Pigmentation Disorders

Pigmentation Disorders

Q. 1 Acquired symmetric hyper pigmentation of the sun exposed skin of the face and neck, which is strongly associated with pregnancy & use of oral contraceptives is called-
 A Melanoma
 B Cafe-au-lait spots
 C Freckle
 D Melasma
Q. 1 Acquired symmetric hyper pigmentation of the sun exposed skin of the face and neck, which is strongly associated with pregnancy & use of oral contraceptives is called-
 A Melanoma
 B Cafe-au-lait spots
 C Freckle
 D Melasma
Ans. D

Explanation:

(Ref: Burket, Ed. 10th Pg-132)

• Melasma or Cholasma describes the discrete patches of facial pigmentation which occur in pregnancy and in some women taking oral contraceptives.

• This pigmentation is seen particularly in periorbital and perioral region.


Q. 2

A melanocytic naevus surrounded by a depigmented halo is called:

 A

Sutton’s nevus

 B

Meyerson’s naevus

 C

Cockade naevus

 D

Nevus anaemicus

Q. 2

A melanocytic naevus surrounded by a depigmented halo is called:

 A

Sutton’s nevus

 B

Meyerson’s naevus

 C

Cockade naevus

 D

Nevus anaemicus

Ans. A

Explanation:

Sutton’s nevus/halo’s nevus : a halo of depigmentation appears around a preexisting melanocytic naevus.

Meyerson’s naevus is used to describe a melanocytic naevus that has developed an associated inflammatory reaction, which looks like eczema. 

Ref: Rook’s textbook of dermatology, 8th edition Pg 54.20.


Q. 3

A giant congenital melanocytic nevus is usually of the size:

 A

5-10cm

 B

10-15 cm

 C

15-20 cm

 D

>20cm

Q. 3

A giant congenital melanocytic nevus is usually of the size:

 A

5-10cm

 B

10-15 cm

 C

15-20 cm

 D

>20cm

Ans. D

Explanation:

American National Institutes of Health (NIH) consensus definition to categorize naevi as small under 1.5 cm in diameter, large as having a diameter between 1.5 and 20 cm and giant naevi as having a diameter of 20 cm or more.

Note: It is also called garment or bathing-trunk naevus. Most common site is lower back.
Ref: Rook’s textbook of dermatology, Edition-8, Page 54.10.

Q. 4

Which of the following is not a vascular malformation?

 A

Infantile haemangioma

 B

Salmon patch

 C

Port wine stain

 D

Naevus aneamicus

Q. 4

Which of the following is not a vascular malformation?

 A

Infantile haemangioma

 B

Salmon patch

 C

Port wine stain

 D

Naevus aneamicus

Ans. A

Explanation:

Vascular birthmarks are broadly classified into:

A) Vascular tumours B) Vascular malformations
 
All the above mentioned conditions are vascular malformations except for haemangioma which is a vascular tumour.
 
Note: salmon patch – synonyms — stork bite or mark/ Nuchal stain
 
Ref: Rook’s textbook of dermatology, Edition-8, Page-18.40.

Q. 5

28 year old pregnant female came to you with complaints of brownish pigmentation on the bridge of nose and cheek. She noticed it after returning from her vacation at  beach. There is no pain or itching at the affected site. What is your most likely diagnosis?

 A

Chloasma

 B

Photodermatitis

 C

SLE

 D

Acne rosacea

Q. 5

28 year old pregnant female came to you with complaints of brownish pigmentation on the bridge of nose and cheek. She noticed it after returning from her vacation at  beach. There is no pain or itching at the affected site. What is your most likely diagnosis?

 A

Chloasma

 B

Photodermatitis

 C

SLE

 D

Acne rosacea

Ans. A

Explanation:

This patient is pregnant and has noted the pigmentation after a period of exposure to the sun during her vacation, both these factors act as triggers for the development of chloasma.

It is symmetrically seen on cheeks, nose, forehead and chin.

Chemical peeling using glycolic acid and trichloroacetic acid is an important method of treatment.

Medical treatment can be done using topical hydroquinone or azelaic acid.

