Investigations in Dermatology Sanjeev Gupta, Rohit Batra, Sumit Gupta, Saurabh Swaroop Gupta
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdominal pain 57, 146
Acanthosis nigricans 131
Acebutolol 109
Acetaminophen 50
Acetazolamide 34
Acetone 6
Acid
bile 64
ethylenediaminetetraacetic 25, 153
fast bacilli 7f, 8f
hyaluronic 55
hydrochloric 26
nalidixic 67
serum uric 44
uric 42
Acidic pH 34
Acidic polysaccharides 3
Acidification test 43, 45
Acne 132, 138
vulgaris 159
Acrochordons 131
Acrocyanosis 27
Acrodermatitis enteropathica 158
Acute symptomatic hyponatremia, treatment of 45
Acute toxicity, causes of 157
Addison's disease 107, 129, 134
Adenine dinucleotide phosphate 67
Adenosine triphosphate 152
Adrenal cancers 126
Adrenal hyperplasia, congenital 123
Adrenal insufficiency, secondary 129
Adrenocorticotropic hormone 128
stimulation test 129
Adrogue–Madias formula 45
Alanine
aminotransferase 60
transaminase 49, 50
Albumin 52, 53
liver's production of 52
underproduction of 53
Albumin:globulin ratio 53
Alcian blue 5
Alcohol 6
consumption 113
Alkaline phosphatase 53, 54
Alkaptonuria 35
Allergens 18
storage of 19
Allergic diseases 142
diagnosis of 144
Allergic reaction 143f
pathophysiology of 141f
Allopurinol 103
Alopecia 157
areata 159
Amenorrhea 122
Amino acid metabolism 49
Amiodarone 75
therapy 75
A-mode 162
Amoxicillin 155
Amyloidosis 41
Amyopathic disease 110
Anal intercourse 100
Androgen production 122t
Androgenetic alopecia 134
Anemia 26, 28
symptoms of 26
type of 26
Anesthesia 13
Angry back reaction 19
Anorchia 99
Anovulatory infertility 121
Antacids 154
Antibiotics 155
Antibody 15, 88, 101, 107, 108t
antimitochondrial 101, 103
antineutrophil cytoplasmic 101, 103
antisperm 97
levels of 87f
myositis-associated 109
myositis-specific 110
nonspecific 87
ribonucleoprotein 108
smooth muscle 55
specific 88
tests for 77, 78t
types of 87
Anti-CCP antibody test, use of 117
Anticentromere 109
Antichromatin antibodies 103, 104
Anti-citrullinated peptide antibodies 117
Anti-cyclic citrullinated peptide 117
Antidiuretic hormone 35
Antigen 15, 59
test for 80
Antigen-antibody reaction 79
Anti-hepatitis B core 59
Antihistamines 155
Antihistone antibodies 109
Antihuman immunodeficiency virus, generation of 78t
Anti-inflammatory
actions 112
drugs 50
Anti-Müllerian hormone 130
levels, interpretation of 130, 130t
Antinuclear antibody 55, 102, 104, 105, 105t, 106, 106t
negative systemic lupus erythematosus 107
sensitivity 107
Antioxidant 68
role 138
Antiphospholipid antibodies 102
testing, indications for 103
Anti-Smith antibodies 108, 109
Antithyroid
autoantibodies 73
peroxidase antibodies 73
Antitopoisomerase 109
Antivirals 155
Anxiety 35
Aortitis 92
Aphthous stomatitis, recurrent 161
Aplastic anemia 23, 24
Apomorphine 75
Apoptosis 101
Aquagenic pruritus 27
Arrhythmias 153
Arteriogenic erectile dysfunction 122
Arteriovenous malformation 165
Arteritis 28
Artifacts 37
Artificial insemination by donor 99
Aspartate
aminotransferase 49
transaminase 49
Asthenospermia 122
Asthma 22
symptoms 141
Atenolol 109
Atopic dermatitis 139, 142
Atopic eczema 23
Atrophic thyroiditis 73
Auto-antibodies 105t
Autoantigens 101
Autoimmune
connective tissue disease 101, 108t
disease 42, 106
disorders 22
hemolytic anemia 25, 107
hepatitis 60, 103, 107
Autoimmunity 101
Auxochrome 3
Azathioprine 51, 70, 71
doses of 71t
metabolism of 70, 70f
