5 - Skin Signs Of Systemic Disease Flashcards
Main manifestations of hyperthyroidism?
- Hyperthyrodism w diffuse goiter
- Ophthalmopathy
- lid lag, proptosis, chemosis, conjunctivitis, exophthalmos etc - Dermopathy (pretibial myxedema)
Can be together or independent
Morphology of hyperthyroidism?
- Moist, smooth, warm skin
- Hyperhydrosis
- Palmar erythema
- Soft, fine and/or thinning of hair
- Bronze tint to skin
- Thyroid acropachy
- Plummer’s nail changes
With hypothyroidism the skin appears?
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
Carotenemia?
Yellow tint to palms/soles
Dermopathy is aka?
Pretibial myxedema
Presentation of pretibial myxedema (early/late)
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
Dermopathy aka pretibial myxedema is seen with?
Hyper or hypothyroid
But MC in graves
Pretibial myxedema tx?
Topical steroids under occlusion
Compression stockings (20-40mmhg)
Intralesional triamcinolone 3-5mg/ml (smaller lesions)
What is vitiligo?
Acquired loss of pigmentation due to absence of melanocytes
Usually seen before age 20
Etiology of vitiligo?
Autoimmune (antibody to melanocytes)
Genetic (30% of cases)
Vitiligo types?
Type A
- generalized
Type B
- segmental
Type A = MC
Type A vitiligo
Generalized
symmetric pattern of white macules
- dorsal hands
- face
- body folds
- genetalia
- body openings
Associated with halo nevi
Koebner pehnomenon?
Associated w type a vitiligo
- elbows
- sunburned areas
Type B vitiligo?
Segmental
Asymmetric pattern
Follicles also depigmented
Earlier onset
Eye, Ear and meningeal concerns with vitiligo?
Depigmented retinal epithelium -> uveitis risk
Depigmented membranous labryinth -> hearing issues
Aseptic meningitis in those w leptomeningeal melanocytic destruction
Comorbidities of vitiligo?
Alopecia areata Hypothyroidism Graves Addison Pernicious anemai DM1 Melanoma
Tx for vitiligo?
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)
Treatment options for stimulating the melanocytes?
- Phototherapy (NB-UVB)
- topical corticosteroids
- topical calcineurin inhibitors (tacrolimus/pimecrolimus)
- vitamin D3 (calcitriol)
- excimer laser
- cammoflauge
Camouflage methods for vitiligo?
Dihydroacetone self tanning (FDA approved)
Depigmenting remaining skin
- monobenzone
- hydroquinone
Skin presentation of cushing syndrome?
Atrophic skin changes Bright purple striae Ecchymosis Steroid acne Hirsutism Hypertrichosis Androgenic alopecia
Non derm ssx on slid 20
Etiology of cushing?
Adrenal axis dysfunction
Iatrogenic
- administration of PO corticosteroids
- overuse of topical steroids
Describe acantosis nigricans
Symmetrical brown thickening of skin
Velvety texture
Hyperpigmented
Eventually
- Leathery
- Warty
- Papillomatous
Distribution of acanthosis nigricans?
Axilla (MC) Flexors of neck Groin Belt line Dorsal surfaces of fingers Around areola
List of diseases that acanthosis nigricans is associated with?
- insulin resistant states
- hyperandrogenic states
- cushing
- acromegaly
- obesity
- hypothyroidism
- addison
- hypogonadism w insulin resistance
- prader-willi syndrome
- drugs (nicotinic acid, estrogens, steroids)
- malignancy (gastric)
Tx for acanthosis nigricans?
Usually asymptomatic
- so nothing
Otherwise
- ammonium lactate (lac-hydrin) 12% cream (soften)
- tretinoin cream (thins)
- treat malignancy endocrinopathy (if present)
What are xanthomas?
Lipid deposits in the skin and tendons
- 2/2 lipid abnormality (hyperlipidemia)
5 maj types of xanthomas?
Xanthelasma Eruptive Plane Tuberous Tendinous
Mc form of xanthoma?
Xanthalasma
Describe xanthalasma
- superficial, flat, yellow plaques around eyes (inner/outer canthus)
- 50% have NO associated lipid abnormality
Xanthelasma is a?
