5 - Skin Signs Of Systemic Disease Flashcards
1
Q
Main manifestations of hyperthyroidism?
A
- Hyperthyrodism w diffuse goiter
- Ophthalmopathy
- lid lag, proptosis, chemosis, conjunctivitis, exophthalmos etc - Dermopathy (pretibial myxedema)
Can be together or independent
2
Q
Morphology of hyperthyroidism?
A
- Moist, smooth, warm skin
- Hyperhydrosis
- Palmar erythema
- Soft, fine and/or thinning of hair
- Bronze tint to skin
- Thyroid acropachy
- Plummer’s nail changes
3
Q
With hypothyroidism the skin appears?
A
Swollen Cool Waxy Dry Coarse Pale Increased wrinkles Caroenemia Vitiligo
He has more symptoms that arent skin related but it is a derm test…
Slide 6
4
Q
Carotenemia?
A
Yellow tint to palms/soles
5
Q
Dermopathy is aka?
A
Pretibial myxedema
6
Q
Presentation of pretibial myxedema (early/late)
A
Early:
- bilateral asymmetric firm, nonpitting nodules and plaques
- pink, skin-colored or purple
Late:
- confluence to be symmetrically involved pretibial regions
- extreme: lower legs, dorsal feet become distorted
- exaggeration of hair follicles (orange peel)
Crazy pics on 9 and 10
7
Q
Dermopathy aka pretibial myxedema is seen with?
A
Hyper or hypothyroid
But MC in graves
8
Q
Pretibial myxedema tx?
A
Topical steroids under occlusion
Compression stockings (20-40mmhg)
Intralesional triamcinolone 3-5mg/ml (smaller lesions)
9
Q
What is vitiligo?
A
Acquired loss of pigmentation due to absence of melanocytes
Usually seen before age 20
10
Q
Etiology of vitiligo?
A
Autoimmune (antibody to melanocytes)
Genetic (30% of cases)
11
Q
Vitiligo types?
A
Type A
- generalized
Type B
- segmental
Type A = MC
12
Q
Type A vitiligo
A
Generalized
symmetric pattern of white macules
- dorsal hands
- face
- body folds
- genetalia
- body openings
Associated with halo nevi
13
Q
Koebner pehnomenon?
A
Associated w type a vitiligo
- elbows
- sunburned areas
14
Q
Type B vitiligo?
A
Segmental
Asymmetric pattern
Follicles also depigmented
Earlier onset
15
Q
Eye, Ear and meningeal concerns with vitiligo?
A
Depigmented retinal epithelium -> uveitis risk
Depigmented membranous labryinth -> hearing issues
Aseptic meningitis in those w leptomeningeal melanocytic destruction
16
Q
Comorbidities of vitiligo?
A
Alopecia areata Hypothyroidism Graves Addison Pernicious anemai DM1 Melanoma
17
Q
Tx for vitiligo?
A
Fair skinned
- no tx
- avoid tanning
Darker skinned
- stimulate melanocytes within hair follicle reservoir to migrate to depigmented skin (wont work on skin w little/no hair)
18
Q
Treatment options for stimulating the melanocytes?
A
- Phototherapy (NB-UVB)
- topical corticosteroids
- topical calcineurin inhibitors (tacrolimus/pimecrolimus)
- vitamin D3 (calcitriol)
- excimer laser
- cammoflauge
19
Q
Camouflage methods for vitiligo?
A
Dihydroacetone self tanning (FDA approved)
Depigmenting remaining skin
- monobenzone
- hydroquinone
20
Q
Skin presentation of cushing syndrome?
A
Atrophic skin changes Bright purple striae Ecchymosis Steroid acne Hirsutism Hypertrichosis Androgenic alopecia
Non derm ssx on slid 20
21
Q
Etiology of cushing?
A
Adrenal axis dysfunction
Iatrogenic
- administration of PO corticosteroids
- overuse of topical steroids
22
Q
Describe acantosis nigricans
A
Symmetrical brown thickening of skin
Velvety texture
Hyperpigmented
Eventually
- Leathery
- Warty
- Papillomatous
23
Q
Distribution of acanthosis nigricans?