Azithromycin 155
Azoospermia 97, 99t
causes of 99
B
Bacillus
anthracis 6
cereus 6
Bacteria 37
capsule of 5f
culture, drop of 3
types of 112
Bad cholesterol 63, 65
Basal cell carcinoma 164
Basopenia 23
Basophils 23
B-cells 101
Bed side tests 1
Behçet's disease 161
Behçet's syndrome 22
Bile duct 53
Biliary cirrhosis, primary 103
Bilirubin 51, 52t
normal levels of 51t
Bilirubinuria 35
Biopsy
complications of 14
excisional 14
incisional 14
shave 13
site 12
Bladder infection 35
Blood
accounts 21
coagulation tendency 53
sugar 30
tests 98
transfusion 69
urea nitrogen 43
vessel disease 62
Blood cells 21, 41
methods of examination of 21
normal count of 21b
Blood glucose 30, 133f
level 30, 131
B-mode 162, 166
ultrasound 167
Body mass effect 112
Bone
marrow failure 24
tissues 53
Breath, shortness of 68
Bright field microscope 2t, 86f
Budd–Chiari syndrome 61
Budding yeast cells 10f
Bullous disease 47
chronic 11, 12
Bullous disorders 11t
Bullous pemphigoid 11, 23, 139, 142, 161
Bundle of cigar appearance 8
Burns, severe 25
C
Calcific uremic arteriolopathy 47
Calcinosis 106, 109, 111
Calciphylaxis 47
Calcitonin 72, 149, 150
Calcium 36
channel blockers 35
homeostasis 149
Candidiasis 10f
Capillary blood glucose 30
Captopril 109
Carbamazepine 109
Carbohydrate 67, 152
metabolism 49
Cardiolipin 88, 101
antigen 88
Carotid ultrasonography 167
Casts 37
Celiac disease 154
Cell
carcinoma 138
kinds of 21
Central and peripheral tolerance 102f
Cephalexin 155
Cerebral vein 113
Cerebrospinal fluid examination 92
Ceruloplasmin 53
Chicken pox 23
Chloramphenicol 67
Chloroquine 67
Chlorpromazine 75
Cholecalciferol 136
Cholesterol 62, 62t, 64, 88
Choline chloride 90
Chromophore 3
Chronic disease, anemia of 25, 146
Chronic kidney disease, prevalence of 42
Chvostek sign 153
Ciprofloxacin 103, 155
Cirrhosis 52
nephrotic syndrome 45
Citrulline 117
Clearance test 43
Clearing agent 2
Clostridium perfringens 6
C-mode 162
Cockcroft–Gault formula 43
Colchicine 67
Color Doppler sonography, indications for 168
Common connective tissue disorders 111t
Common dermatological disorders 12t, 17t
Complete blood counts 77
Computed tomography 99, 168
scan 122, 168
Condom collection 94
Connective tissue 5, 42
diseases 106, 111
disorder 105t, 110
autoantibodies in 101
Contact dermatitis 158
Coolen's method 128
Coomb's test 68
Corticosteroids 51, 126
Cortisol 127, 128b
levels 128
production, disorders of 128
Cortisol-binding globulin 128
Cosmetology 164
Cotrimoxazole 67
COVID-19 112
Cowper's glands 94
C-reactive protein 112, 117
clinical importance of 113
elevated levels 113
factor affecting 112
functions of 112
methods for detection of 113
mild elevation of 113
normalization of 113
Creatinine 42
Crohn's disease 154
Cryoglobulinemia, mixed 61
Cryptorchidism 99
Cushing's disease 128
Cushing's syndrome 31, 35, 66, 128, 131
Cutaneous ageing 160
Cutaneous antimicrobial effects 137
Cutaneous innate immunity 137
Cutaneous leishmaniasis 159
Cutaneous lupus erythematosus, subacute 111
Cutaneous neurofibromas 165
Cutaneous ulcers 160
Cutaneous wounds 160
Cyanomethemoglobin 26
Cyclosporine 31, 41, 48, 51, 66
Cytohistopathological examination 1
Cytohistopathological investigations 1
D
Dapsone 33, 67
Dehydration 2, 36
Dehydroepiandrosterone sulfate 122, 123
Delavirdine 155
Deoxyribonucleic acid 57, 59, 107, 111, 138, 156
double stranded 106
Deranged renal function 71