Independent risk factor for CV death
- even though 50% dont have hyperlipidemia
Describe eruptive xanthomas
Sudden onset - crops of Yellow 1-4mm papules w red halo
Signs of hyperlipidemia
- clear rapidly when levels decrease
Where are eruptive xanthomas found?
Extensor surfaces of:
- arms
- legs
- buttocks
- over pressure points
Describe tuberous xanthoma
Slowly evolving yellow:
- papule
- nodules
- tumors
On extensor surfaces of body and palms
Painless
What are tuberous xanthomas a sign of?
Hypertriglyceriedmia
Biliary cirrhosis
May persist even after tx
Where are tendinous xanthomas found?
Found on:
- Tendons
- Ligaments
- Fascia
- MC on achilles
What causes tendinous xanthoma?
Hyperlipidemia
Biliary cirrhosis
- may persist even after tx
Tx for xanthoma?
Low fat/calorie diet
Stop smoking
Exercise
Dyslipidemia tx
Trichloroacetic acid (TCA) for cosmetic tx
Side effect of trichloroacetic acid (TCA)?
Hypo/hyperpigmentation
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)
Who gets granuloma annulare?
Children/young adults
Female:male (2:1)
Granuloma annulare prognosis?
Self limiting condition of ukn etiology
Persist and then resolve
Where are granuloma annulare found?
Dorsum of hand Feet Elbows Knees Anywhere (generalized GA)
Generalized GA is associated w?
DM
HIV
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
What is sarcoidosis?
Systemic granulomatous dz of ukn origin
Associated sx:
- fever
- fatigue
- wt loss
- dypsnea
- some derm shit
Who gets sarcoidosis?
Young adult <40
M=F
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
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
What is lupus pernio?
infiltration of nose, cheeks or earlobes that is:
- Diffuse
- violaceous
- Soft
- Doughy
Distribution of sarcoidosis?
Skin disease:
- anywhere
—(esp face, nose, mouth, extremities)
Systemic
- lungs
- eyes (uveitis)
- bones
Workup for sarcoidosis?
bx (confirms dx)
- bronchoscopic
- lesional
- lymph
Cxr
Eye exam
Ecg
Blood tests
Sarcoidosis tx?
Oral steroids (widespread skin, or vital organs)
Intralesional steroids
- triamcinolone 3mg/ml (small lesions)
Methotrexate (low dose)
- for refractory
Where is necrobiosis lipoidica found?
80% found at ant. Tib/fib
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
Describe the degenerative ischemic changes of necrobiosis lipoidica?
Thinning of skin
Shallow depressed scars
Woody induration - diabetic dermopathy
- w or w/o vesicles/bulla
Etiology of necrobiosis lipoidica?
Ukn (DM maybe)
- 75% have DM
May be conncted to diabetic microangiopathy
Symptoms of necrobiosis lipoidica?
Asymptomatic
Or
Burning and stinging lesions
Prognosis for necrobiosis lipoidica?
12-20% self resolve (spontaneously)
Chronic (rare)
- ulcerated lesions result in SCC
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)
Almost 100% of kaposi’s sarcoma pts have?
Mustaches
Or aids (i forget which)
Subgroups of kaposi’s sarcoma (KS)
- Classic
- African cutaneous
- African lymphadenopathic
- Aids
- Immunosuppressive
MC tumor in HIV pts?
Classic KS
Describe classic KS progression
Older men
Slow progression
Hands, feet lower legs and progresses up arms/legs
Location of HIV aids KS?
Anywhere
Rapid onset
MC trunk, head, neck
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
KS when you press on it?
Decrease size w firm pressure
increase to normal on release
Helps to differentiate from LP
Dx of kaposi’s sarcoma?
Biopsy
- proliferation of blood vessels w neoplastic endothelial cells
KS pts dont actually have to have?
AIDS but they are very commonly seen together
Etiology of kaposi’s sarcoma?
HHV 8
- aka kaposi’s sarcoma-associate herpes virus
How is HHV 8 spread?
Via the mouth in MSM interactions
HHV-8 causes 3 distinct syndromes in the AIDS population. They are?
Kaposi’s sarcoma
Primary effusion
Lymphoma (PEL)
Multicentric castleman’s disease
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
Tx for kaposis sarcoma?
Liquid nitrogen cryotherapy (80% resolution)
Excisional surgery (single lesion)
Intralesional chemo (vinblastine) (larger lesions)
Radiotherapy (large masses)
HAART if extensive
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
