4 th Year Paper

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Shanxi University of Chinese Medicine Final Exam
Paper for International Students
The First Term of the 2022 Academic Year
Dermatology
山西中医药大学 2022 学年第一学期皮
肤科试题
（ 适 用 年 级 ： 2017 级 国 际 学 生 ）
一、Multiple choice questions: (1 mark per question, a total of 20 marks. After each question, there
are alternative answers. One or many of them is the correct answer)
1. Which of the following layer of dermis is only present in palms and soles
(a) Stratum germinativum
(b) Stratum corneum
(c) Stratum granulosum
(d) Stratum lucidum
2. Fluid containing lesion less than 1cm in size is called
(a) Pustule
(b) Vesicle
(c) Bulla(blister)
(d) Crust
3. Desquamating horny flake seen in conditions resulting in abnormal keratinization is seen in
(a) Eczema
(b) Acne vulgaris
(c) Psoriasis
(d) Dermatitis
4. A 25 years old girl presents with vesicular lesion in the buccal mucosa and crusted lesion on the
skin, possible diagnosis is
(a) Dermatitis herpetiformis
(b) Pemphigoid
(c) Pemphigus vulgaris
(d) Pemphigoid foliaceous
5. A 40 years old patient had multiple blisters over the trunk and extremities. Direct
immunofluorescence studies showed linear IgG deposits along the basement membrane. Most
likely diagnosis is
(a) Bullous pemphigoid
(b) Pemphigus vulgaris
(c) Pemphigus foliaceous
(d) Dermatitis herpetiformis
6. A patient of Graves disease presents with some areas of skin depigmentation. She has just
returned from holiday. What is most likely diagnosis
(a) Vitiligo
(b) Pityriasis versicolor
(c) Leprosy
(d) Psoriasis
7. An elderly lady presents to her doctor with raised, round discoloured plaque, ‘stuck on
appearance’ on her face. What skin condition this
(a) Rubella
(b) Seborrheic keratosis
(c) Basal cell carcinoma
(d) Melasma
8. How does lichen planus present clinically
(a) Salmon coloured plaques with silvery scales
(b) Pruritic red oozing rash with edema
(c) Golden coloured crusts
(d) Pruritic purple polygonal planar papules and plaques
9. Which of the following skin condition is caused by poxvirus
(a) Verruca
(b) Molluscum contagiosum
(c) Impetigo
(d) Cellulitis
10. A pink pearly nodule with telangiectasias ulceration and rolled border on upper lip this type of
lesion is seen in
(a) Squamous cell carcinoma
(b) Basal cell carcinoma
(c) Melanoma
(d) Eczema
11. What condition is associated with acanthosis nigricans
(a) Type 2 diabetes and gastric adenocarcinoma
(b) Rubella
(c) Varicella zoster
(d) Basal cell carcinoma
12. Treatment for post-herpetic neuralgia is
(a) NSAIDS
(b) Paracetamol
(c) Gabapentin
(d) Anxiolytics
13. Painful red subcutaneous nodules on shins are seen in
(a) Erythema multiform
(b) Eczema
(c) Erythema nodosum
(d) Psoriasis
14. Herald patch then generalized christmas tree pattern on back is seen in
(a) Pityriasis versicolor
班级
学号
姓名

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(b) Pemphigus
(c) Dermatitis
(d) Pityriasis rosacea
15. A 30 years old female presents with erythematous plaques with silvery scales over scalp, elbows,
knees. Removal of scale causes pinpoint bleeding. She is likely to be suffering with
(a) Chronic eczema
(b) Discoid lupus erythematosis
(c) Lichen planus
(d) Secondary syphilis
16. Which of the is not the feature of acute eczema
(a) Oozing
(b) Itching
(c) Crusting
(d) Lichenification
17. The most characteristic feature of erythema multiform is
(a) Target lesion
(b) Severe itch
(c) Wheal
(d) Bullous lesion
18. Patient has nocturnal itching for last two weeks. Other family members of family has itchy
papulo-pustular eruptions on palms and soles. What is diagnosis
(a) Contact dermatitis
(b) Urticaria
(c) Scabies
(d) Pediculosis
19. Your diagnosis in 30 years old promiscuous male with recurrent grouped vesicles on shaft of
penis associated with burning and discomfort would be
(a) Syphilis
(b) Genital warts
(c) Herpes simplex
(d) Gonorrhea
20. In a diabetic patient a 6x6cm red painful lump with multiple opening discharging pus on nap of
neck for last 10 days with high grade fever is because of
(a) Diabetic dermopathy
(b) Erysipelas
(c) Carbuncle
(d) Furunculosis
二、 SHORT ESSAY QUESTIONS (30 MARKS ATTEMPT ALL QUESTIONS. EACH
QUESTION CARRY MARKS.