Dermal melasma 16
Dermatological disorders 47, 158t
Dermatological indications 164
Dermatology 23, 26, 29, 31, 33, 56, 128b, 142
Dermatomyositis 107, 109, 110, 163
Dermatosis, acquired perforating 47
Diabetes 34, 39, 50
control, tight 30
mellitus 42, 154
type 1 107, 132
type 2 132
Diarrhea 36, 45, 57
Diffusion weighted imaging 170
Diltiazem 109
Dilution test 44
Direct antiglobulin test 68
Direct immunofluorescence 15
Disopyramide 109
Distal lower extremities 13
Diuretics 35
Dopamine
agonists 75
antagonists 75
Doppler effect 166
Doppler ultrasonography, classifications of 166
Doppler ultrasound 166
Doxycycline 155
D-penicillamine 103
Dry mount 3
preparation 3f
Dysarthria 45
Dyslipidemia 64
Dysphagia 45
E
Eating disorder 119
Ebstein–Barr virus 57
Eczema 140, 158
Ejaculate volume 97
Ejaculation, part of 94
Electron microscopy 2
mounting 2
staining 3
Emesis 36
End-diastolic velocity 168
Endocrine disorders 22
Endocrinological functions 157
Endogenous synthesis 136t
Endoplasmic reticulum 151
Enzyme 67
immunoassays rapid tests 85
level of 71
name of 50
Enzyme-linked immunosorbent assay 77, 78, 105, 116
Eosin stain 5
Eosinophil 22
chemotactic factor 143
Epicutaneous test 20
Epidermal melasma 16
Epidermis 163
Epidermolysis bullosa acquisita 12
Epididymal dysfunction 99
Epididymal extraction 94
Epididymis 97
Epiphysis 124
Epithelial cells 37
Epithelial tumors 2
Erectile dysfunction 122, 134, 157, 167
evaluation of 167
Ergocalciferol 136
Erythema 18, 135
Erythroblastosis fetalis 29
Erythrocyte sedimentation rate 27
measurement of 27
micro 28
stages in 27
Erythroderma 31, 38
Erythromelalgia 27
Erythromycin 51
Esomeprazole 154
Esophageal dysmotility 106, 109, 111
Estimated glomerular filtration rate 43
Estrogen 66, 126
intake 24
Ethanol 126
Eukaryotic chromatin 103
Euvolemic hyponatremia 45
Excessive sweating 36, 154
Excited skin syndrome 19
Extracellular portion 152
Extractable nuclear antigens 104, 107, 108
F
Fabry's disease 2
False negative
reactions 19
results 89
False positive
reaction 19
results 89
Fasting
blood glucose 31
effect of 64
Fat
excretion of 65
metabolism 65f
Fat-transport pathways
endogenous 64
exogenous 64
Favism 67
Female athlete triad 119
Ferritin
causes of high 146
levels, estimation of 147
Fibro test 55
Fibroblast adipocytes 112
Fite-faraco stain 8
Fluconazole 51
Fluid attenuated inversion recovery 170
Fluoroquinolones 67
Folic acid deficiency 24
Follicle stimulating hormone 95, 98t, 99, 118-120
Folliculitis decalvans 159t
Food and drug administration 71
Frank proteinuria 44
Free androgen index 127
Free hormone levels 73
Freshly-ejaculated semen 94
Friedewald's equation 62
Fungal examination 9
Fungal hyphae 10f
G
Gadolinium 171
Galactorrhea 122
Gamma-glutamyl transferase 54
Gastrointestinal tract 138, 147, 154
Genotypic test 71
Genotypic variations, diversity of 71
Gianotti–Crosti syndrome 61
Giemsa's stain 4, 4f, 11f
Globulin 52, 53
overproduction of 53
Glomerular filtration rate 43
Glomerular function, test for 42
Glucocorticoid
hormone 127
therapy 127
Glucose infusion, rate of 132
Glucose tolerance test 133, 134
Glucose-6-phosphate dehydrogenase 67
deficiency 67
symptoms of 67
test 69
Glucosuria, dipstick test for 37t
Glycemia 33, 134
Glycogenolysis 124
Glycoproteins, large 101
Glycosylated hemoglobin 32
Gonadal suppression therapy 119, 120
Gonadotroph receptor mutations 127
