsHairs
Broken intoBroken into
short stumpsshort stumps
Broken atBroken at
points ofpoints of
emergenceemergence
LooseLoose
Not brokenNot broken
off-coconutoff-coconut
hairshairs
HealingHealing No scarNo scar No scarNo scar ScarScar ScarScar
86. Clinical picture of onychomycosis:
1- Distal subungual
2- Proximal subungual
3- Superficial white
4- Candidal paronychia.
Characterized by:
a- Eating up of the lateral ridges of the nail
b- History of oozing pus
c- Cushion like swelling of the paronycheal
tissue
d- Transverse striation of the nail plate
f- Brownish discoloration of the nail plate.
91. Diagnosis of fungal infections
1- Clinical picture
2- Direct KOH preparation
3- Wood's light test “+ve Wood's light
test” occurs in :
See cats and Dogs fight
T.schoenlei
nii
M.canis M. audouni M. distortum T.
ferrogonium
92. Diagnosis (cont.)
4- Direct examination of the hair by KOH prep.
Type of invasion
Endothrix T T. tonsurans
V T. violaceum
S T. soudanense
Ectothrix others
Favic Trichophyton schoenleinii
“Areal hyphea wuth air bubbles”
93. In Pityriasis versicolor the color may be due to
the type of porphyrin produced by the
organism.
Direct KOH preparation produce “ Meat ball
and spaghetti ”.
230. A.V is a chronic inflammatoryA.V is a chronic inflammatory
multi-factorial disease of themulti-factorial disease of the
pilosebaceous unit characterized by thepilosebaceous unit characterized by the
formation of comedons, papules,formation of comedons, papules,
pustules and nodules.pustules and nodules.
231. 1- Increased sebum production1- Increased sebum production
SeborrheaSeborrhea
2- Ductal hypercornification2- Ductal hypercornification
comedone formationcomedone formation
3-3- Ductal colonization of P. acneDuctal colonization of P. acne
Degradation of sebum irritating free fatty acids,
chemotactic factors, and pro-inflammatory mediators
4-4- InflammationInflammation and immune responseand immune response
papules, pustules and nodulespapules, pustules and nodules
232. 1.1. Why it startsWhy it starts at puberty?at puberty?
2.2. Why it occursWhy it occurs in both sexes?in both sexes?
3.3. Why it occursWhy it occurs in some individuals and leavesin some individuals and leaves
others?others?
4.4. Why it occursWhy it occurs in certain sites?in certain sites?
5.5. Why it is severeWhy it is severe in acne sitein acne site and mild inand mild in
others or sometimes it may be even absent?others or sometimes it may be even absent?
6.6. Is there any relationIs there any relation between severity ofbetween severity of
acne and the titer of testosterone in blood?acne and the titer of testosterone in blood?
7.7. Why acne do not occurWhy acne do not occur in the scalp?in the scalp?
Receptors type of hair follicleReceptors type of hair follicle
233. Severity Description
Mild
Comedones (noninflammatory lesions) are the
main lesions. Papules and pustules may be
present but are small and few in number
(generally <10).
Moderate
Moderate numbers of papules and pustules (10
- 40) and comedones (10 - 40) are present. Mild
disease of the trunk may also be present.
Moderatel
y severe
Numerous papules and pustules are present
(40 - 100), usually with severe many comedones
(40 - 100) and occasional larger, deeper nodular
inflamed lesions (up to 5). Widespread affected
areas usually involve the face, chest, and back
Severe
Nodulocystic acne and acne conglobata with
many large, painful nodular or pustular lesions
are present, along with many smaller papules,
pustules, and comedones
248. ComedonalComedonal InflammatoryInflammatory MixedMixed
Azaleic acidAzaleic acid
BenzoylBenzoyl
peroxideperoxide
AntibioticsAntibiotics
Retinoic acidRetinoic acid
IsotretinoinIsotretinoin
Combination therapy may be used e.g. use anticomedonalCombination therapy may be used e.g. use anticomedonal
therapy in the morning & anti-inflammatory agent in thetherapy in the morning & anti-inflammatory agent in the
eveningevening
249. • Oral antibiotics will be added in thisOral antibiotics will be added in this
group to the topical therapygroup to the topical therapy
• This group should include those whoThis group should include those who
have mild acne and have nothave mild acne and have not
responded to a few months ofresponded to a few months of
differing topical therapydiffering topical therapy
250. • IsotretinoinIsotretinoin in the dose ofin the dose of 0.5– 1.00.5– 1.0
mg/kg BW/day for a minimum of 4 monthsmg/kg BW/day for a minimum of 4 months
• This group also includes patients withThis group also includes patients with
moderate acne who have not responded wellmoderate acne who have not responded well
to adequate previous therapiesto adequate previous therapies
• Although isotretinoin is indicated in severeAlthough isotretinoin is indicated in severe
acne, combination of systemic antibiotics inacne, combination of systemic antibiotics in
severe disfiguring acne, combination ofsevere disfiguring acne, combination of
systemic antibiotics and small dose ofsystemic antibiotics and small dose of
steroids should be tried toosteroids should be tried too
272. Stages of Sperm ProductionStages of Sperm Production
1
Spermatogenesis
Division & differentiation of spermatogonia
(2N) into Spermatid (IN)
2
Spermiogenesis
Changes in spermatids and their
transformation into sperms in the lumina
of semineferous tubules
3
Spermiation
Release and passage of sperms to the
epididymis to complete maturity and gain
the fertilizing capacity
275. Stages of Sperm ProductionStages of Sperm Production
Spermiogenesis
276.
