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Senior - Derm 1 > 5 - Skin Signs Of Systemic Disease > Flashcards

5 - Skin Signs Of Systemic Disease Flashcards

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Dermatology Board Prep flashcards
1
Q

Main manifestations of hyperthyroidism?

A
  1. Hyperthyrodism w diffuse goiter
  2. Ophthalmopathy
    - lid lag, proptosis, chemosis, conjunctivitis, exophthalmos etc
  3. Dermopathy (pretibial myxedema)

Can be together or independent

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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
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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

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4
Q

Carotenemia?

A

Yellow tint to palms/soles

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5
Q

Dermopathy is aka?

A

Pretibial myxedema

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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

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7
Q

Dermopathy aka pretibial myxedema is seen with?

A

Hyper or hypothyroid

But MC in graves

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8
Q

Pretibial myxedema tx?

A

Topical steroids under occlusion

Compression stockings (20-40mmhg)

Intralesional triamcinolone 3-5mg/ml (smaller lesions)

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9
Q

What is vitiligo?

A

Acquired loss of pigmentation due to absence of melanocytes

Usually seen before age 20

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10
Q

Etiology of vitiligo?

A

Autoimmune (antibody to melanocytes)

Genetic (30% of cases)

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11
Q

Vitiligo types?

A

Type A
- generalized

Type B
- segmental

Type A = MC

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12
Q

Type A vitiligo

A

Generalized

symmetric pattern of white macules

  • dorsal hands
  • face
  • body folds
  • genetalia
  • body openings

Associated with halo nevi

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13
Q

Koebner pehnomenon?

A

Associated w type a vitiligo

  • elbows
  • sunburned areas
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14
Q

Type B vitiligo?

A

Segmental

Asymmetric pattern

Follicles also depigmented

Earlier onset

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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

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16
Q

Comorbidities of vitiligo?

A 
Alopecia areata
Hypothyroidism
Graves
Addison 
Pernicious anemai
DM1
Melanoma
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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)

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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
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19
Q

Camouflage methods for vitiligo?

A

Dihydroacetone self tanning (FDA approved)

Depigmenting remaining skin

  • monobenzone
  • hydroquinone
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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

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21
Q

Etiology of cushing?

A

Adrenal axis dysfunction

Iatrogenic

  • administration of PO corticosteroids
  • overuse of topical steroids
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22
Q

Describe acantosis nigricans

A

Symmetrical brown thickening of skin

Velvety texture

Hyperpigmented

Eventually

  • Leathery
  • Warty
  • Papillomatous
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23
Q

Distribution of acanthosis nigricans?

A 
Axilla (MC)
Flexors of neck
Groin
Belt line
Dorsal surfaces of fingers
Around areola
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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)
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25
Q

Tx for acanthosis nigricans?

A

Usually asymptomatic
- so nothing

Otherwise

  • ammonium lactate (lac-hydrin) 12% cream (soften)
  • tretinoin cream (thins)
  • treat malignancy endocrinopathy (if present)
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26
Q

What are xanthomas?

A

Lipid deposits in the skin and tendons

- 2/2 lipid abnormality (hyperlipidemia)

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27
Q

5 maj types of xanthomas?

A 
Xanthelasma
Eruptive
Plane
Tuberous
Tendinous
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28
Q

Mc form of xanthoma?

A

Xanthalasma

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29
Q

Describe xanthalasma

A
  • superficial, flat, yellow plaques around eyes (inner/outer canthus)
  • 50% have NO associated lipid abnormality
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30
Q

Xanthelasma is a?

A

Independent risk factor for CV death

- even though 50% dont have hyperlipidemia

31
Q

Describe eruptive xanthomas

A

Sudden onset - crops of Yellow 1-4mm papules w red halo

Signs of hyperlipidemia
- clear rapidly when levels decrease

32
Q

Where are eruptive xanthomas found?

A

Extensor surfaces of:

  • arms
  • legs
  • buttocks
  • over pressure points
33
Q

Describe tuberous xanthoma

A

Slowly evolving yellow:

  • papule
  • nodules
  • tumors

On extensor surfaces of body and palms

Painless

34
Q

What are tuberous xanthomas a sign of?

A

Hypertriglyceriedmia
Biliary cirrhosis

May persist even after tx

35
Q

Where are tendinous xanthomas found?

A

Found on:

  • Tendons
  • Ligaments
  • Fascia
  • MC on achilles
36
Q

What causes tendinous xanthoma?

A

Hyperlipidemia
Biliary cirrhosis

  • may persist even after tx
37
Q

Tx for xanthoma?

A

Low fat/calorie diet
Stop smoking
Exercise
Dyslipidemia tx

Trichloroacetic acid (TCA) for cosmetic tx

38
Q

Side effect of trichloroacetic acid (TCA)?