Gonadotropin
deficiency 120
secretion 126
Gonadotropin-releasing hormone 95
agonists 99
Goodpasture syndrome 41
Graft-versus-host disease 113
Gram negative
bacilli 6f
organism 6
Gram positive
cocci 6f
organism 6
Gram's iodine 6
Gram's stain 4f, 6, 6f
Granulomatous infections, chronic 69
Grocott's methenamine silver staining 5
Gumma 92
H
Hailey–Hailey disease 11
Hair
changes 47
follicle cycling 137
loss 138
Haloperidol 75
Hanging drop preparation, steps for 3f
Haptoglobin 68
Hashimoto's thyroiditis 73, 107
Health effects 124
Heart failure, congestive 45, 50
Heavy enzyme defects 69
Heavy metal poisoning 41
Heinz bodies 68
HELLP syndrome 23
Hemangioma, infantile 165
Hematology 21
Hematoxylin 5, 5f
Hematuria, microscopic 38
Hemochromatosis 99, 146-148
Hemoglobin 25
measurement of 25
Hemogram 44
Hemolysis, symptoms of 68
Hemolytic anemia 27, 32
Hemolytic jaundice, risk factors for 52
Hemospermia 96
Henoch–Schönlein purpura 23
Hepatic causes 51
Hepatic fibrosis, tests to detect 55
Hepatitis 57
A virus 57
acute 57
B 58, 59f, 59t, 61
core 59
surface 59
virion 58f
virus 58, 59
B e 59
antigen 59
C 60, 61
clinical features 60
laboratory diagnosis 60
prophylaxis 60
treatment 60
virus 116
chronic 57
markers 57
signs 57
symptoms 57
Hepatotoxic drugs 56
Hereditary spherocytosis 25, 68
Herpes simplex 11
recurrent 159
Hidradenitis suppurativa 132, 159, 164
High follicle-stimulating hormone levels 120
High-density lipoprotein 62, 65
levels, interpretation of 63t
Hives 140
Hodgkin's lymphoma 23
Homeostasis model assessment 132
Homeostatic iron regulator 55
Homogenous 106f
Hormonal investigations 118
Human blood glucose 30
Human immunodeficiency virus 23, 76, 79
confirmatory tests 79
diagnosis 81
indications of 76
positive 76
pretest counseling 76
principles of 78
rapid tests 79
screening tests 78
testing approaches 77
tests 81
Hydralazine 67, 103, 106, 109
Hydroxylation 135
Hypercalcemia 35, 150
causes of 150
childhood 151
Hypercholesterolemia 64
Hypercortisolism
primary 128
secondary 128
Hyperglycemia
drugs causing 31
persistent 31
transient 31
Hypergonadotropic hypogonadism 126
Hyperinsulinemic-euglycemic glucose clamp 132
Hyperkalemia 46
treatment of 46
Hypernatremia 46
causes of 46
signs 46
symptoms 46
treatment 46
Hyperprolactinemia 119–121, 122f, 127
Hypertension 39, 42
Hyperthyroidism 31, 73
signs 73
skin 74
symptoms 73
Hypertriglyceridemia 64
Hypervolemic hyponatremia 45
Hypoandrogenism 122
Hypocalcemia 150
causes of 150
transient 31, 150
Hypocortisolism
primary 129
secondary 129
Hypoechoic subcutaneous tissue 162
Hypoglycemia, persistent 31
Hypogonadism 119, 120
Hypogonadotropic hypogonadism 126
Hypokalemia 47
symptoms of severe 47
Hyponatremia 45, 47
signs of 45
symptoms of 45
Hypopituitarism 119, 120
Hypothalamic pituitary disorders 99
Hypothalamic suppression 119, 120
Hypothalamus 129
Hypothyroidism 24, 73
amiodarone-induced 75
congenital 75
signs 73
symptoms 73
Hypovolemic hyponatremia 45
I
Ichthyotic disorders 139
Idiopathic thrombocytopenic purpura 107
Immune
deposits, sites of 15t
regulation, multiple levels of 101
stimulus 101
Immunity 101
Immunizations 89
Immunobullous disorders 15t
Immunofluorescence test 14
Immunoglobulin 52
A 15
E 140-144
causes of 142
level 142t
M, formation of 87
Immunohistochemistry 2, 16
In vitro fertilization 99
Inadequate porphyrin metabolism 35
Indirect immunofluorescence 16