277. The SemenThe Semen
Source and relative volume of semen components
(in order of ejaculation)
5% + 30% + 60% + 5%
Secretions
from
Couper's
and Littre's
glands, i.e.
pressmen
that help
lubrication
and
neutralizati
on
Prostatic
secretion
(acidic)
Seminal
vesicles
(alkaline)
Sperms and
secretion of
testes and
epididymes
The Seminal Fluid (Plasma)
279. URETHRITIS
Urethritis
Gonococcal Non gonococcal
Due to Neisseria gonorrhoea Sexually transmitted
- Chlamydia trachomatis
(main cause)
- Ureaplasma urealyticum
- Trichomonas vaginalis
Non-sexually transmitted
- urinary tract infection
- seconday to : urethral
instrumentation, foreign
bodies, renal stones or
crystalluria.
280. Sites of involvement
Mode of infection
Incubation period : 2-5 days
Diagnosis
Smears
Culture
Chocolate agar
Thayer martin medium
Direct immunoflourescence
Radio immunoassay
Monoclonal antibodies technique
Tests for antibiotic sensitivity
Gonorrhea
281. • the amount of inoculumthe amount of inoculum
• degree of sex excitementdegree of sex excitement
• local condition of the mucouslocal condition of the mucous
membranemembrane
• local congenital anomalylocal congenital anomaly
• local congestionlocal congestion
• personal susceptibilitypersonal susceptibility
• immunityimmunity
MaleMale
FemaleFemale
282. Gonorrhea Complications
Local complications
Male
Balanitis or balanoposthitis
tysonitis
Littritis/ periurethral abscess /
cowperitis
Prostatitis (acute, chronic, abscess)
Chronic prostatitis> 10 pus cells/
high power field, with clumps
Seminal vesiculitis (painful
erections and haemospermia)
Epididymitis
Urethral stricture
Anal pruritus, pain, tenesmus and
discharge
Female
Skenitis
Bartholinitis
Pelvic inflammatory
disease
Perihepatitis (Fitz-
Hugh-Curtis syndrome)
in some cases with
salpingitis.
284. Penicillin
Spectinomycin 2 gm IM single
dose.
Ceftriaxone 250 mg IM single
dose
Quinolones as ofloxacin 400 mg
single dose
Gonorrhea TreatmentTreatment
285. Non gonococcal urethritis due to
Chlamydia trachomatis
Clinical Picture
Other features : male Female
Prostatitis epididymitis urethral
stricture
Bartholnitis Cervicitis (mainly)
Infertility . Proctitis Pelvic inflammatory disease
Reiter's syndrome (urethritis-
conjunctivitis – arthritis)
Abortion – prematurity - stillbirth
Obligatory intracellular infections
Incubation period: 2-3 weeks
Urethritis (milder than gonococcal urethritis)
Postgonococcal urethritis
287. TREATMENT
Treatment of Non gonococcal
urethritis
Tetracycline 500 mg 1x4x14
Doxycycline 100 mg 1x2x14
Azithromycin 1 gm single dose
During pregnancy erythromycin
500 mg 1x4x14
288. •Etiology: T. vaginalisT. vaginalis
•survive outside the body….survive outside the body….
•Anaerobic protozoanAnaerobic protozoan
•Females > malesFemales > males
•reservoirs for infectionreservoirs for infection
•Males are transient carriers?Males are transient carriers?
•How infected?How infected?
•Incubation periodIncubation period ((3 days-3 weeks)
289. FemalesFemales may show minormay show minor
symptoms of vaginitis andsymptoms of vaginitis and
offensive discharge, urethritis &offensive discharge, urethritis &
dysuriadysuria
red vaginal wall & red spots on cervixred vaginal wall & red spots on cervix
(strawberry cervix).(strawberry cervix).
MalesMales: Asymptomatic or may show: Asymptomatic or may show
urethritis with a tickling sensation inurethritis with a tickling sensation in
the urethrathe urethra