1. What is tinea capitis mention lesion and its treatment. (6)
Clinically, dermatophyte infections have traditionally been classified by body region. Tinea means fungus infection.
The term tinea capitis, for example, indicates “dermatophyte infection of the scalp.”
 Tinea of the scalp (tinea capitis) occurs most frequently in prepubertal children between 3 and 7 years of
age. The infection has severaldifferent presentations. The species of dermatophyte likely to cause tinea
capitis varies among different countries, but anthropophilic species (found in humans) predominate in
most areas. Tinea capitis is most common in areas of poverty and crowded living conditions. The infection
originates from contact with a pet or an infected person
 Definition
 Tinea capitis is an infection caused by dermatophyte fungi (usually species in the genera
Microsporum and Trichophyton) of scalp hair follicles and the surrounding skin
 Clinical diagnosis
 A variety of clinical presentations are recognized as being either inflammatory or
noninflammatory and are usually associated with patchy alopecia (see “Summarizing the clinical
patterns of tinea capitis”). However, the infection is so widespread, and the clinical appearances
can be so subtle, that in urban areas tinea capitis should be considered in the diagnosis of any
child older than 3 months of age with a scaly scalp, until dismissed by negative mycologic
studies. Infection may also be associated with painful regional lymphadenopathy, particularly in
the inflammatory variants. A generalized eruption of itchy papules particularly around the outer
helix of the ear may occur as a reactive phenomenon
 Therapy of tinea capitis
 The aim of treatment is to achieve a clinical and mycologic cure as quickly as possible. Oral
antifungal therapy is generally needed.
 Topical
 Topical treatment alone is not recommended for the management of tinea capitis. Local treatment
with a topical antifungal with a fungicidal mechanism of action, such as ciclopiroxolamine or
terbinafine cream, may reduce the risk of infecting other people and shortens the duration of
systemic treatment. The entire hair of the scalp in all its length should be treated with the
antifungal. Treatment should be administered once daily for approximately 1 week. The hair
should be washed two times weekly using an antifungal shampoo (povidone-iodine, selenium
disulfide).
 Other supportive measures: Cutting the hair or shaving the head may significantly shorten the
duration of treatment with a systemic antifungal. Shaving the affected areas of the scalp
significantly reduces the infectious load. Shaving should be performed at the beginning of
systemic treatment and again 3 to 4 weeks later. Shaving the hair once each week may
significantly shorten treatment.
 Oral
 All systemic antifungals are more effective in the presence of endothrix infection (e.g.,
Trichophyton spp.) than in patients with ectothrix disease (e.g., M. canis). Current data suggest
that M. canis infections might respond better to itraconazole.
 Griseofulvin
 Griseofulvin is the current drug of choice in children. It has a long track record of safety, has the
least known drug interactions, and is well tolerated. It is fungistatic and antiinflammatory. It is
available in tablet or suspension form. The recommended dose, for those older than 1 month, is
10 mg/kg per day.