Infections 28
Infectious disease 164, 165
Infectious mononucleosis 50
Infertility 134
Inflammatory disease 164
Insulin 133
levels 133f
normal range 132
sensitivity, quantitative 133
Insulin resistance 131, 133f
causes of 131
risk factors of 131
symptoms of 131
Insulin test 132
interpretation 132
Intercellular junctions 2
Interferon 109
alpha 51
synthesis of 121
Internal organ thrombosis 103
Interstitial lung disease 110
Intestines 53
Intracytoplasmic sperm injection 98
Iodine-containing drug 75
Iritis 92
Iron 145
deficiency anemia 33
overload, causes 146
profile, tests in 146t
Isotretinoin 51
Itchy eyes 140
J
Jaundice 35, 51, 56, 68
clinical 51
hemolytic 52
pathological 51
posthepatic 51
prehepatic 51
Job–Chacko modification 9
K
Kallmann syndrome 99, 119, 120, 127
Keratinocyte differentiation 151
Ketoconazole 51, 126
Kidney 42, 53
disease 28, 29, 35, 44
function 39
Kinetoplast 107
Klinefelter syndrome 99
Koilonychia 27
L
Laboratory testing cortisol assays 128
Lactate dehydrogenase 68
Lamivudine 155
Laxative, chronic 154
Lecithin 88
cholesterol acyltransferase 64, 65
Leishmaniasis 116
Lepra bacilli, morphology of 12f
Leprosy 160
peripheral nerves in 165
Leptin receptor mutations 127
Leukocyte alkaline phosphatase 54
Leukocytoclastic vasculitis 61
Leukopenia 77
Levofloxacin 155
Libido, loss of 122
Lichen planus 61
Lindsay's nails 47
Lipid
metabolism 64
profile 62, 66
Lipoprotein 62
composition of 63f
intermediate-density 64, 65
very low-density 65
Liquid chromatography 128
Lithium 35
Live spermatozoa 97t
Livedo reticularis 27, 103
Liver 53
biopsy 55
disease 24
dysfunction 53, 56
enzymes 50t, 68
failure, acute 57
function
disturbed 55t
tests 49
proteins 53t
Lovastatin 109
Low creatinine 44
Low ferritin levels, causes of 145
Low follicle-stimulating hormone levels 120
Low reticulocyte count 29
Low semen volume, causes of 96
Low serum albumin 28
Low-density lipoprotein 62, 63, 65
levels, interpretation of 64t
Lupus 28
erythematosus 12, 108, 111
Luteinizing hormone 95, 98t, 99, 118, 120
levels 118, 119
secretion 118
Luteotropic hormone 121
Luteotropin 121
Lutropin alfa 120
Lymphatic malformation 165
Lymphocytes 22, 101
Lymphocytic leukemia, chronic 24
Lymphocytopenia 23
Lymphocytosis 22
Lymphoma 28
M
Macrocytic anemia 25
Magnesium 152
and skin conditions 155
common food sources of 152t
congenital 154
deficiency
signs of 153
symptoms of 153
extracellular 152
levels, reduce 154
sources of 152
toxicity
signs of 153
symptoms of 153
Magnetic resonance
angiography 171
imaging 99, 122, 170, 170f
Malachite green 6
Malaria 89
Masson trichrome 5t
Masturbation 94
Mean corpuscular hemoglobin 24
Mean corpuscular volume 24
Medicine, complementary and alternative 55
Megaloblastic anemia 29
Melanin 35
Melanocyte stimulating hormone 128
Melanocytic tumors 35
Melanoma 164
color Doppler in 164
Melasma 160
type of 16
Mercaptopurine 70
Metabolic alkalosis 34
Methemoglobinemia 68
Methotrexate 51
Methyl dopa 67
Methylating enzyme 70
Methylene blue 4, 4f, 7, 67
Methylmercaptopurine 70
Methyl-thioinosine monophosphate 70
Michel's medium 15
Microscopy 1
dark field 2t, 86, 86f, 87f
dark ground 1, 2f
optical 1
Minocycline 103, 155
Miscarriages, recurrent 103
Mixed-deficiency 25
M-mode 162
Molluscum contagiosum 159t
Monkey esophagus 16
Monocytes 23
Monocytopenia 23
Morphea 164
Motility 96
Mount
dry 3
prepared 3
wet 2
Mounting, types of 2