A
Axilla (MC) Flexors of neck Groin Belt line Dorsal surfaces of fingers Around areola
24
Q
List of diseases that acanthosis nigricans is associated with?
A
- insulin resistant states
- hyperandrogenic states
- cushing
- acromegaly
- obesity
- hypothyroidism
- addison
- hypogonadism w insulin resistance
- prader-willi syndrome
- drugs (nicotinic acid, estrogens, steroids)
- malignancy (gastric)
25
Tx for acanthosis nigricans?
Usually asymptomatic
- so nothing
Otherwise
- ammonium lactate (lac-hydrin) 12% cream (soften)
- tretinoin cream (thins)
- treat malignancy endocrinopathy (if present)
26
What are xanthomas?
Lipid deposits in the skin and tendons
| - 2/2 lipid abnormality (hyperlipidemia)
27
5 maj types of xanthomas?
```
Xanthelasma
Eruptive
Plane
Tuberous
Tendinous
```
28
Mc form of xanthoma?
Xanthalasma
29
Describe xanthalasma
- superficial, flat, yellow plaques around eyes (inner/outer canthus)
- 50% have NO associated lipid abnormality
30
Xanthelasma is a?
Independent risk factor for CV death
| - even though 50% dont have hyperlipidemia
31
Describe eruptive xanthomas
Sudden onset - crops of Yellow 1-4mm papules w red halo
Signs of hyperlipidemia
- clear rapidly when levels decrease
32
Where are eruptive xanthomas found?
Extensor surfaces of:
- arms
- legs
- buttocks
- over pressure points
33
Describe tuberous xanthoma
Slowly evolving yellow:
- papule
- nodules
- tumors
On extensor surfaces of body and palms
Painless
34
What are tuberous xanthomas a sign of?
Hypertriglyceriedmia
Biliary cirrhosis
May persist even after tx
35
Where are tendinous xanthomas found?
Found on:
- Tendons
- Ligaments
- Fascia
- MC on achilles
36
What causes tendinous xanthoma?
Hyperlipidemia
Biliary cirrhosis
- may persist even after tx
37
Tx for xanthoma?
Low fat/calorie diet
Stop smoking
Exercise
Dyslipidemia tx
Trichloroacetic acid (TCA) for cosmetic tx
38
Side effect of trichloroacetic acid (TCA)?
Hypo/hyperpigmentation
39
Desscribe granuloma annulare
Ring of small, firm flesh colored - red papules
Begins flesh colored papule
Undergoes central involution
Ring of papules slowly increase in diameter (months)
40
Who gets granuloma annulare?
Children/young adults
Female:male (2:1)
41
Granuloma annulare prognosis?
Self limiting condition of ukn etiology
Persist and then resolve
42
Where are granuloma annulare found?
```
Dorsum of hand
Feet
Elbows
Knees
Anywhere (generalized GA)
```
43
Generalized GA is associated w?
DM
| HIV
44
GA tx?
```
Nothing resolves it
Usually asymptomatic
Cosmetic tx:
- topical steroid w occlusion
- intralesional steroid (in papule ring only)
```
PUVA (disseminated GA)
Generalized GA responds to
- dapsone
- isotretinoin
- hydroxychloroquine
45
What is sarcoidosis?
Systemic granulomatous dz of ukn origin
Associated sx:
- fever
- fatigue
- wt loss
- dypsnea
- some derm shit
46
Who gets sarcoidosis?
Young adult <40
| M=F
47
Morphology of sarcoidosis
Early:
- skin colored papules and/or brown/purple plaques on face, extremeties, buttocks, trunk
- erythema nodosum
- lupus pernio
- affinity to scars (later in the course)
- apple jelly appearance on glass slide
48
What is erythema nodosum?
MC nonspecific lesion in early sarcoidosis- 40% (good prognosis)
- red node-like swelling over shins
- ill-defined border
- flu like symptoms
49
What is lupus pernio?
infiltration of nose, cheeks or earlobes that is:
- Diffuse
- violaceous
- Soft
- Doughy
50
Distribution of sarcoidosis?