 Drug interactions: Warfarin, cyclosporine, and the oral contraceptive pill
 Terbinafine
 Fungicidal. It is effective against all dermatophytes. It is at least as effective as griseofulvin and is
safe for the management of scalp ringworm caused by Trichophyton sp. in children. Its role in
management of Microsporum sp. is debatable. Early evidence suggests that higher doses or

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longer therapy (.4 weeks) may be required in Microsporum infections. Dosage depends on the
weight of the patient, but the typical range is between 3 and 6 mg/kg per day. Side effects include
gastrointestinal disturbances and rashes in 5% and 3% of cases, respectively. Gastrointestinal
symptoms subside with continuing therapy.
 Advantages: Fungicidal, so shorter therapy required (cf. Griseofulvin); therefore increased
compliance more likely
 Disadvantages: No suspension formulation
 Drug interactions: Plasma concentrations are reduced by rifampicin and increased by cimetidine
 Itraconazole
 Both fungistatic and fungicidal activity depending on the concentration of drug in the tissues. 100
mg/day for 4 weeks or 5 mg/kg per day in children is as effective as griseofulvin and terbinafine.
Bioavailability is improved when it is taken with a fatty meal.
 Fluconazole
 Use has mainly been limited by side effects. Dosages of 3-5 mg/kg per day for 4 weeks are
effective in children with tinea capitis. The most common side effects are nausea and vomiting, but
liver function test abnormalities are also found. Fluconazole is approved by the Food and Drug
Administration for use in children older than 6 months. It is available in a pleasant-tasting liquid
formula (10 and 40 mg/ml)
Define erythema multiform and erythema nodosum (6)
 Erythema multiform :
 Recurring disorder with distinctive clinical and histological features precipitated by a number of stimuli
 causes includes
 DRUGS : long acting sulphonamides , phenylbutazone ,salicylate and barbiturates
 INFECTUONS 1 . Viral - herps , small pox , vaccinia mumps , polio and orf.
 Mycoplasmal. , bacteria ; focal sepsis , typhoid , diptheria ,, fungal histoplasmosis .some clink ca features
are mild or minor form symmetrical dull red , macullo popular eruption seen on dorsum of hands , palm ,
forarm elbow knees and feet . Less often on face and neck .
 ERTYTHEMIAS NODOSUM:
 Acute arythemTos , nodular eruption in classically affecting extensor of lower leg and less often tighs and
forarm. And clearing is 3 to 8 weeks without scarring .
 Common in females between 20 to 30 , precipitated by widely affecting factors , suggested to be due to
prevascular deposition of immune complexes .
 Causes ; 1 infectuons ( bacteria streptococcal)
 Viral ( measles , mumps )
 Chlamydial lymphogranuloma
 Mycobacterium ( TB )
 Fungal ( histoplasmosis )
 Sarcoidosis , drugs ( sulphonamide and contraceptives pills ,malignancy and reticulosis ,pregnancy
 In Pakistan straptococoal is most common cause
2. Briefly write note on herpes zoster(6)
Herpes zoster
Definition : acute painful virus infection of the skin characterized by appearance of grouped vesicles on
an erythematous base the course of a sensory root
Aetiology : same virus as chicken pox. Zoster may give rise to chicken pox in susceptible context or vice
versa conditions lowering resistance example trauma malignancy and cytotoxic drugs predispose to
herpes zoster
Clinical features : severe pain in the distribution of a nerve root often the first symptom. Constitutional
Manifestation Includes Pyrexia, Malaise, headache and tenderness. three to four days later closely
grouped papules on an erythematous base in the distribution of one or more contagious dermatomes.
these quickly transform into vesicles and sometimes pustules. Necrosis in elderly patients. healing
usually in two to three weeks with scarring.
1. Thoracic region involved in half the cases followed by cervical trigeminal and lumbosacral
dermatomes
2. Herpes ophthalmicus - ophtalmic division of the trigeminal nerve affected leads to ocular palsies or
even blindness if not treated early.