Multicellular worms 142
Multiple myeloma 28, 41, 53
Multiple sclerosis 170
Mycobacteria 7
Mycobacterium tuberculosis 8
Myelodysplastic syndrome 24, 29
Myeloid leukemia, acute 23
Myocardial infarction 49
Myoglobinuria 35
Myositis, antibodies with 110t
N
Nail 9, 164
changes 47
dystrophy 157
Naphthalene 67
Nausea 57
Necrolytic acral erythema 160
Necrolytic migratory erythema 160
Necrosis 103
Nelson's syndrome 129
Neomycin 18
Nephrogenic fibrosing dermopathy 47
Nephropathy, contrast-induced 169
Neurological function 157
Neutral stain 4f
Neutrophil 22
chemotactic factor 143
urticarial dermatosis 22
Nevus, benign 165
Nichols strain 90
Nitrites 36
Nitrofurantoin 67
Nonhistone proteins 104
Nontreponemal test 85, 88
Normal prolactin values 121t
Normal skin 163
Nucleic acid 3, 80
amplification testing 81
Nucleotidase enzyme 55
Nutritional anemia 27
deficiency 29
O
Obstructive uropathy 42
Ochronosis 35
Oligomenorrhea 121
Oligospermia 97, 99t
causes of 99
Oligozoospermia 122
Omeprazole 154
Oracol swabs 92
Oral contraceptives 66
Oral fluid test 92
Oral glucose tolerance test 31
Orchitis 97
Osteomyelitis, chronic 116
Ovarian cancers 126
Ovulation, detection of 119
Oxidative phosphorylation 152
P
P24 antigen 80
Pantoprazole 103, 154
Papule 18
Para-aminohippuric acid 43
clearance test 44
Paracetamol 50
Paralysis 45
Paraneoplastic syndromes 36
Parasites 37
Parasympathetic nervous system 128
Parathyroid hormone 149-151
Patch test 1, 17
allergens, application of 17f
material 18
open 19
photopatch 19
principle of 18
procedure 17, 18
results 19
semi-open 19
types of 19
units 18
vehicles 18
Peak systolic velocity, estimation of 168
Pemphigus 11, 38
foliaceus 11
vulgaris 139
Penile ultrasonography 167
Peptide hormone 131
Peptidyl arginine-deaminase 117
Periodic acid-Schiff 5
Perl's prussian blue 5
Pernicious anemia 24, 146
Peyronie's disease 167, 168
pH, causes of 96
Phenolic substances 35
Phenols 35
Phenothiazines 20
Phenytoin 109
Phosphates 36
Phospholipid 101
Physics 170
Pilonidal cyst 165
Pinta 91
Pituitary adenoma 129
Pituitary tumor 129
Pityriasis versicolor 158
Placenta 53
Plasma 21, 31
glucose levels 32t
Platelets 21, 23
cytoplasmic morphology of 4
Plethora 27
Poikiloderma 22
Polyangiitis, microscopic 103
Polyarteritis nodosa 61
Polycystic ovarian
disease 165
syndrome 119, 123, 126, 130
Polycythemia 24, 27
Polymerase chain reaction 80, 86
role of 80
Polymyalgia rheumatica 28
Polymyositis 107, 110
Porphyria cutanea tarda 47, 61, 146
Postejaculate urinalysis 95
indications of 96
Postprandial glucose 30
Potassium 36
hydroxide 3
smear 9
Pre-diabetics 133f
Pre-eclampsia 41
Pregnancy 89
Premature ejaculation 122
Priapism 168
Primaquine 67
Primary testosterone deficiency 127
Probenecid 67
Procainamide 67, 106, 109
Progestins 126
Prolactin 98t, 121
Proliferative disorders 151
Propafenone 109
Propylthiouracil 103, 109
Protein 5, 37
acute-phase 112
Proteinuria 38, 39, 41, 40t, 44
dipstick test for 37t
Prothrombin time 53
Proton pump inhibitors 154
Pruritus 61
Pseudohyperkalemia 46
Pseudohyphae 10f
Psoralens 20
Psoriasis 61, 132, 138, 165
Psoriatic arthritis 117
Psychogenic polydipsia 36
Pubic region 148
Punch biopsy 13
Purpura 103
Pyoderma gangrenosum 22, 27
Pyridoxine 75
Pyruvate kinase deficiency 68
Pyuria 34
Q
Qualitative test 68, 88
Quantitative test 68, 89
R
Radioallergosorbent test 142, 142t
Radiofrequency, pulses of 170