A

Hypo/hyperpigmentation

39
Q

Desscribe granuloma annulare

A

Ring of small, firm flesh colored - red papules

Begins flesh colored papule
Undergoes central involution
Ring of papules slowly increase in diameter (months)

40
Q

Who gets granuloma annulare?

A

Children/young adults

Female:male (2:1)

41
Q

Granuloma annulare prognosis?

A

Self limiting condition of ukn etiology

Persist and then resolve

42
Q

Where are granuloma annulare found?

A 
Dorsum of hand
Feet
Elbows
Knees
Anywhere (generalized GA)
43
Q

Generalized GA is associated w?

A

DM

HIV

44
Q

GA tx?

A 
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
Q

What is sarcoidosis?

A

Systemic granulomatous dz of ukn origin

Associated sx:

  • fever
  • fatigue
  • wt loss
  • dypsnea
  • some derm shit
46
Q

Who gets sarcoidosis?

A

Young adult <40

M=F

47
Q

Morphology of sarcoidosis

A

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
Q

What is erythema nodosum?

A

MC nonspecific lesion in early sarcoidosis- 40% (good prognosis)

  • red node-like swelling over shins
  • ill-defined border
  • flu like symptoms
49
Q

What is lupus pernio?

A

infiltration of nose, cheeks or earlobes that is:

  • Diffuse
  • violaceous
  • Soft
  • Doughy
50
Q

Distribution of sarcoidosis?

A

Skin disease:
- anywhere
—(esp face, nose, mouth, extremities)

Systemic

  • lungs
  • eyes (uveitis)
  • bones
51
Q

Workup for sarcoidosis?

A

bx (confirms dx)

  • bronchoscopic
  • lesional
  • lymph

Cxr
Eye exam
Ecg
Blood tests

52
Q

Sarcoidosis tx?

A

Oral steroids (widespread skin, or vital organs)

Intralesional steroids
- triamcinolone 3mg/ml (small lesions)

Methotrexate (low dose)
- for refractory

53
Q

Where is necrobiosis lipoidica found?

A

80% found at ant. Tib/fib

54
Q

Morphology of necrobiosis lipoidica?

A

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
Q

Describe the degenerative ischemic changes of necrobiosis lipoidica?

A

Thinning of skin
Shallow depressed scars
Woody induration - diabetic dermopathy
- w or w/o vesicles/bulla

56
Q

Etiology of necrobiosis lipoidica?

A

Ukn (DM maybe)
- 75% have DM

May be conncted to diabetic microangiopathy

57
Q

Symptoms of necrobiosis lipoidica?

A

Asymptomatic

Or

Burning and stinging lesions

58
Q

Prognosis for necrobiosis lipoidica?

A

12-20% self resolve (spontaneously)

Chronic (rare)
- ulcerated lesions result in SCC

59
Q

Tx for necrobiosis lipoidica?

A

(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
Q

Almost 100% of kaposi’s sarcoma pts have?

A

Mustaches

Or aids (i forget which)

61
Q

Subgroups of kaposi’s sarcoma (KS)

A
  1. Classic
  2. African cutaneous
  3. African lymphadenopathic
  4. Aids
  5. Immunosuppressive
62
Q

MC tumor in HIV pts?

A

Classic KS

63
Q

Describe classic KS progression

A

Older men
Slow progression

Hands, feet lower legs and progresses up arms/legs

64
Q

Location of HIV aids KS?

A

Anywhere
Rapid onset
MC trunk, head, neck

65
Q

Morphology of Aids KS?

A

Slightly raised
Oval or elongated
Poorly demarcated
Rusk colored infiltrates

Rapid pregression to red/purple nodules and plaques

Ulcerate and bleed

66
Q

KS when you press on it?

A

Decrease size w firm pressure
increase to normal on release

Helps to differentiate from LP

67
Q

Dx of kaposi’s sarcoma?

A

Biopsy

- proliferation of blood vessels w neoplastic endothelial cells

68
Q

KS pts dont actually have to have?

A

AIDS but they are very commonly seen together

69
Q

Etiology of kaposi’s sarcoma?

A

HHV 8

- aka kaposi’s sarcoma-associate herpes virus

70
Q

How is HHV 8 spread?

A

Via the mouth in MSM interactions

71
Q

HHV-8 causes 3 distinct syndromes in the AIDS population. They are?

A

Kaposi’s sarcoma

Primary effusion
Lymphoma (PEL)

Multicentric castleman’s disease

72
Q

The 3 HHV-8 syndromes and HIV?

A

HHV 8 is found with all 3 syndromes but only multicentric castleman’s disease is only found among HIV pts

73
Q

Tx for kaposis sarcoma?

A

Liquid nitrogen cryotherapy (80% resolution)

Excisional surgery (single lesion)

Intralesional chemo (vinblastine) (larger lesions)

Radiotherapy (large masses)

HAART if extensive

74
Q

Say what you want about mr booth

A

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

Senior - Derm 1 (7 decks)

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