Skin disease:
- anywhere
—(esp face, nose, mouth, extremities)
Systemic
- lungs
- eyes (uveitis)
- bones
51
Workup for sarcoidosis?
bx (confirms dx)
- bronchoscopic
- lesional
- lymph
Cxr
Eye exam
Ecg
Blood tests
52
Sarcoidosis tx?
Oral steroids (widespread skin, or vital organs)
Intralesional steroids
- triamcinolone 3mg/ml (small lesions)
Methotrexate (low dose)
- for refractory
53
Where is necrobiosis lipoidica found?
80% found at ant. Tib/fib
54
Morphology of necrobiosis lipoidica?
Begins
- oval, violaceous patch
- expands slowly
Proceeds to
- red advancing boarder
- yellow brown center
Surface
- atrophies
- waxy
- prominent telangioectasias
Ulcerations follow
Degerative ischemic changes
55
Describe the degenerative ischemic changes of necrobiosis lipoidica?
Thinning of skin
Shallow depressed scars
Woody induration - diabetic dermopathy
- w or w/o vesicles/bulla
56
Etiology of necrobiosis lipoidica?
Ukn (DM maybe)
- 75% have DM
May be conncted to diabetic microangiopathy
57
Symptoms of necrobiosis lipoidica?
Asymptomatic
Or
Burning and stinging lesions
58
Prognosis for necrobiosis lipoidica?
12-20% self resolve (spontaneously)
Chronic (rare)
- ulcerated lesions result in SCC
59
Tx for necrobiosis lipoidica?
(No evidence based guidelines)
```
topical and intralesional steroids
- stops inflammation but causes atrophy
Systemic steroids (3-5 wks)
- may stop disease
Trental (pentoxifylline) 400mg tid
- sig results in 1 mo
- decreases blood viscosity and inhibits PLT aggregation
ASA q 48hrs
- inhibit PLT agg to control ulceration (min 3-7 mo) (questionable)
```
60
Almost 100% of kaposi’s sarcoma pts have?
Mustaches
Or aids (i forget which)
61
Subgroups of kaposi’s sarcoma (KS)
1. Classic
2. African cutaneous
3. African lymphadenopathic
4. Aids
5. Immunosuppressive
62
MC tumor in HIV pts?
Classic KS
63
Describe classic KS progression
Older men
Slow progression
Hands, feet lower legs and progresses up arms/legs
64
Location of HIV aids KS?
Anywhere
Rapid onset
MC trunk, head, neck
65
Morphology of Aids KS?
Slightly raised
Oval or elongated
Poorly demarcated
Rusk colored infiltrates
Rapid pregression to red/purple nodules and plaques
Ulcerate and bleed
66
KS when you press on it?
Decrease size w firm pressure
increase to normal on release
Helps to differentiate from LP
67
Dx of kaposi’s sarcoma?
Biopsy
| - proliferation of blood vessels w neoplastic endothelial cells
68
KS pts dont actually have to have?
AIDS but they are very commonly seen together
69
Etiology of kaposi’s sarcoma?
HHV 8
| - aka kaposi’s sarcoma-associate herpes virus
70
How is HHV 8 spread?
Via the mouth in MSM interactions
71
HHV-8 causes 3 distinct syndromes in the AIDS population. They are?
Kaposi’s sarcoma
Primary effusion
Lymphoma (PEL)
Multicentric castleman’s disease
72
The 3 HHV-8 syndromes and HIV?
HHV 8 is found with all 3 syndromes but only multicentric castleman’s disease is only found among HIV pts
73
Tx for kaposis sarcoma?
Liquid nitrogen cryotherapy (80% resolution)
Excisional surgery (single lesion)
Intralesional chemo (vinblastine) (larger lesions)
Radiotherapy (large masses)
HAART if extensive
74
Say what you want about mr booth
But anyone who adds 9 pages of review at the end of their slide deck is good in my book
- such a relief to realize youre done early