Ref: Illustrated Synopsis of Dermatology and Sexually Transmitted Diseases By Neena Khanna 2ND edn page 135.


Q. 6

A 25 yr old lady develops brown macular lesions over the bridge of nose and cheeks following exposure to sunlight. What is the most probable diagnosis?

 A

Chloasma

 B

Photodermatitis

 C

SLE

 D

Acne rosacea

Q. 6

A 25 yr old lady develops brown macular lesions over the bridge of nose and cheeks following exposure to sunlight. What is the most probable diagnosis?

 A

Chloasma

 B

Photodermatitis

 C

SLE

 D

Acne rosacea

Ans. A

Explanation:

This lady is showing features of chloasma which is a brownish macular hyperpigmentation of the face mostly over the cheek, forehead, nose, upper lip and chin.
In a small percentage of cases it is also seen on the malar or mandibular areas of the face and occasionally the dorsum of the forearms.
It is exacerbated by sunlight. 
 
This is usually seen in women during pregnancy, in women taking OCPs and living in sunny regions.
It is also associated with the ingestion of diphenylhydantoin.
 
Ref: Suurmond D. (2009). Section 13. Pigmentary Disorders. In D. Suurmond (Ed), Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, 6e.

Q. 7

The treatment of choice for mongolian spots is:

 A

Laser therapy

 B

Skin grafting

 C

Steroids

 D

None of the above

Q. 7

The treatment of choice for mongolian spots is:

 A

Laser therapy

 B

Skin grafting

 C

Steroids

 D

None of the above

Ans. D

Explanation:

Mongolian spots are bluish, well demarcated spots on the buttocks and trunk. The name is a misnomer because these are not related to Down’s syndrome and usually disappears before the first birthday. There is no need of treatment and so the answer is ‘None of the above’.

Ref: O.P.Ghai, 6th Ed, Page 136; 7th Ed, Page 146


Q. 8

A 21 year old lady who is on an oral contraceptive pill presents with light brown pigmenta­tion of the malar eminences. What is the likely diagnosis?

 A

Haemochromatosis

 B

Systemic Lupus Erythematosis

 C

Melasma

 D

Melanoma

Q. 8

A 21 year old lady who is on an oral contraceptive pill presents with light brown pigmenta­tion of the malar eminences. What is the likely diagnosis?

 A

Haemochromatosis

 B

Systemic Lupus Erythematosis

 C

Melasma

 D

Melanoma

Ans. C

Explanation:

Melasma is light brown pigmentation of the skin which is harmless.

They are gradually blotchy macular hyperpigmentation especially of the malar surfaces, chin or forehead.

Origin can be pregnancy related to the use of Oral Contraceptives.

A good number of cases are idiopathic.

They are self limiting after pregnancy and when OCP is discontinued.

 
Ref: In a Page: Signs and Symptoms By Scott Kahan, 2004, Pages 81-82

Q. 9

The most common presentation of a blue rubber bleb nevus syndrome is:

 A

Asymptomatic iron deficiency anemia

 B

Cardiac conduction defects

 C

Renal aminoaciduria

 D

Painful peripheral neuropathy

Q. 9

The most common presentation of a blue rubber bleb nevus syndrome is:

 A

Asymptomatic iron deficiency anemia

 B

Cardiac conduction defects

 C

Renal aminoaciduria

 D

Painful peripheral neuropathy

Ans. A

Explanation:

Blue rubber bleb nevus syndrome is a rare disorder characterized by the development of cavernous hemangiomas, most commonly involve the skin and the GI tract. 

The most common presentations of blue rubber bleb nevus syndrome are either the appearance of the skin lesions alone or iron deficiency anemia. 

Ref: American Gastroenterological Association (AGA) Institute Technical Review on Obscure Gastrointestinal Bleeding 2007.


Q. 10

The most likely diagnosis is a case of intractable convulsions mental defect and facial nevus is‑

 A

Sturge Weber syndrome

 B

Tuberous sclerosis

 C

Von-Hippen -Lindau disease

 D

Von- Reckling-Hausens disease

Q. 10

The most likely diagnosis is a case of intractable convulsions mental defect and facial nevus is‑

 A

Sturge Weber syndrome

 B

Tuberous sclerosis

 C

Von-Hippen -Lindau disease

 D

Von- Reckling-Hausens disease

Ans. A

Explanation:

Ans. is ‘a’ i.e., Sturge-weber syndrome

o Sturge weber syndrome and Von-Reckling-Hausen disease (NF-1) have been explained earlier about other options.