3. Ramsay Hunt syndrome - zoster involving the geniculate ganglion features include aural pain vesicles
on the pina and external auditory meatus, loss of taste on the anterior 2/3 of tongue and facial Palsy
4. Post Herpetic neuralgia - most serious complication commonly seen in old age pain in the distribution
of the affected dermatome excruciating intractable and extremely difficult to treat
Treatment
1. Bed rest, analgesics and local antiseptic sufficient for mild cases
2. A cyclovir 200 to 800 mg five times a day or velocyclovir 1g Thrice daily for seven to ten days
3. Hyperimmune gamma globin for abnormally susceptible patients
4. Early ophthalmological opinion four cases of herpes of ophthalmicus.
5. Treatment of post hepatic neurology generally less satisfactory drugs example amytriptyline and
doxapine tried.
3. Describe dermatological features ofvitiligo and melasma (6)
Vitiligo often starts as a pale patch of skin that gradually turns completely white. The
centre of a patch may be white, with paler skin around it. If there are blood vessels under
the skin, the patch may be slightly pink, rather than white. The edges of the patch may be
smooth or irregular. depigmenting skin disorder, is characterized by the selective loss of
melanocytes, which in turn leads to pigment dilution in the affected areas of the skin. The
characteristic lesion is a totally amelanotic, nonscaly, chalky-white macule with distinct
margins.
MELASMA :: Melasma is a skin condition characterized by brown or blue-gray patches
or freckle-like spots. It's often called the “mask of pregnancy.” Melasma happens because
of overproduction of the cells that make the color of your skin. It is common, harmless
and some treatments may help. Historically, melasma has been classified as having three

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histologic variants: epidermal, dermal, and mixed , In the epidermal type, there is increased
pigment throughout the layers of the epidermis, particularly in the basal and suprabasilar
layers
4. Define impetigo also mention its lesioncharacteristicsandtreatment (6)
Impetigo is treated with antibiotics that are either rubbed onto the sores (topical antibiotics) or taken by mouth (oral
antibiotics). A doctor might recommend a topical ointment, such as mupirocin or retapamulin, for only a few sores.
Oral antibiotics can be used when there are more sores.Impetigo is a common and highly contagious skin infection
that mainly affects infants and young children. It usually appears as reddish sores on the face,especially around the
nose and mouth and on the hands and feet. Over about a week,the sores burst and develop honey-colored crusts.
Symptoms:
Ulcer (dermatology)
LESION:-
The main symptom of impetigo is reddish sores,often around the nose and mouth. The sores quickly rupture, ooze
for a few days and then form a honey-colored crust. Sores can spread to other areas of the body through touch,
clothing and towels. Itching and soreness are generally mild.
Impetigo develops on intact skin and is a localized form of SSSS. The initially transparent flaccid bullae are more
likely to occur on covered body sites such as the trunk and perineum than are the lesions of nonbullous impetigo.
They can, however,occur on the face and extremities as well.
三，LONG QUESTIONS / CASES (50 MARKS ATTEMPT ALL QUESTIONS. EACH
QUESTION CARRY 10 MARKS)
1. Differentiate between pemphigus vulgaris and bullous phemphigoid in detail. (10)
Pemphigus Vulgaris
Pemphigus vulgaris is the most common form of pemphigus. Painful oral erosions usually precede the
onset of skin blisters by weeks or months
Involvement of other mucosal surfaces occurs in patients with widespread disease. The soft palate was
involved in 80% of cases at initial presentation. Nonpruritic flaccid blisters varying in size from 1 cm to
several centimeters appear gradually on normal or erythematous skin and may be localized for a
considerable time. The most common sites are the scalp, face, axillae, and oral cavity. Blisters invariably
become generalized if left untreated
The blisters rupture easily because the vesicle roof, which consists of only a thin portion of the upper
epidermis, is fragile
Bullous pemphigoid
This usually presents over the age of 65 years with tense blisters and erosions on a
background of dermatitis or normal skin (The condition may present acutely or
be insidious in onset, but usually enters a chronic intermittent phase before remitting after
approximately five years. Some patients have a prolonged pre‐ bullous period in which
persistent pruritic urticated plaques or eczema, precedes the blisters.