Radiology 162
Rape 100
Rapid plasma reagin test 90
Raynaud's phenomenon 106, 109-111
Red blood cell 4, 21, 22, 32, 33, 36, 41, 51, 67, 71
abnormalities 28
Red cell
distribution width 25
indices 24
types 24
Regional enteritis 154
Reiter's syndrome 121
Renal disease 34, 47
causes of 42
indicators of 44
Renal failure 45, 154
Renal function tests 42
Renal stones 169
Repeat open application test 20
Respiratory alkalosis 34
Reticulocyte count 29
high 29
Retinoids 66
Rhabdomyolysis 35
acute 50
Rheumatoid arthritis 28, 106, 115, 116, 121
Rheumatoid factor 115, 117
Ribavirin 33
Ribonucleic acid 106
single-stranded 57
Ribonucleoprotein 107
Rosacea 138
Rythema 163
S
Safranine 6
Sahli's hemoglobinometer 26
Sahli's method 26
Salicylate 34
Salt split technique 16
Sarcoidosis 163
Sarcoptes scabiei var hominis 10f
Satellite lesions, detection of 164
Scabies
mite 10f
scraping for 10
Scalp 9
Sclerodactyly 106, 111
Scleroderma 109, 110t, 113
disease, severe 109
Scybala 10
Seborrheic dermatitis 158
Semen 94, 100
collection 94
detection of 100
fructose testing 97
microscopy examination 96
samples 98
specimen, quality of 94
volume, high 96
Semen analysis 94, 100
computer-assisted 98
indications for 94
limitation of 99
Seminal vesicles 94
hypofunction of 122
Serologic tests 87, 91
Serum 31, 89
alkaline phosphatase 54t
aminotransferases, low levels of 50
analysis 44
calcium 149, 150
and skin 151
fractions, values of 149t
creatinine 43
electrolytes 44
ferritin 145, 147, 148
glutamic oxaloacetic transaminase 49
immunoglobulin E 140
magnesium 152
protein electrophoresis 55
reagin test, unheated 90
thyroid hormones 73
urea and creatinine 44
vitamin D 135
zinc 156
Sex organs 124
Sexual intercourse 100
Sexual murders 100
Sexually transmitted disease 38
Sezary syndrome 23
Sheehan's syndrome 129
Short tau inversion recovery 171
Sicca syndrome 61
Sickle cell anemia 25
Sideroblastic anemia 146
Simvastatin 109
Sinus thrombosis 113
Sjögren's syndrome 104, 107, 111, 116
Skeletal function 157
Skin 9, 47, 74, 123, 135, 137
cancer 138, 160, 164
differentiation 137
diseases 138
tags 131
Skin biopsy 12
excisional 12
incisional 12
indications of 12
punch 12
shave 12
types 12
Slit-skin smear examination 11
Small ovarian follicles 130
Sodium 36
bicarbonate 34
Sodomy 100
Sperm
concentration 97
density, factors affecting 96
detection of 100
morphology 97
Spermatogenesis, hormonal control of 95t
Spermatozoa 37, 96
Spore formation 6
Spore staining 6
Squamous cell carcinoma 104, 164
Staining techniques 4
Stains
acidic 4
basic 4
neutral 4
types of 4
Steatohepatitis, non-alcoholic 58
Steroid 66
function of 128
therapy 72
Stevens–Johnson syndrome 22, 31, 48
Streptococcus pneumoniae 29
Substance, clearance of 43
Sulfamethoxazole 155
Sulfasalazine 67, 103, 109
Sulfonamide 20, 67
Sweet's syndrome 22, 161
Swyer syndrome 119, 120
Syphilis 85, 116
biopsy in 86
diagnosis of 85
serological tests for 85
stage of 91
Systemic lupus erythematosus 53, 106, 108, 111, 116, 137
Systemic vasculitis 28
T
Tapes 18
T-cells 101
Telangiectasia 106, 111
Terry's nail 56
Testicular causes 99
Testicular failure, secondary 126
Testicular sperm extraction 99
Testing policy 92
Testosterone 98t, 118, 123, 123f, 124
and metabolites, function of 125f
control 124
deficiency, clinical features of 126
levels, factors affecting 125
medical uses of 125
medications causing low 126
