091914 skin signs of systemic disease Flashcards
diabetic dermopathy prevalance
common-30%-in long standing diabetes
diabetic dermopathy occurs where
lower legs
what does diabetic dermopathy look like
atrophic, pink and hyperpigmented macules and plaques (looks like scars)
diabetic dermopathy is a marker for
poor diabetic control
bullous diabeticorum
tense blisters
rarer-0.5% of pts w/ diabetes mellitus
long standing diabetes mellitus w/ other complications
acral in location, often recurrent
no effective treatment to prevent
necrobiosis lipoidica
rare-only 0.03% of pts with diabetes mellitus
not all have diabetes
yellow atrophic plaques w/ telangiectasia
usually shins
tx is difficult
acanthosis nigricans
common in TYPE II DIABETES
marker for insulin resistance
velvety hyperpigmented thickening of skin
intertiginous or flexures. less on extensor surfaces or face
with or without skin tags
is acanthosis nigricans seen only in diabetes?
no, can have:
AN1-familial
AN2-malignancy
AN3-endocrine, obsesity, insulin resistance
common associations of diabetes mellitus on skin
tinea candidiasis cellulitis MRSA infections neuropathic ulcers peripheral arterial disease (ischemia) various gangrene (ischemia and infection)
signs of hyperthyroidism from skin
fine velvety smooth skin warm and moist skin (sweating) hyperpigmentation pruritis fine and thin hair onycholysis (nail lifts off from nail bed)
signs of hypothyroidism from skin
dry rough skin cold and pale skin yellow skin thick scale on feet coarse, brittle, slow growing hair ALOPECIA OF LATERAL THIRD OF EYEBROWS
thin, brittle slow growing nails
pretibial myxedema
occurs in some with Grave’s diesase (1-5%)
cutaneous infiltration of skin of shins w/ mucin
peau d orange, bumpy and firm
Addison’s disease
primary adrenocortical insufficiency (autoimmune in 80%)
what skin manifestations do you see in Addison’s disease
hyperpigmentation in sun exposed areas, mucous membranes, skin creases, sites of trauma
nail pigmentation (striate)-brown streaks in nail
mucosal pigmentation
the above are non-specific for Addisons
loss of ambisexual hair in post pubertal women
fibrosis and calcification of cartilage (ear) is rare
Cushing’s syndrome signs
moon facies dorsicervical fat pad (buffalo hump) truncal obesity spindly limbs striae distensae easy bruisability slow wound healing acne, hirsutism
porphyria cutaneous tarda
porphyria-inherited and acquired disorders of heme synthesis pathway, resulting in accumulation of porphyrins
PCT is the most common porphyria. fragility. vesicles that heal with scarring on sun-exposed areas (face, hands). hypertrichosis (abnormal hair growth) may be present on temples and may have malar cheeks.
systemic lupus erythematosus
80% of these pts have problems with skin
may have pink scaly patch on malar region of face
may have diffuse alopecia, oral ulcers, Raynaud phenomenon
photosensitivity
discoid (Chronic) lupus erythematosus
majority of cases of this disease is skin limited
hyperkeratotic, violaceous plaques on head and neck. heal with atrophic scars
atrophic scarring with telangiectasis, follicular scales, and too much or too little pigment–can lose hair due to scars
subacute cutaneous lupus erythematosus
can be skin limited or associated w/ internal disease
pink, scaly plaques on sun exposed areas. sometimes annular.
acute cutaneous lupus erythematosus
resolves WITHOUT SCARRING
often brought on by sun
malar rash
strongly associated with SLE
dermatomyositis skin findings
photosensitive dermatosis
heliotrope rash-pink/purple discoloration of upper eyelids, often w/ edema
pink, scaly patches and plaques may be present on sun exposed areas (called shawl sign if on chest, shoulders, back).
poikiloderma rash on trunk and extremities
Gottron’s papules: pink/purple, papules on elbows, knees, dorsal surfaces of hands and foot
nailfold capillary changes
dermatomyositis is associated with what cancer?
OVARIAN
and others
sarcoidosis
caused by noncaseating (non necrotic) granulomas in multiple organs, including pulmonary in 90% of cases and skin in 25% of cases
in skin can be pleomorphic. a great pretender-looks like lot of things
most common: red brown macules and papules on the face, typically around eyes and nose
erythema nodosum may be associated
if you see sarcoidosis, what should you do?
look for systemic disease
diascopy is
taking a slide and applying pressure to skin to see the color better
used in cutaneous sarcoidosis
Lofgren’s syndrome
very common
a sarcoidosis syndrome
associated with hilar adenopathy and erythema nodosum
dermatitis herpetiformis
autoimmune blistering disease due to sensitivity to gluten
INTENSELY PRURITIC papulo-vesicles (herpetiformis, meaning vesicles like herpes), which are scratched off so that only erosions and excoriations are present