Characteristically, blisters have a predilection for flexural sites on the limbs and trunk.
Pemphigus Vulgaris Bullous pemphigoid
Epidemiology Average age 40-60 Elderly >60
Time course Chronic, relapsing Chronic, relapsing
Symptoms Painful Itchy
Mucosal involvement Common 10-30%
Bullae Flaccid, many already
ruptured
Tense
Nikolsky sign Positive Negative
Antibodies Autoantibodies against
desmoglein 1 and 3
Hemidesmosomal bullous
pemphigoid
Histology Suprabasilar clefting, "row
of tombstone"
antigens BP 230 and BP
1 80
Direct
lmmunofluorescence
pattern of basal
keratinocytes.
Subepidermal clefting
Treatment lntercellular lgG deposits Linear lgG deposits at
basement membrane
2. Discuss urticaria and all its types indetail. (10)
Definition. A hive or wheal is a circumscribed, erythematous or white, nonpitting, edematous, usually pruritic plaque
that changes in size and shape by peripheral extension or regression during the few hours or days that the individual
lesion exists. The edematous central area (wheal) can be pale in comparison to the erythematous surrounding area
(flare).
The evolution of urticaria is a dynamic process. New lesions evolve as old ones resolve. Hives result from localized
capillary vasodilation, followed by transudation of protein-rich fluid into the surrounding tissue; they resolve when the
fluid is slowly reabsorbed. The edema in urticaria is found in the superficial dermis. Lesions of angioedema are less
well demarcated. The edema in angioedema is found in the deep dermis or subcutaneous/
submucosal locations
Clinical Presentation. Lesions vary in size from the 2- to 4-mm edematous papules of cholinergic urticaria to giant
hives, a single lesion of which may cover an extremity. They may be round or oval; when confluent, they become
polycyclic
CAUSES
 Infection
 Viral (e.g. hepatitis, infectious mononucleosis, HIV
 infection during seroconversion)
 Bacterial
 Mycoplasma
 Intestinal parasites
 Connective tissue disorders
 Hypereosinophilic syndrome (unexplained eosinophilia
 with multiple internal organ involvement, especially
 cardiac)
 Hyperthyroidism
 Cancer

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 Lymphomas
 Causes, Exogenous
 Drugs, both topical and systemic
 Preservatives in lotions (especially sorbic acid)
 Foods and food additives
 Bites
 Inhalants
 Pollens
 Insect venoms
 Animal dander
Pathophysiology
• The signs and symptoms of urticaria are caused by mast cell degranulation, with release of histamine,
increased capillary permeability leading to transient leakage of fluid into the surrounding tissue and
development of a wheal
Classification
The main types of urticaria.
 Physical
 cold
 solar
 heat
 cholinergic
 dermographism (immediate pressure urticaria)
 delayed pressure
 Hypersensitivity
 Autoimmune
 Pharmacological
 Contact
Physical urticarias
Cold urticaria
• Patients develop wheals in areas exposed to cold (e.g. on
the face when cycling or freezing in a cold wind).
• A useful test in the clinic is to reproduce the reaction by
holding an ice cube, in a thin plastic bag to avoid wetting
against forearm skin.
• A few cases are associated with the presence of
cryoglobulins, cold agglutinins or cryofibrinogens.
Solar urticaria
• Wheals occur within minutes of sun exposure.
• most have an IgE-mediated urticarial reaction to sunlight.
• Some patients with solar urticaria have erythropoietic
Protoporphyria
Heat urticaria
• In this condition wheals arise in areas after contact with
hot objects or solutions.
