A 32-year-old schoolteacher from Jaipur has symmetrical, light-brown, blotchy patches on both cheeks, the bridge of the nose and the upper lip for 2 years. They darken every summer and began while she was taking combined oral contraceptives. The patches are neither scaly nor itchy. Which treatment is most appropriate first?

Triple combination cream with daily sunscreen

Topical ketoconazole cream for 4 weeks

Monobenzone cream to the patches

Potent topical steroid cream for months

Pigmentary, hair, nail disorders and skin signs of systemic disease

10 NEET-PG practice questions on Pigmentary, hair, nail disorders and skin signs of systemic disease, part of Dermatology. The first 10 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 32-year-old schoolteacher from Jaipur has symmetrical, light-brown, blotchy patches on both cheeks, the bridge of the nose and the upper lip for 2 years. They darken every summer and began while she was taking combined oral contraceptives. The patches are neither scaly nor itchy. Which treatment is most appropriate first?
1. ATopical ketoconazole cream for 4 weeks
2. BMonobenzone cream to the patches
3. CPotent topical steroid cream for months
4. DTriple combination cream with daily sunscreen
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Answer: D · Triple combination cream with daily sunscreen
Symmetrical brown macules on the cheeks, nose and upper lip, worsened by sunlight and linked to hormones, are melasma. Strict daily broad-spectrum sunscreen is essential, and the first-line topical treatment is a triple combination cream of hydroquinone, tretinoin and a mild steroid such as fluocinolone, used for a limited period. Oral contraceptives are stopped if possible. Long-term use of potent steroid creams, sold widely in India as 'fairness' creams, causes a steroid-damaged face with atrophy, telangiectasia and rebound pigmentation.
- A: Ketoconazole treats pityriasis versicolor, a scaly fungal infection.
- B: Monobenzone permanently destroys melanocytes and is reserved for depigmenting extensive vitiligo.
- C: Months of potent steroid on the face cause atrophy, telangiectasia and acneiform eruptions.
Question 2 · Medium
A 36-year-old woman with generalised vitiligo for 5 years comes to the OPD with tiredness, constipation, weight gain and dry skin. Her pulse is 58/min. Which associated disorder is most likely?
1. AType 1 diabetes mellitus
2. BAutoimmune hypothyroidism
3. CPernicious anaemia
4. DAddison disease
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Answer: B · Autoimmune hypothyroidism
Vitiligo is an autoimmune disease, and autoimmune thyroid disease, mainly Hashimoto thyroiditis, is its commonest associated disorder. Tiredness, constipation, weight gain, dry skin and bradycardia point to hypothyroidism, so TSH and anti-TPO antibodies are checked; many dermatologists check thyroid function in every patient with vitiligo. Addison disease, pernicious anaemia, type 1 diabetes and alopecia areata are less common associations.
- A: Type 1 diabetes presents with thirst, polyuria and weight loss.
- C: Pernicious anaemia causes tiredness and neuropathy but not weight gain, constipation or bradycardia.
- D: Addison disease causes weight loss, hypotension and hyperpigmentation, not weight gain and bradycardia.
Question 3 · Easy
A 24-year-old woman has milky-white, sharply defined patches around her mouth and on the backs of her fingers, with white hairs within some patches. Sensation over the patches is normal and there is no scaling. Under a Wood's lamp the patches look chalky bright white. What is the most likely diagnosis?
1. APityriasis alba
2. BVitiligo
3. CPityriasis versicolor
4. DIndeterminate leprosy
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Answer: B · Vitiligo
Completely depigmented, milky-white patches with sharp borders in typical periorificial and acral sites, with white hairs (leukotrichia), are vitiligo, caused by autoimmune destruction of melanocytes. Under a Wood's lamp the absence of melanin makes the patches stand out chalky white, which separates them from hypopigmented conditions and shows early lesions on fair skin. Leukotrichia means follicular melanocytes are lost and predicts a poorer response to medical treatment.
- A: Pityriasis alba gives ill-defined, hypopigmented, finely scaly patches on a child's face.
- C: Pityriasis versicolor gives fine scaly macules that may show yellowish fluorescence under a Wood's lamp.
- D: Leprosy patches are hypopigmented, not depigmented, and usually show reduced sensation.
Question 4 · Medium
A 28-year-old woman comes 3 months after a normal delivery, alarmed that handfuls of hair come out when she combs or washes it. The scalp shows diffuse thinning without bald patches, scaling or scarring. A gentle pull test removes 8 hairs, each with a small white bulb at the root. What is the most likely diagnosis?
1. ATelogen effluvium
2. BDiffuse alopecia areata
3. CAnagen effluvium
4. DFemale pattern hair loss
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Answer: A · Telogen effluvium
A trigger such as childbirth, high fever (for example typhoid or dengue), crash dieting or major surgery pushes many anagen follicles into telogen together, and the hairs shed about 2-3 months later as club hairs with a white bulb. This is telogen effluvium, which is diffuse and non-scarring. Postpartum telogen effluvium recovers by itself over months, so reassurance, with a check of iron stores and thyroid function, is usually enough.
