12: Derm Manifestations of Metabolic Dz - Frush

Question 1

Necrobiosis Lipoidica Diabeticorum

Answer 1

• located on anterior shin/ dorsum of foot
• well circumscribed, oval, violateous to red plaques
• advancing red border with yellow brown central area
• many have waxy feel

Question 2

tx necrobiosis lipoidica diabeticorum

Answer 2

• asymptomatic
• wound care if ulceration present
• topical corticosteroids may cause more skin atrophy

Question 3

diabetic dermopathy

Answer 3

• anterior shin
• round to oval, smaller
• falt topped, red, scal papules

Question 4

non scarring diabetic bullosis

Answer 4

• tips and dorsal aspect of fingers and toes
• erytheamtous periphery
• non hemmorrhagic
• heals spontaenosuly
• long standing diabetic

Question 5

scarring diabetic bullosis

Answer 5

• occasionally hemorrhagic
• inflammamtory base present
• long standing diabetic

Question 6

tx diabetic bullosis

Answer 6

• leave bulla intact

- aspirate if very tense

Question 7

etiology of pigmented purpura

Answer 7

• deposition of red blood cellls

- petechiae coalesce to form spots

Question 8

pigmented purpura

Answer 8

• orange or brown pigmentation

“cayenne-pepper” spots

Question 9

granuloma annulare

Answer 9

• dorsal and lateral aspect of feet, ankles, and legs

- ring of firm, well-defined, small, pink to red papules

Question 10

tx gangrene

Answer 10

revascularization if possible

do not debride unless revascularized or acutely infected

Question 11

xanthoma eruptivum

Answer 11

• firm, non-tender, yellow papules arising on an erythematous base
• assoc with hyperlipidermia, lyperglycemia and glycosuria
• tx by controling blood glucose and lipid levels

Question 12

why yellow toe nails?

Answer 12

possible caused by decreased circulation to nail bed and matrix or onychomycosis

Question 13

gold standard diagnosis of gout

Answer 13

joint aspirate with findings of negative birefringent crystals

Question 14

tx acute gout

Answer 14

• oral NSAIDs (indomethacin)
• oral steroids
• steroid injection
• rest

Question 15

skin of hypothyroidism

Answer 15

• cold skin [due to cutaneous vasoconstriction ]
• xerosis [ absence of skin sweating]
• pale mottled skin
• yellow discoloration
• keratoderma of feet
• dry brittle hair

Question 16

graves disease

Answer 16

hyperthyroidism

hyperthyroidism can also be caused by multinodular goiter, thyroid adenoma, excessive hormone administration

Question 17

skin of hyperthyroidism

Answer 17

• warm skin
• moist and soft
• pink or red
• smooth texture
• hyperhydrosis
• hyper or hypopigmentation

Question 18

pretibial myxedema

Answer 18

• sharply circumscribed, flesh-colored pink or violaceous plaques nodules
• anterior lower legs
• translucent or waxy appearance
• swollen legs and feet

Question 19

produced by large deposits of acid mucopolysaccharides (chondroitin sulfate and hyaluronic acid)

Answer 19

pretibial myxedema

Question 20

xanthomatosis

Answer 20

flat, yellow plaques, papules or nodules

Question 21

types of xanthomatosis
eruptiva
planum
tuberosum
tendinosum

Answer 21

• small yellow plaques or papules that appear suddenly
• small palmar and planar lipid papules
• slow forming yellow papules or nodules on knees, elbows, extensor surfaces
• smooth deep nodules attached to tendons, ligament and deep fascia (achilles tendon)

Question 22

scurvy skin

Answer 22

petechial hemorrhages, small then large ecchymosis

follicular hyperkeratosis