production 124
routes of administration for 125
supplementation 126
contraindications of 127
Tetracycline 35, 51, 155
Thalassemia 146
Thiazides 20, 67
Thioguanine nucleotide 70
Thiopurine therapy, risk of 71
Thiopurine-S-methyltransferase
deficiency 70, 71
gene 71
levels of 71t
Thrombocytes 21
Thrombocytopenia 77
Thrombocytopenic purpura 61
Thyroglobulin antibodies 73
Thyroid 74
binding proteins 73
disease 28
function test 55, 72, 98
interpretations of 74t
gland 72
hormones 72, 73
releasing hormone 72
stimulating hormone 72, 122
Thyrotoxicosis, amiodarone-induced 75
Thyroxine 72
Tioguanine monophosphate 70
Tissue
density of 169
sections 86
transglutaminase 55
Toluidine red unheated serum test 90
Total iron binding capacity 55
Total motility 97
Total testosterone levels 125t
Toxic epidermal necrolysis 11, 22, 31
Toxicity symptoms 137, 139
management of 137
Toxins 22
Transfer ribonucleic acid 104
Treponema pallidum 1, 2, 2f, 85, 86
hemagglutination assay 91
immobilization test 90
Treponemal enzyme immunoassay 91
Treponemal tests 85, 90, 91
limitations of 91
Treponemes 87f
Triggers 67
Triglyceride 62, 62t, 64
Tri-iodothyronine 72
Trimethoprim 155
Trimethoprim-sulfamethoxazole 33, 51
Triplex mode combines 167
Trousseau's sign 153
Tube drainage 45
Tuberculosis 116
Tubular function, tests for 43, 44
Turner's syndrome 127
Typhoid fever 23
Tzanck cell 11, 11f
Tzanck smear 11t
Tzanck test 11
U
Ulcers 103
Ultrasonography, limitations of 165
Ultrasound, low and high frequency 163
Ultraviolet B 136
Uremic dermopathy 47
Uremic frost frequent 47
Uremic pruritus 160t
Urinalysis 41
Urinary electrolytes 36
Urinary protein 39
Urinary tract 36
infection 34, 41, 42
Urine 41
concentration test 44
examination 34, 38, 43
microscopy 36
output, causes of decreased 36
pH of 34
pregnancy test 38
routine microscopy reveals 44
sample 39
pretreatment of 128
specific gravity of 36
test 81
methods 39
volume, causes of excess 35
Urticaria 61
chronic 61, 142
V
Vaginal lubricants 96
Varicella zoster 11
Varicocele 99
Vas deferens 97
Vascular malformations 165
Venereal disease research laboratory test 85, 88
Venous malformation 165
Vibration controlled transient elastography 55
Viral genes, detection of 81
Viral hepatitis 23, 50, 58t
acute 61
types of 57t
Viral infections 89
Viral orchitis 99
Viral warts 159
Vitamin
A 125
B12 24
deficiency 146
C 67
binding protein 135
deficiency 137, 150
synthesis 135
D2 136
D3 136
K 53
Vitiligo 132, 138
Voluntary confidential counseling 77
Vomiting 45, 57
W
Waldenström macroglobulinemia 28, 53
Wasserman reaction 88
Wedge biopsy 14
Wegener's granulomatosis 103
Westergren method 28
Western blot technique 91
Wet mount preparation 3f
White blood cells 21, 22, 37
Wood's lamp 1, 16f
examination 16, 17t
techniques of 16
Wound healing 138
X
Xanthine oxidase 70
Xanthomas, types of 66
X-rays, amount of 169
Y
Yaws 91
Yeast 37
Yellow nail syndrome 47
Z
Zidovudine 155
Ziehl–Neelsen stain 4, 7
Zileuton 50
Zinc 156
content 157
deficiency 125, 157
physiological functions of 156
preparations, types of 157
supplements 157
therapy 158
toxicity 157
specific treatment of 158
×
Chapter Notes

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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
CONTRIBUTORS  
EDITORS
 
MANAGING EDITOR
 
CONTRIBUTING AUTHORS
FOREWORD
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