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621.explanation

Correct answer -C
Answer is C i.e.,Tetracycline.

ACNE VULGARIS
• It is a self-limited disorder primarily of teenagers and
young adults.
• Increase in sebum production by sebaceous glands after puberty is the permissive factor for the disease expression.
• Clinical hallmark of acne vulgaris: Comedone, which
may be closed (whitehead) or open (blackhead).
• The earliest lesions seen in adolescence are generally
mildly inflamed or noninflammatory comedones on the forehead.
• Most common location for acne is the face, but involvement of the chest and back is common.
*Treatment of Acne
• Minimal to moderate pauci-inflammatory disease
respond adequately to local therapy alone: Topical agents
such as retinoic acid, benzoyl peroxide, or salicylic acid.
• Given the image, it is obvious that the case is not a minimal to moderate case of acne vulgaris. It is more likely moderate to acne vulgaris with inflammatory papules, pustules and comedones.
• Harrisons states: “Patients with moderate to severe acne
with a prominent inflammatory component will benefit from the addition of systemic therapy, such as tetracycline in doses of 250–500 mg BD or doxycycline in doses of 100 mg BD”.
• If patients with severe nodulocystic acne are
unresponsive to the therapies discussed above: Treatment
with the synthetic retinoid isotretinoin is the choice. Its
dose is based on the patient’s weight, and it is given once
daily for 5 months.
• Isotretinoin gives excellent result, but its teratogenic side
effects limits its use in reproductive age group females.

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621.Best treatment of 24-year-old female with the following lesions?

620.explanation

Correct answer -C
Answer is C i.e.,Psoriasis.

• The silver scaly lesion on the skin of the patient in the given image is more likely a case of psoriasis.
••PSORIASIS
• Psoriasis is one of the most common dermatologic diseases, affecting up to 2% of the world’s population.
• Clinical feature: Characterized by—
ƒ Erythematous, sharply demarcated papules and
rounded plaques covered by silvery micaceous scale.
The skin lesions of psoriasis are variably pruritic.
ƒ Koebner or isomorphic phenomenon: Traumatized
areas often develop lesions of psoriasis.
*Types of Psoriasis
1. Plaque-type: It is the most common variety of psoriasis.
ƒ Patients present with stable, slowly enlarging plaques,
which remains unchanged for long periods of time.
ƒ The most commonly involved areas are the elbows, knees, gluteal cleft, and scalp. Involvement tends to be
symmetric.
2. Inverse psoriasis affects the intertriginous regions,including the axilla, groin, submammary region, and navel.
3. Guttate psoriasis (eruptive psoriasis): This is most common in children and young adults.
ƒ Patients present with many small erythematous, scaling papules, frequently after upper respiratory tract infection with β-hemolytic streptococci.
4. Pustular psoriasis: Usually localized to the palms and
soles, or may be generalized. Can present with fever and
or pustular eruptions.
*Treatment
• Limited psoriasis: Topical glucocorticoids, Calcipotriene
(topical vitamin D analogue), retinoid (tazarotene).
• Widespread psoriasis:
ƒ UV light: Ultraviolet B (UVB), narrow band UVB,
and ultraviolet A (UV A) light with either oral or
topical psoralens (PUVA) is used.
ƒ Methotrexate is an effective agent, especially in patients with psoriatic arthritis.
Note: Oral glucocorticoids should not be used for the treatment of psoriasis due to the potential for development of life- threatening pustular psoriasis when therapy is discontinued.

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620.What is the diagnosis of the given image?

619.explanation

Correct answer -C
Answer is C i.e.,Lichen planus.

LICHEN PLANUS
• Lichen planus (LP) is a papulosquamous disorder that
may affect the skin, scalp, nails, and mucous membranes.
• The primary cutaneous lesions of LP are pruritic, polygonal, flat-topped, violaceous papules.
• Most common site can occur anywhere but have a predilection for the wrists, shins, lower back, and genitalia.
••Characteristic Feature
1. Wickham’s striae: A network of gray lines on the surface
of papules.
2. Lichen planopilaris: Involvement of the scalp may lead to scarring alopecia, and nail involvement may lead to
permanent deformity or loss of finger nails and toe nails.
3. Lichen planus commonly involves mucous membranes,
particularly the buccal mucosa (Erosive stomatitis) which may persist for years and linked to an increased risk of oral squamous cell carcinoma.
4. LP may be associated with hepatitis C infection.
The course of LP is variable, but most patients have spontaneous remissions 6 months to 2 years after the
onset of disease.
*Treatment of choice: Topical glucocorticoids.

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619.A 25-year-old patient present with violaceous lesion on arms. What is the likely diagnosis:

618.explanation

Correct answer -C
Answer is C i.e.,c. Erythema multiforme.

• The shown target lesions on palm are diagnostic of erythema multiforme.
• The classic target lesions of erythema multiforme appear
symmetrically on the elbows, knees, palms, soles, and face.
• In severe cases, these lesions spread diffusely and involve mucosal surface.
• Choice B, Steven JOhnson syndrome is ruled out due to presentation of vesico-bullous lesions.

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618.25-year-old Truck driver with repeated Herpes infection presents with following skin lesions. Diagnosis is:

617.explanation

Correct answer -D
Answer is D i.e.,Psoriasis.

• The silver scaly lesion as shown in the patient in the
given image is more likely a case of psoriasis.
**PSORIASIS
• Psoriasis is one of the most common dermatologic
diseases, affecting up to 2% of the world’s population.
• Clinical feature: Characterized by—
ƒ Erythematous, sharply demarcated papules and
rounded plaques covered by silvery micaceous scale.
The skin lesions of psoriasis are variably pruritic.
ƒ Koebner or isomorphic phenomenon: Traumatized
areas often develop lesions of psoriasis.

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617.In the shown lesion scratching leads to bleeding followed by further formation of similar lesions is suggestive of?

616.explanation

Correct answer -B
Answer is B i.Basal cell cancer.

The image shows a lesion on the face showing a raised and beaded appearance. It is suggestive of the diagnosis of BCC. The most common site is the face with a line drawn between angle of mouth and ear Lobule–Onghren’s line.

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616.A 60-year-old lady presents with lesion on upper eyelid as shown in image. Diagnosis is?

615.explanation

Correct answer -A
Answer is A i.e.,Molluscum contagiosum.

• Vesicle with central umbilication is most likely suggestive of molluscum contagiosum.
• Molluscum contagiosum is a cutaneous poxvirus infection characterized by multiple umbilicated flesh-colored or hypopigmented papules.
• Molluscum contagiosum is highly prevalent among children and is the most common human disease resulting from poxvirus
infection.
• Swimming pools are a common vector for transmission.

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