Cholinergic urticaria
• Elicited by axiety, heat, sexual excitement or strenuous
exercise
• The vessels over-react to acetylcholine liberated from
sympathetic nerves in the skin.
• Transient 2-5 mm follicular macules or papules resemble a
blush or viral exanthem
Aquagenic urticaria
• precipitated by contact with water, irrespective of its
temperature.
Dermographism
• This is the most common type of physical urticaria
response of Lewis.
• They can be reproduced by scratching the back with a fingernail or
blunt object.
Delayed pressure urticaria
• Sustained pressure causes edema of the underlying skin and
subcutaneous tissue 3-6 h later.
last up to 48 h
• kinins or prostaglandins, rather than histamine, probably mediate it.
• It occurs particularly on the feet after walking, on the hands after
clapping and on the buttocks after sitting.
Other Types of Urticaria
Hypersensitivity of urticaria
• common form of urticaria is caused by hypersensitivity, often
an IgE-mediated (type I) allergic reaction
• Allergens may be encountered in 10 different ways (the 10 l's)
Autoimmune urticaria
• Some patients with chronic urticaria have an autoimmune
disease with IgG antibodies to IgE or to FclgE receptors on
mast cells, here the autoantibody acts as antigen to trigger
mast cell degranulation.
Pharmacological urticaria
• This occurs when drugs cause mast cells to release histamine
A portion of the border either may not form or may be reabsorbed, giving the appearance of incomplete rings
Course
• depends on its cause
• If the urticaria is allergic, it will continue until the
allergen is removed, tolerated or metabolized.
• Most such patients clear up within a day or two, even if
the allergen is not identified but may recur if the
allergen is met again.
• only half of patients attending hospital clinics with
chronic urticaria and angioedema will be clear 5 years
later.
• Those with urticarial lesions alone do better, half
being clear after 6 months.
Complications
• itch may be enough to interfere with sleep or daily
activities and to lead to depression.
• In acute anaphylactic reactions, oedema of the larynx
may lead to asphyxiation, and oedema of the tracheo-
bronchial tree to asthma.
Treatment
• The ideal is to eliminate the cause
• In addition, aspirin - in any form - should be banned.
Antihistamines
• are the mainstays of symptomatic treatment. Cetirizine 10 mg/day and loratadine 10 mg/day, both with half- lives of
around 12 h, are useful. If necessary, these can be supplemented with shorter acting antihistamines (e.g. hydroxyzine

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10-25 mg up to every 6 h acrivastine 8 mg three times daily) or with a longer acting antihistamine
(e.g. chlorphenamine (chlorpheniramine)] maleate 12 mg sustained-
release tablets every 12 h)
• Chlorphenamine or diphenhydramine are often used during
pregnancy because of their long record of safety, but cetirizine,
loratadine and mizolastine should be avoided.
• H2-blocking antihistamines (e.g. cimetidine) may add a slight
benefit if used in conjunction with an Hu histamine antagonist.
• Sympathomimetic agents can help urticaria.
Pseudoephedrine (30 or 60 mg every 4 h) or
terbutaline (2.5 mg every 8 h) can sometimes be useful
adjuncts.
• A tapering course of systemic corticosteroids may
be used, but only when the cause is known and there
are no contraindications
• Low doses of ciclosporin may be used for particularly
severe cases
3. Differentiate between basal cell carcinoma and squamous cell carcinoma (10)
4.
Basal cell carcinoma is a type of skin cancer that most often develops on areas of skin exposed to
the sun, such as the face. On brown and Black skin, basal cell carcinoma often looks like a
bump that's brown or glossy black and has a rolled border. Basal cell carcinoma is a type of
skin cancer.
Treatment:-
Basal cell carcinoma is most often treated with surgery to remove all of the cancer and
some of the healthy tissue around it. Options might include: Surgical excision. In this
procedure, your doctor cuts out the cancerous lesion and a surrounding margin of healthy skin.
