Dermatology Study Notes:
Comprehensive Guide for
FMGE Preparation
1. Anatomy & Physiology of the Skin
General Overview
The skin is the largest organ of the body and serves multiple critical
functions[1].
Key Statistics:
Weight: Approximately 4–5 kg
Surface Area: Approximately 1.7 m²
Primary Functions:
Barrier protection against external environment
Metabolic function (Vitamin D synthesis)
Temperature regulation
Secretion
Immune surveillance (via Langerhans cells)
Sensation (via Merkel cells)
Layers of the Skin
A. Epidermis (Outer Layer)
Tissue Type: Stratified squamous epithelium
Sub-layers (from outer to inner):
• Stratum Corneum: Outermost layer consisting of flat, anucleated (dead),
keratinized cells. Responsible for the "barrier function."
• Stratum Lucidum: A transitional zone found only in thick skin (palms
and soles). Contains eleidin granules.
• Stratum Granulosum: Contains keratohyalin granules (basophilic) and
lamellar granules (Odland bodies) which release lipids to form a water
barrier.
• Stratum Spinosum (Prickle Cell Layer): Multilaminar layer with
polygonal cells connected by desmosomes. This connection gives the cells
a "spiny" appearance during histology.
• Stratum Basale (Germinative Layer): Single layer of columnar cells
where cell proliferation (division) occurs. Contains melanocytes (pigment)
and Merkel cells (touch).
B. Dermis (Middle Layer)
Function: Connective tissue that provides tensile strength and support.
Layers:
Papillary Dermis: Upper 1/10th; loose connective tissue
Reticular Dermis: Lower 9/10th; dense irregular connective tissue
Components:
Collagen: Type I (most abundant) and Type III; provides strength
Elastic Fibers: Provide elasticity (defects cause Marfan syndrome)
Proteoglycans: Help hold water/hydration
C. Hypodermis (Subcutaneous Layer)
Structure: Composed of adipocytes (fat cells) arranged in lobules separated by
septa
Function: Insulation and shock absorption
Skin Appendages
• Eccrine Sweat Glands: Open directly onto the skin surface; critical for
thermoregulation
• Apocrine Glands: Open into hair follicles (found in axillae, groin, areola).
Secretions are odorless until acted upon by skin bacteria
• Sebaceous Glands: Secrete sebum (oil) via holocrine secretion (the
whole cell disintegrates). Found everywhere except palms and soles
2. Dermatological Examination &
Lesions
Primary Skin Lesions (Initial Changes)
• Macule: Flat, non-palpable color change <1 cm (e.g., freckle). If >1 cm,
it is a Patch
• Papule: Solid, elevated lesion <1 cm
• Nodule: Solid, elevated lesion >1 cm, often extending deeper than a
papule
• Plaque: Elevated, flat-topped lesion >1 cm (often formed by coalescing
papules, common in Psoriasis)
• Vesicle: Fluid-filled blister <1 cm (e.g., Herpes)
• Bulla: Fluid-filled blister >1 cm
• Pustule: A vesicle containing pus (leukocytes)
• Wheal (Hive): Transient, edematous plaque caused by dermal edema
(e.g., Urticaria)
Secondary Skin Lesions (Evolved Changes)
• Scale: Flaking of the stratum corneum (e.g., Dandruff, Psoriasis)
• Crust: Dried serum, blood, or pus (e.g., Scab)
• Excoriation: A scratch mark; erosion caused by scratching
• Lichenification: Thickening of the skin with exaggerated skin markings,
usually due to chronic scratching
• Fissure: A linear crack or cleft in the skin
• Ulcer: Full-thickness loss of epidermis and dermis; heals with scarring
Diagnostic Tests
• Diascopy: Pressing a glass slide against a lesion. If it blanches, it is
vascular; if it does not, it is extravasated blood (petechiae/purpura). Used
to see "Apple Jelly Nodules" in Lupus Vulgaris
• Wood's Lamp: UV light used to visualize fungal infections (Tinea Capitis)
or pigment disorders (Vitiligo fluoresces white)
• Tzanck Smear: Cytology test looking for multinucleated giant cells in
herpes virus infections
• Nikolsky Sign: Rubbing skin causes separation of top layers (Positive in
Pemphigus Vulgaris)
3. Papulosquamous Disorders
Psoriasis
Nature: Chronic autoimmune condition[1]
Trigger Factors:
Trauma (Koebner phenomenon)
Infection (Strep throat triggering Guttate psoriasis)
Drugs (Beta-blockers, Lithium)
Stress
Clinical Features:
Well-defined erythematous (red) plaques with silvery white scales
Auspitz Sign: Pinpoint bleeding when scale is removed
Common Sites: Extensor surfaces (Elbows, Knees), Scalp, Lower back
Treatment:
• Topical: Corticosteroids, Salicylic acid (keratolytic), Coal tar, Vitamin D
analogs
• Systemic: Methotrexate, Cyclosporine, Biologicals
Lichen Planus
The 5 P's: Purple, Polygonal, Pruritic (itchy), Planar (flat), Papules
Characteristic Sign: Wickham's Striae (white lacy lines on the lesion surface or
oral mucosa)
Common Sites: Flexor surfaces of wrists and ankles
Histology: Saw-tooth appearance of rete ridges
Pityriasis Rosea
Cause: Viral (HHV-6/7 reactivation)
Clinical Features: Starts with a single large "Herald Patch," followed by a
generalized eruption of smaller scaly macules in a "Christmas Tree" pattern on
the back
Prognosis: Self-limiting (resolves spontaneously)
4. Eczema (Dermatitis)
Classification
Contact Dermatitis
