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

22 NEET-PG practice questions on Pigmentary, hair, nail disorders and skin signs of systemic disease, part of Dermatology. The first 22 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
Question 11 · Easy
Spoon-shaped, concave nails in a pale woman with heavy menstrual bleeding most strongly suggest which deficiency?
1. AIron
2. BZinc
3. CVitamin B12
4. DBiotin
Answer and explanation in LearnFree account
Question 12 · Medium
Gradual diffuse thinning over the crown for 3 years, with a widened central parting but a preserved frontal hairline, worries a bank officer of 34. Her menses are regular, and there is no acne or hirsutism. TSH, ferritin and haemoglobin are normal, the hair-pull test is negative, and dermoscopy shows variation in hair-shaft diameter of more than 20%. Which first-line treatment is most appropriate?
1. AOral finasteride
2. BTopical minoxidil
3. CIntralesional triamcinolone
4. DOral griseofulvin
Answer and explanation in LearnFree account
Question 13 · Medium
On the nephrology ward, a man on maintenance haemodialysis has nails whose proximal half is white and whose distal half is reddish-brown, with a sharp line between the two. The colour does not fade when the nail is pressed and does not move forward as the nail grows. Which nail sign is this?
1. AHalf-and-half nails
2. BTerry nails
3. CMees lines
4. DMuehrcke paired lines
Answer and explanation in LearnFree account
Question 14 · Hard
Segmental vitiligo on the left cheek and temple of a college student began 4 years ago and spread over 18 months; for the last 2 years there have been no new patches and no extension, and the Koebner phenomenon is absent. A year of topical tacrolimus and 6 months of narrowband UVB gave only slight perifollicular repigmentation. She has no thyroid disease, no family history of vitiligo and no other patches on the body. Her parents ask what can now be done for the patch before her wedding next year. What is the most appropriate next step?
1. ADepigmentation with monobenzone
2. BSuction blister epidermal grafting
3. CTwo more years of narrowband UVB
4. DOral mini-pulse corticosteroids
Answer and explanation in LearnFree account
Question 15 · Medium
Ill-defined, hypopigmented, finely scaly patches on both cheeks of a schoolboy with a history of eczema in the elbow flexures have been more obvious since the summer holidays. The patches are not fully depigmented, sensation over them is normal, and they do not become more prominent or chalk-white under a Wood lamp. A KOH mount of the scale is negative. Which is the most likely diagnosis?
1. AIndeterminate leprosy
2. BVitiligo
3. CPityriasis alba
4. DPityriasis versicolor
Answer and explanation in LearnFree account
Question 16 · Hard
On routine examination, a woman of 62 is found to have a dark streak on her thumbnail that has widened over eight months. She cannot recall any injury. The nail is shown. Which is the most appropriate next step?
Figure: Figure: Case Rep Dermatol. 2026 Sep 7;18(1):731–7. doi: 10.1159/cde/abvag017, CC BY, via PubMed Central
1. ABiopsy of the nail matrix pigmented lesion
2. BWide local excision without a biopsy
3. CObservation with photographs every six months
4. DOral terbinafine for 12 weeks
Answer and explanation in LearnFree account
Question 17 · Hard
A man of 40 has noticed over two years several milky-white patches on the neck and behind the ear, and a white lock of hair at the back of his scalp, as shown. There is no itch or scale. Which mechanism best explains the loss of colour?
Figure: Photo: Klaus D. Peter, Gummersbach, Germany, CC BY 3.0 de, via Wikimedia Commons
1. AFailure of melanosome transfer to keratinocytes
2. BAutoimmune destruction of melanocytes by cytotoxic CD8 T cells
3. CMalassezia yeast inhibiting tyrosinase
4. DInherited tyrosinase gene defect with melanocytes that cannot make pigment
Answer and explanation in LearnFree account
Question 18 · Easy
Soft, painless, yellowish plaques near the inner corners of both upper eyelids of a middle-aged woman are shown. Which investigation should be ordered first?
Figure: Photo: Klaus D. Peter, Wiehl, Germany, CC BY 3.0 de, via Wikimedia Commons
1. ASerum uric acid
2. BThyroid function tests
3. CFasting lipid profile
4. DSkin biopsy for amyloid
Answer and explanation in LearnFree account
Question 19 · Medium
After a minor pin prick on her shin a woman with long-standing bloody diarrhoea noted a tender pustule that enlarged over a week into the ulcer shown. The edge is violaceous and undermined, wound cultures are sterile, and she has no fever. What is the most appropriate treatment?
Figure: Photo: Țetcu Mircea Rareș, CC BY-SA 4.0, via Wikimedia Commons
1. AEmpirical intravenous antibiotics
2. BSurgical debridement with skin grafting
3. CSystemic corticosteroid
4. DCompression bandaging alone
Answer and explanation in LearnFree account
Question 20 · Medium
A man of 32 is worried about thinning at the crown over six years, as shown. He has no scalp scaling or redness. Which mechanism applies to the oral drug used first-line for him?
Figure: Photo: BlaiserPascal, CC BY-SA 4.0, via Wikimedia Commons
1. AOpening of ATP-sensitive potassium channels
2. BInhibition of type 2 5-alpha-reductase
3. CInhibition of calcineurin
4. DBlockade of the androgen receptor
Answer and explanation in LearnFree account
Question 21 · Medium
A woman of 35 with a BMI of 36 and irregular periods has had darkening of the underarm skin for two years, as shown. The skin is velvety, thickened and brown, and is also seen on the back of the neck. Which mechanism best explains the skin change?
Figure: Photo: Mark F. Brady; Prashanth Rawla., CC BY-SA 4.0, via Wikimedia Commons
1. ARaised ACTH stimulating melanocortin-1 receptors on melanocytes
2. BOestrogen-driven proliferation and activity of melanocytes
3. CHaemosiderin deposition from leaking dermal capillaries
4. DHyperinsulinaemia acting on IGF-1 receptors of keratinocytes and fibroblasts
Answer and explanation in LearnFree account
Question 22 · Medium
A man who has smoked for 30 years has a chronic cough with blood-streaked sputum. His fingertips are shown. The nails curve over the tips and the angle between nail and nail fold is lost. Which mechanism best explains this finding?
Figure: Photo: Desherinka, CC BY-SA 4.0, via Wikimedia Commons
1. AVenous congestion of the finger pulp
2. BDirect invasion of the distal phalanx by tumour cells
3. CExcess growth hormone driving soft tissue growth
4. DMegakaryocyte fragments reaching the digital circulation and releasing PDGF and VEGF
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?

