Investigations in DERMATOLOGY
Investigations in DERMATOLOGY
Editors
Sanjeev Gupta MD DNB
Professor and Head Department of Dermatology MM Institute of Medical Sciences and Research
Mullana, Ambala, Haryana, India
Rohit Batra MD
Consultant Dermatologist Sir Ganga Ram Hospital
New Delhi, India
Sumit Gupta MD
Consultant Dermatologist Sir Ganga Ram Hospital
New Delhi, India
Managing Editor
Saurabh Swaroop Gupta MD DNB
Assistant Professor Department of Dermatology MM Institute of Medical Sciences and Research Mullana, Ambala,Haryana, India
Forewords
Shyam Verma
Archana Singal

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Investigations in Dermatology / Sanjeev Gupta, Rohit Batra, Sumit Gupta
First Edition: 2023
9789354655135
Printed at:
Our Teachers
For nurturing and full-filling our academic aspirations
Our Parents
For their belongings, true affection and unconditional love
Our Wives and Children
Dr Sunita Gupta, Namya and Gauri (Sanjeev Gupta)
Dr Neha Batra, Aarna (Rohit Batra)
Dr Rhythm, Vikramaditya (Sumit Gupta)
For their understanding, forbearance, and unconditional support
Our Patients
For providing us an opportunity to serve them and learn from them
EDITORS
- Sanjeev Gupta MD DNB
- Professor and Head
- Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Rohit Batra MD
- Consultant Dermatologist
- Sir Ganga Ram Hospital
- New Delhi, India
- Sumit Gupta MD
- Consultant Dermatologist
- Sir Ganga Ram Hospital
- New Delhi, India
MANAGING EDITOR
- Saurabh Swaroop Gupta MD DNB
- Assistant Professor
- Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
CONTRIBUTING AUTHORS
- Aastha Sharma MD
- Speciality Consultant Department of Dermatology
- University Hospital of North Durham
- Durham, United Kingdom
- Ajinkya Gujrathi MD
- Senior Resident MM Medical College and Hospital
- Solan, Himachal Pradesh, India
- Akriti Gakhar MD
- Consultant Dermatologist
- New Delhi, India
- Amit Mittal MD
- Professor and Head Department of Radiodiagnosis
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Amit Soni MD DM
- Associate Professor
- Department of Gastroenterology
- Shri Guru Ram Rai Institute of Medical and Health Sciences Dehradun, Uttarakhand, India
- Aneet Mahendra MD
- Professor, Department of Dermatology, MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
- Anuradha Yadav MD
- Senior Resident Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Arushi Gakhar MD
- Consultant Dermatologist
- New Delhi, India
- Deeksha Goyal MD
- Senior Resident
- Department of Dermatology
- MM Institute of Medical Sciences and Research Mullana, Ambala, India
- Himanshu Singla MD
- Consultant Radiologist
- Singla Clinic and
- Ultrasound Centre
- Ambala, Haryana, India
- Jasleen Kaur
- Department of Dermatology MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Meghna Khatri
- Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Namya Gupta
- Kalpana Chawla Government Medical College
- Karnal, Haryana, India
- Narender Kaur MD
- Professor and Head
- Department of Microbiology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Nidhi Jindal MD
- Consultant Dermatologist
- Apollo Clinic and Oliva Skin and Hair Clinic
- Kolkata, West Bengal, India
- Pradhuman DNB
- Senior Resident
- Department of Radiology
- SGT Medical College Hospital and Research Institute
- Gurugram, Haryana, India
- Rachita Dhurat MD
- Professor and Head
- LTM Medical College
- Sion, Mumbai, Maharashtra, India
- Rohit Batra MD
- Consultant Dermatologist
- Sir Ganga Ram Hospital New Delhi, India
- Rohit Singla MD
- Associate Professor
- Department of Dermatology MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Sanjeev Gupta MD DNB
- Professor and Head
- Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Saurabh Swaroop Gupta MD DNB
- Assistant Professor Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Sumeet Pethe MD
- Consultant Dermatologist
- Suresh Vasant Pethe Skin Clinic
- Pune, Maharashtra, India
- Sumit Gupta MD
- Consultant Dermatologist Sir Ganga Ram Hospital
- New Delhi, India
- Sunita Gupta MD
- Professor and Head
- Department of General Medicine
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Udya Chauhan
- Department of Dermatology
- MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
- Vivek Singh
- Department of Dermatology MM Institute of Medical Sciences and Research
- Mullana, Ambala, Haryana, India
It is a pleasure to write this foreword for this novel book edited by three young, dynamic, well-informed dermatologists who also happen to be good friends who I have known for several years. It is indeed a bright thought to conceive the idea of such a book that deals with an aspect which is “so close and yet so far” for practicing dermatologists. Bob Dylan's famous song “The Times They Are A-Changin” rings so true here! Gone are the days when dermatology was a purely visually oriented field, practiced in a small, well-lit room with good lighting and a magnifying lens being its most important prerequisites. Advances and modernization of dermatology are invariably accompanied by the need as well as the urge to order more investigations for accuracy and documentation. Some investigations, however, are ordered or performed mechanically and out of habit. A busy practitioner juggling his time between clinical examination and procedures often does not find time to read indications and relevance for several investigations. This handy book, edited by an astute clinician–academician and two well-trained seasoned dermatologists, will meet that need of a ready reference for the busy practitioner. Authors chosen by them are hand-picked and there is no doubt that they will do justice to their topics. I congratulate the editors and the authors for conceiving and executing the writing of this ready reckoner. I truly hope that it is widely circulated and read.