Tuberous sclerosis (Bourneville’s disease)

o Tuberous sclerosis is characterized by : ‑

  1. Cutaneous lesions —> Adenoma sebaceum, ash-leaf shaped hypopigmented macules, shagreen patches, depigmented nevi.
  2. Seizures
  3. Mental retardation

o Other features —-> Calcified subependymal nodules, Subependymal giant cell astrocytoma, ependymoma, Rhabdomyomas of the heart, and angiomyomas of the kidney, liver, adrenals and pancreas.

Von Hippel – Lindau syndrome

o This syndrome consists of Retinal, cerebellar and spinal hemangioblastoma.

o Renal cell carcinoma, Pheochromocytoma, benign cyst of the kidney, liver, pancrease and epididymis may also occur.

o Polycythemia may occur due to secretion of erythropoietin from hemangioblastoma.


Q. 11

Maximum malignant potential is in –

 A

Superficial naevus

 B

Epidermal naevus

 C

Junctional naevus

 D

Intradermis naevus

Q. 11

Maximum malignant potential is in –

 A

Superficial naevus

 B

Epidermal naevus

 C

Junctional naevus

 D

Intradermis naevus

Ans. C

Explanation:

Ans. is ‘c’ i.e., Junctional nevus

A malignant melanoma may arise  :

a)         de-novo in apparently normal skin

b)         in a preexisting pigmented nevus

Malignant change in a benign noevus occurs only in the JUNCTIONAL or compound varities. Pure dermal naevus is safe –


Q. 12

Malignant change in nevus is characterised by‑

 A

Darkening

 B

Hemorrhage

 C

Itching

 D

All

Q. 12

Malignant change in nevus is characterised by‑

 A

Darkening

 B

Hemorrhage

 C

Itching

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Itching

Warning size of melanoma are : ‑

i)           Itching or pain in a pre-existing mole.

ii)         Enlargement of a pre-existign lesion.

iii)        Irregularity of the borders of a pigmented lesion.

iv)       Variegation of color within a pigmented lesion.

v)         Assymetry of lesions.


Q. 13

Common sites for mongolian spot are –

 A

Face

 B

Neck

 C

Lumbosacral area

 D

All

Q. 13

Common sites for mongolian spot are –

 A

Face

 B

Neck

 C

Lumbosacral area

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Lumbosacral area

Mongolian spots are blue or slate – gray macular lesions which occur most commonly in pre-sacral area (mainly in lower back & buttocks) but may be found over the posterior thighs, legs, and shoulders.


Q. 14

Hyperpigmented lesions are

 A

Pityriasisalba

 B

Melanoma

 C

Naevus anaemicus

 D

All

Q. 14

Hyperpigmented lesions are

 A

Pityriasisalba

 B

Melanoma

 C

Naevus anaemicus

 D

All

Ans. B

Explanation:

B i.e. Melanoma

Hyperpigmentation (hyper melanosis) of skin is seen in endocrine disorders like Addison’s diseaseQ, acromegaly, Nelson’s syndrome, Cushing’s (ectopic ACTH) syndromeQ, carcinoid syndrome, pheochromocytoma, and hyperthyroidism (Grave’s disease) but not in hypothyroidism or myxedeme. Melanoma, dyskeratosis congenita & lentigines lichen planusQ cause hyperpigmentation.