Spoon-shaped, concave nails in a pale woman with heavy menstrual bleeding most strongly suggest which deficiency?

On the nephrology ward, a man on maintenance haemodialysis has nails whose proximal half is white and whose distal half is reddish-brown, with a sharp line between the two. The colour does not fade when the nail is pressed and does not move forward as the nail grows. Which nail sign is this?

On routine examination, a woman of 62 is found to have a dark streak on her thumbnail that has widened over eight months. She cannot recall any injury. The nail is shown. Which is the most appropriate next step?

A man of 40 has noticed over two years several milky-white patches on the neck and behind the ear, and a white lock of hair at the back of his scalp, as shown. There is no itch or scale. Which mechanism best explains the loss of colour?

Soft, painless, yellowish plaques near the inner corners of both upper eyelids of a middle-aged woman are shown. Which investigation should be ordered first?

After a minor pin prick on her shin a woman with long-standing bloody diarrhoea noted a tender pustule that enlarged over a week into the ulcer shown. The edge is violaceous and undermined, wound cultures are sterile, and she has no fever. What is the most appropriate treatment?

A man of 32 is worried about thinning at the crown over six years, as shown. He has no scalp scaling or redness. Which mechanism applies to the oral drug used first-line for him?

A woman of 35 with a BMI of 36 and irregular periods has had darkening of the underarm skin for two years, as shown. The skin is velvety, thickened and brown, and is also seen on the back of the neck. Which mechanism best explains the skin change?

A man who has smoked for 30 years has a chronic cough with blood-streaked sputum. His fingertips are shown. The nails curve over the tips and the angle between nail and nail fold is lost. Which mechanism best explains this finding?