Shyam Verma MBBS DVD PhD FRCP (London)
Consultant Dermatologist, Vadodara, India
Founding Editor of Indian Dermatology Online Journal
International Board Member of European Academy of Dermatology and Venereology
Vice President of International Society of Dermatology
FOREWORD
I feel privileged to write the foreword for the 1st edition of Investigations in Dermatology, edited by Drs Sanjeev Gupta, Rohit Batra, and Sumit Gupta. This book obviously fills the existing gap in the management of dermatologic patients.
Dermatology, earlier considered to be an allied medical specialty to medicine, is a very fast evolving discipline. Presence of skin lesions carries a huge psychosocial burden and should be addressed effectively and accurately. Skin lesions are amenable to visual examination, and their morphology, configuration, site of lesions, and age of onset often give a clue to varied differential diagnoses. Likewise, skin lesions are also most prone to self-medication, especially in a country where most drugs (topical or systemic) are available over the counter without prescription with resultant change in morphology and difficulty in arriving at a correct diagnosis. Thus, the final diagnosis is reached at after conducting various office or laboratory investigations. In addition, majority of skin diseases are not limited to the skin and have a systemic component or association, whose presence and extent need exploration. This fact is coupled with fast-expanding therapeutic armamentarium including immunosuppressives, biologics/biosimilar, etc., which require pretreatment/baseline and periodic laboratory monitoring.
Akin to therapeutics, diagnostic modalities are evolving very fast; some are simple and can be carried out in the office with immediate results while for others some hours to days are required. Knowledge of these laboratory tests, their right indications, and interpretation requires sound knowledge of the disease process. This book is an excellent attempt to offer comprehensive description of the rationale, procedure, and interpretation of dermatologic diseases–related office procedures and hematological, histological (including specialized tests such as direct and indirect immunofluorescence), and radiological investigations, required for the management of skin diseases. Generous use of diagrammatic representations, flowchart, and tables is a unique reader-friendly feature. This book fills an obvious gap in the management of skin diseases and seems to be a must-have book for each and every practitioner.
I congratulate all the editors for their brilliant concept and flawless execution and wish them best of luck in their academic endeavor.
Archana Singal MD FAMS
Director Professor and Head, Dermatology and STD University College of Medical Sciences and GTB Hospital, New Delhi, India
Associate Section Editor, British Journal of Dermatology
Editor Elect-IJDVL (2022)
Founding President Nail Society of India (NSI) 2012–2020
PREFACE
“Knowledge makes one humble, humility begets worthiness, worthiness creates wealth and enrichment, enrichment leads to right conduct, right conduct brings contentment.”
Skin diseases are considered to be the mirror image of internal diseases. Although most of the skin diseases are usually diagnosed by simple visual inspection, yet laboratory investigations are required in several clinical circumstances. Various systemic and internal disorders manifest in the skin directly and indirectly; therefore, we require a number of investigations to rule out or confirm the diagnosis. Investigations in dermatology may be necessary to make a diagnosis or to reassure the patient that there is nothing more sinister underlying their skin manifestation. Because of advancement in understanding of etiopathogenesis of various diseases of dermatology and internal medicine and introduction of biologics, the need of various investigations has tremendously increased in the recent past. It is the moral and ethical duty of treating doctors to have better understanding and knowledge of basic interpretation of all the investigations, rather than referring to other specialties.
After so many years in the field, we realized that there was a sparsity of one dedicated book which covered all the investigations required in clinical practice. So, we tried to accept this challenge and are hence presenting you our book on investigations. Welcome to our book “Investigations in Dermatology”. This book will throw light and enlighten the readers with interpretation, usefulness, and limitation of all diagnostic procedures used in dermatology and internal medicine.
The book is illustrative with multiple figures and flowcharts and also includes salient features and summary at the end of each chapter. It will not only be of practical importance for dermatologists but will also provide great benefit to all undergraduate and postgraduate students, internists, and family practitioners practicing in India as well as worldwide.
We thank all contributors for finishing this herculean task in time. It has been a pleasure and vast learning experience with an excellent team of authors and editorial board members. We would also like to thank our patients and students who directly and indirectly motivated us to accept this challenge. We will be failing in our duty if we do not thank our family who supported, motivated, and tolerated us for stealing their precious family time.
Special thanks to publisher Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr MS Mani (Group President), Dr Richa Saxena (Associate Director—Professional Publishing), Ms Pooja Bhandari (Production Head), Ms Upasana Kak (Development Editor), and all members of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for invaluable contribution.
Happy reading!
Sanjeev Gupta
Rohit Batra
Sumit Gupta