Q. 15

Hypopigmentation is/are seen in:

 A

Vitiligo

 B

Pityriasis versicolor

 C

Lichen planus

 D

Melasma

Q. 15

Hypopigmentation is/are seen in:

 A

Vitiligo

 B

Pityriasis versicolor

 C

Lichen planus

 D

Melasma

Ans. B

Explanation:

B i.e. Pityriasis versicolor

Pityriasis alba, pityriasis versicolor, pinta, yaws, syphilis (secondary syphilis – leukoderma syphiliticum), tuberculoid and indeterminate leprosyQ – all can cause hypopigmentation (hypomelanosis). A few papules or erythematosquamous plaques develop in primary stage of pinta which become more extensive in secondary stage (pintids) after an interval of months or years. Initial red color of pintids changes to brown, slate blue, black or grey, and eventually there is depigmentation intermixed with hyperpigmentation. Primary & secondary stages are infectious. In tertiary (late) stage, which takes several years to develop, there is irregular pigmentation, vitiligo like achromia (hypopigmentation), areas of hyperkeratosis and eventually atrophy.

Nonscaly, non itchy, transient (evanescent) macular syphilide (roseolar rash) of secondary syphilis is generalized, symmetrical, coppery red oval or round spots. Fading roseolar rash may sometimes, leave a pattern of depigmented spots on a hyperpigmented background (k/a leukoderma syphiliticum) most commonly located on the back or sides of neck (k/a necklace of venus).

Melasma (mask of pregnancy) Vt hyperpigmentationQ. Lichen planus usually Vt hyperpigmentationQ. Lichen planus usually Vt hyperpigmentation but hypopigmentation may also occurQ.


Q. 16

Hypopigmented patches can be seen in :

 A

Becker naevus

 B

Freckles

 C

Nevus Ito

 D

Nevus anemicus

Q. 16

Hypopigmented patches can be seen in :

 A

Becker naevus

 B

Freckles

 C

Nevus Ito

 D

Nevus anemicus

Ans. D

Explanation:

D i.e. Naevus anemicus


Q. 17

Hypo-depigmented lesion seen in :

 A

Naevas Ito

 B

Naevus depigmentosa

 C

Naevas Ota

 D

All

Q. 17

Hypo-depigmented lesion seen in :

 A

Naevas Ito

 B

Naevus depigmentosa

 C

Naevas Ota

 D

All

Ans. B

Explanation:

B i.e. Naevus depigmentosa

Freckles (or ephelides), Melasma (chloasma or mask of pregnancy), Mongolian spots, Cafe au lait, Becker’s nevus or melanosis (pigmented hairy epidermal nevus), nevus of Ota and nevus of Ito cause hyperpigmented patches (Mn: “Free Meal & Mongolian Café BOY = BOI arer hyperpigmented”). Whereas, Nevus depigmentosus (or achromicus), nevus anaemicus, Sutton’s (Halo) nevus (leukoderma acquisitum centrifugum), hypomelanosis of Ito and Piebaldism leads to hypopigmentation. (Mn- “Pie DASH nevus are hypopigmented”).

Becker’s nevus is sporadically acquired disorder (may be of familial occurance), 5 times more commonly affecting males. It is usually first noticed during adolescence, initially pale in colour which becomes more prominent during sun exposure. It follows Blaschko’s lines, but with lack of conformity (d/t late occurance). It starts as an area of irregular macular (hyper) pigmentation with geographical outline usually on shoulder, anterior chest or scapular region. Once present it remains indefinitely and shows predisposition to androgen sensitivity (since it is prone to acne & hypertrichosis). Lesion may show central thickening and increased terminal hairs on & around the lesion. Becker’s nevus syndrome is Becker’s nevus with ipsilateral non cutaneous developmental abnormalities like breast hypoplasia, supernumerary nipples, spina bifida etc. Nevus of Ota (oculo-dermal melanocytosis/nevus fuscocaeruleus ophthalmo-maxillaris) is usually congenital & unilateral slate brown or blue hyperpigmentation in the areas of skin, sclera, cornea, iris, retina, ocular muscles, orbit & hard palate supplied by ophthalmic and maxillary division of trigeminal nerve, more prevalentally in Japanese. Nevus of Ito is hyperpigmentation in area supplied by posterior supraclavicular and lateral brachial cutaneous nerves, commonly in Japanese.