Irritant Type:
Direct chemical damage (acids, detergents)
No incubation period
Localized strictly to contact site
Allergic Type:
Type IV Hypersensitivity (T-cell mediated)
Requires sensitization (~2 weeks incubation)
Spreads beyond contact site
Common allergens: Nickel, Poison Ivy
Atopic Dermatitis
Chronic and relapsing
Associated with the "Atopic Triad" (Asthma, Allergic Rhinitis, Eczema)
Distribution: Face/Cheeks in infants; Flexural areas (elbow/knee
creases) in adults
Feature: Intense itching
Seborrheic Dermatitis
Greasy, yellow scales on areas rich in sebaceous glands (scalp/dandruff,
eyebrows, nasolabial folds)
Dyshidrotic Eczema (Pompholyx)
"Tapioca-like" vesicles on palms/soles; intensely itchy
Nummular (Discoid) Eczema
Coin-shaped lesions
5. Bullous (Blistering) Disorders
Feature Pemphigus Vulgaris Bullous Pemphigoid
Desmosomes (Intra- Hemidesmosomes (Sub-
Target
epidermal) epidermal)
Blister Type Flaccid (breaks easily) Tense (hard to break)
Nikolsky Sign Positive (+ve) Negative (−ve)
Age Middle-aged (40-60) Elderly (>60)
Often involved (Oral
Mucosa Rarely involved
ulcers)
Acantholysis (cell
Pathology No Acantholysis
separation)
Table 1: Comparison of Pemphigus Vulgaris and Bullous Pemphigoid
6. Infections
Bacterial (Pyoderma)
• Folliculitis: Inflammation of the hair follicle (pustule)
• Furuncle (Boil): Deep infection of the follicle and surrounding tissue
• Carbuncle: Aggregates of fused furuncles (multiple openings)
Cutaneous TB:
• Lupus Vulgaris: Apple-jelly nodules, scarring; common in adults
• Scrofuloderma: Skin involvement overlying a TB lymph node or bone
infection
Fungal (Tinea/Ringworm)
• Tinea Capitis: Scalp infection. Patches of hair loss and scales
• Tinea Corporis: Body infection. Ring-like lesions with central clearing
and an active red border
• Tinea Cruris: Groin infection (Jock itch)
• Onychomycosis: Fungal infection of nails (yellow, thickened)
• Pityriasis Versicolor: Caused by Malassezia yeast. Hypo or
hyperpigmented patches on the trunk. Microscopy shows "Spaghetti and
meatball" appearance
Viral
• Herpes Simplex (HSV): Grouped vesicles on an erythematous base.
HSV-1 (Oral), HSV-2 (Genital). Recurrent
• Herpes Zoster (Shingles): Reactivation of Varicella Zoster. Painful
vesicular rash following a dermatome (unilateral, does not cross midline)
• Warts (Verrucae): Caused by HPV. Rough, hyperkeratotic papules
Parasitic (Infestations)
Scabies
Cause: Sarcoptes scabiei
Clinical Features:
Intense itching (worse at night)
Burrows (linear tracks) in web spaces of fingers, wrists, genitals
Treatment: Permethrin 5% cream (apply neck down, leave overnight). Treat all
household contacts.
Pediculosis (Lice)
Head, Body, or Pubic lice. Characterized by itching and visible nits (eggs)
attached to hair shafts.
7. Sexually Transmitted Infections:
Syphilis
Organism: Treponema pallidum (Spirochete)
Stages of Syphilis
Primary Syphilis
Chancre: Painless, hard, indurated ulcer at the inoculation site
Heals spontaneously
Secondary Syphilis
Occurs approximately 6 weeks after chancre
Features: Systemic spread, Rash (palms/soles involved), Condyloma Lata
(wart-like lesions), Lymphadenopathy
Highly contagious
Latent Syphilis
Asymptomatic but serology positive
Tertiary Syphilis
Gummas (granulomas)
Neurosyphilis
Cardiovascular syphilis
Treatment: Penicillin G
8. Pigmentary and Hair Disorders
Vitiligo
Definition: Autoimmune destruction of melanocytes resulting in depigmented
(white) patches[2]
Treatment:
Phototherapy (PUVA, UVB)
Topical steroids
Alopecia Areata
Definition: Autoimmune hair loss
Clinical Features:
Smooth, round patches of complete hair loss
"Exclamation mark" hairs seen at margins
Treatment: Intralesional steroids
9. FMGE Preparation Strategy for
Dermatology
Based on high-yield examination patterns, prioritize the following areas[3]:
1. Infections: Bacterial (Pyoderma, TB), Fungal (Tinea species), Viral (HSV,
VZV), Parasitic (Scabies)
2. Vesiculobullous Disorders: Pemphigus Vulgaris vs. Bullous Pemphigoid
(differential diagnosis is critical)
3. Papulosquamous Diseases: Psoriasis, Lichen Planus, Pityriasis Rosea
4. Eczema and Dermatitis: Types, pathophysiology, clinical presentation
5. Pigmentary Disorders: Vitiligo, Alopecia Areata
6. Syphilis: Stages, presentation, serology, treatment
7. Diagnostic Skills: Proper terminology for lesions, examination
techniques
Study Tips:
Master the terminology for describing skin lesions (size, morphology,
arrangement)
Create comparison tables for differential diagnoses
Practice image-based questions regularly
Focus on clinical presentation and management
Revise high-yield topics at least 3 times before examination
References
[1] World Health Organization. (2024). Skin health: A global perspective.
International Journal of Dermatology.
[2] Prabhu, S., & Verma, S. (2023). Management of vitiligo: Current perspectives
and future directions. Indian Dermatology Online Journal, 14(6), 345-357.
[3] DMAEDU. (2024). How to prepare dermatology for FMGE/MCI screening.
Retrieved from [Link]
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