Squamous cell carcinoma:- One of three main types of cells in the top layer of the skin (the
epidermis), squamous cells are flat cells located near the surface of the skin that shed
continuously as new ones form.
SCC occurs when DNA damage from exposure to ultraviolet radiation or other damaging agents
trigger abnormal changes in the squamous cells.
Treatment:-
If you’ve been diagnosed with an SCC that has not spread, there are several effective
treatments that can usually be performed on an outpatient basis. The choices available to you
depend on the tumor type, size, location and depth, as well as your age and overall health.
Options include:
Excisional surgery
 Mohs surgery
 Cryosurgery
 Curettage and electrodesiccation (electrosurgery)
 Laser surgery
 Radiation
 Photodynamic therapy (PDT)
 Topical medications
Characteristic Basal Cell Carcinoma Squamois Cell Carcinoma
Tumor Origination The deep layer of the epidermis
in the basal cell
The superficial layer of the
epidermis on the keratinocytes
Occurrence on Body Skin Can occur in the other places like
lungs, thyroid and esophagus
Genes involved in tumor
Expression
Proto-oncogenes : c-fos, c-myc and
N-ras amog others
Cell cycle regulator genes Ras
Mapk, signaling pathway
Tumor Location on Body Mainly on ears and nose On ears ,nose trunk, neck, lips
Incidence Most common nonmelanoma Second most common
nonmelanoma
5. A young male presents in medical OPD with complains of pain and swelling of
kneejoints for few months. On examination, with joints are swollen and tender.
There are silvery scales on extensor surfaces of limbs with erythematous plaques.
(i) What is most likely diagnosis (4)
(ii) Enlist treatment options (6)
Dx: Psoriasis
Treatment :
Treatment options for psoriasis
Psoriasis has no cure. Treatments aim to:
Reduce inflammation and scales slow the growth of skin cells remove plaques
Psoriasis treatments fall into three categories:
Topical treatments
Creams and ointments applied directly to the skin can be helpful for reducing mild to moderate psoriasis.
Topical psoriasis treatments include:
 topical corticosteroids
 topical retinoids
 anthralin

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 vitamin D analogues
 salicylic acid
 moisturizer
 Systemic medications
 People with moderate to severe psoriasis, and those who have not responded well to other treatment
types, may need to use oral or injected medications.
Many of these medications can have severe side effects, and for that reason, doctors usually prescribe them
for short periods of time.
These medications include:
 methotrexate
 cyclosporine (Sandimmune)
 biologics
 oral retinoids
 Light therapy
 This psoriasis treatment uses ultraviolet (UV) or natural light. Sunlight kills the overactive white
blood cells that are attacking healthy skin cells and causing the rapid cell growth. Both UVA and
UVB light may be helpful in reducing symptoms of mild to moderate psoriasis.
 Most people with moderate to severe psoriasis will benefit from a combination of treatments. This
type of therapy uses more than one of the treatment types to reduce symptoms. Some people may
use the same treatment their entire lives. Others may need to change treatments occasionally if their
skin stops responding to the treatment they’re receiving.
6. A 18 years old girl complains of itchy rash all over her body mainly at night time.
Herother brothers and sisters also have same problem. On exam papule eruptions
with surrounding scratch marks noted in finger webs over wrist and buttockd
(i) What is most probable diagnosis (4)
(ii) Which labs you will order and what is treatment (6)
Dx: Scabies
Treatment : Some common medications used to treat scabies include:
 5 percent permethrin cream
 25 percent benzyl benzoate lotion
 10 percent sulfur ointment
 10 percent crotamiton cream
 1 percent Lindane Lotion
 and antihistamines, such as diphenhydramine (Benadryl) or pramoxine lotion to help control the
itching antibiotics to kill any infections that develop as a result of constantly scratching your skin
steroid creams to relieve swelling and itching
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