Q. 18

The best results in treatment of capillary nevus have been achieved by –

 A

Full thickness skin graft

 B

Dermabrasion

 C

Tatooing

 D

Argon laser treatment

Q. 18

The best results in treatment of capillary nevus have been achieved by –

 A

Full thickness skin graft

 B

Dermabrasion

 C

Tatooing

 D

Argon laser treatment

Ans. D

Explanation:

Ans. is ‘d’ i.e., Argon laser treatment 


Q. 19

Salmon patch usually disappears by age ‑

 A

One mouth

 B

One year

 C

Puberty

 D

None of the above

Q. 19

Salmon patch usually disappears by age ‑

 A

One mouth

 B

One year

 C

Puberty

 D

None of the above

Ans. B

Explanation:

Ans. is ‘b’ i.e., One year 


Q. 20

Which of the following conditions disappear spontaneously in first year of life?

 A

Port wine stain

 B

Naevus flammeus

 C

Salmon’s patch

 D

Strawberry hemangioma

Q. 20

Which of the following conditions disappear spontaneously in first year of life?

 A

Port wine stain

 B

Naevus flammeus

 C

Salmon’s patch

 D

Strawberry hemangioma

Ans. C

Explanation:

Ans. is ‘c’ i.e., Salmon’s patch 


Q. 21

30-year old Basanti presents with light brown lesions involving both her cheeks. The lesions had never been erythematous. Which of the following is the most probable diagnosis:

 A

SLE

 B

Chloasma

 C

Air borne contact dermatitis

 D

Photo sensitive reaction

Q. 21

30-year old Basanti presents with light brown lesions involving both her cheeks. The lesions had never been erythematous. Which of the following is the most probable diagnosis:

 A

SLE

 B

Chloasma

 C

Air borne contact dermatitis

 D

Photo sensitive reaction

Ans. B

Explanation:

Answer is B (Chloasma):


Q. 22

A female developed brown macule on the cheek, forehead and nose after exposure to light following delivery of a baby, the diagnosis is

 A

SLE

 B

Chloasma

 C

Photodermatitis

 D

Acne rosacea

Q. 22

A female developed brown macule on the cheek, forehead and nose after exposure to light following delivery of a baby, the diagnosis is

 A

SLE

 B

Chloasma

 C

Photodermatitis

 D

Acne rosacea

Ans. B

Explanation:

Answer is B (Chloasma):

Patient has a characteristic ‘brown’ macule on cheek, with no history suggestive of any systemic involvement, with positive history of delivery of a baby suggesting pregnancy.


Q. 23

Melasma, during pregnancy is seen on:

March 2011

 A

Breast

 B

Face

 C

Abdomen

 D

Limbs

Q. 23

Melasma, during pregnancy is seen on:

March 2011

 A

Breast

 B

Face

 C

Abdomen

 D

Limbs

Ans. B

Explanation:

Ans. B: Face

Chloasma gravidarum/ pregnancy mask is an extreme form of pigmentation around the cheek, forehead and around the eyes, during pregnancy

Signs of pregnancy:

  • Chadwick’s sign: Congestion of pelvis causes bluish/ purplish hue of vagina/ cervix
  • Goodell’s sign: Cyanosis of softening of cervix
  • Hegar’s sign: Compressibility of isthmus on bimanual examination
  • Piskacek’s sign: Softening of cervix with lateral implantation
  • Osiander’s sign: Pulsations in lateral vaginal fornix
  • Palmer’s sign: Rhythmic contractions of uterus
  • Weinberg sign: Abdominal pregnancy

Q. 24

A 15cm hyperpigmented macule on an adolosent male undergoes changes such as coarceness, growth of hair & acne. Diagnosis is ‑

 A

Melanocytic nevus

 B

Becker nevus

 C

Sebaceous nevus

 D

Sebaceous nevus

Q. 24

A 15cm hyperpigmented macule on an adolosent male undergoes changes such as coarceness, growth of hair & acne. Diagnosis is ‑

 A

Melanocytic nevus

 B

Becker nevus

 C

Sebaceous nevus

 D

Sebaceous nevus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Becker nevus

Becker Nevus

  • Usually starts in adolescence as an irregular smooth hyperpigmented macule.
  • Usually involves shoulder, anterior chest and scapular region, although any part of the may be involved.
  • Slowly grows in size of a palm wile acquiring thick dark hair.
  • Often lesion resembling acne vulgaris in different stages may appear on surface.
  • No treatment is required.


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