- B: Diffuse alopecia areata shows exclamation mark and dystrophic hairs, not club hairs.
- C: Anagen effluvium follows chemotherapy within days to weeks, with broken, tapered hairs.
- D: Female pattern hair loss is a gradual widening of the central parting over years, without sudden shedding.
Question 5 · Easy
A 9-year-old boy is brought with a single round, smooth, completely bald patch on the scalp noticed 3 weeks ago. The skin is normal-looking, without scaling, redness or scarring, and at the margin there are short broken hairs that taper towards the scalp. What is the most likely diagnosis?
1. ATrichotillomania
2. BAlopecia areata
3. CTinea capitis
4. DDiscoid lupus erythematosus
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Answer: B · Alopecia areata
A smooth, non-scarring, non-scaly bald patch with exclamation mark hairs (short hairs that narrow towards the scalp) at the margin is alopecia areata, an autoimmune T-cell attack on anagen hair follicles. The pull test at the margin is often positive in active disease, and nail pitting may coexist. Many single patches regrow on their own, and intralesional or potent topical steroids are used for limited disease.
- A: Trichotillomania leaves irregular patches with broken hairs of varying lengths, not tapering hairs.
- C: Tinea capitis gives scaling, black dots or inflammation, often with enlarged nodes.
- D: Discoid lupus causes scarring alopecia with atrophy, follicular plugging and pigment change.
Question 6 · Medium
A 15-year-old boy with a BMI of 32 kg/m2 is brought by his mother, who has been scrubbing his neck because it 'looks dirty'. His neck and axillae show symmetrical, velvety, dark brown thickened skin with skin tags. His father has type 2 diabetes. What is the mechanism of the skin change?
1. AHigh insulin stimulating IGF-1 receptors in skin
2. BDermatophyte infection of moist skin folds
3. CACTH acting on melanocortin receptors in skin
4. DDeposition of iron in the upper dermis
Answer and explanation in LearnFree account
Question 7 · Medium
A 26-year-old man has had vitiligo limited to his hands for years, but over the last 3 months new white patches have appeared every week, with confetti-like white spots and new lesions along scratch marks. Which treatment is most appropriate first?
1. AOral mini-pulse corticosteroid therapy
2. BTopical hydroquinone cream
3. CSuction blister epidermal grafting
4. DMonobenzone depigmentation therapy
Answer and explanation in LearnFree account
Question 8 · Medium
A medical intern on a ward round in Nagpur examines the fingernails of four patients and records these pairs of nail sign and condition: 1. Koilonychia: iron deficiency anaemia 2. Beau's lines: a severe illness a few months earlier 3. Half-and-half nails: chronic liver disease 4. Splinter haemorrhages: infective endocarditis. Which pairs are correctly matched?
1. A1 and 2 only
2. B1, 2, 3 and 4
3. C2, 3 and 4 only
4. D1, 2 and 4 only
Answer and explanation in LearnFree account
Question 9 · Hard
A 56-year-old woman from Chennai has had difficulty climbing stairs and combing her hair for 2 months. She has a violet-red rash with swelling of both upper eyelids, flat-topped red papules over the knuckles, and a red rash over her upper back and shoulders. CK is 2,800 U/L (reference below 170 U/L). Apart from starting treatment, which evaluation is most important for her?
1. AScreening for an underlying malignancy
2. BTesting for HLA-B*58:01 carriage
3. CThyroid function tests for myxoedema
4. DPatch testing for a contact allergen
Answer and explanation in LearnFree account
Question 10 · Hard
A 38-year-old woman with weight loss, palpitations and tremor for 6 months has bilateral proptosis with lid retraction. On the front of both shins there are firm, non-pitting, raised, skin-coloured to yellowish-brown plaques with a peau d'orange surface. TSH is below 0.01 mIU/L. What is the mechanism of the shin lesions?
1. ALipid-laden macrophages in the dermis
2. BGlycosaminoglycan deposition by stimulated fibroblasts
3. CHaemosiderin deposition from venous stasis
4. DPalisading granulomas around degenerated collagen
Answer and explanation in LearnFree account

Pigmentary, hair, nail disorders and skin signs of systemic disease

A 36-year-old woman with generalised vitiligo for 5 years comes to the OPD with tiredness, constipation, weight gain and dry skin. Her pulse is 58/min. Which associated disorder is most likely?

A 9-year-old boy is brought with a single round, smooth, completely bald patch on the scalp noticed 3 weeks ago. The skin is normal-looking, without scaling, redness or scarring, and at the margin there are short broken hairs that taper towards the scalp. What is the most likely diagnosis?

A 15-year-old boy with a BMI of 32 kg/m2 is brought by his mother, who has been scrubbing his neck because it 'looks dirty'. His neck and axillae show symmetrical, velvety, dark brown thickened skin with skin tags. His father has type 2 diabetes. What is the mechanism of the skin change?

A 26-year-old man has had vitiligo limited to his hands for years, but over the last 3 months new white patches have appeared every week, with confetti-like white spots and new lesions along scratch marks. Which treatment is most appropriate first?