8 - Cutaneous Signs of Systemic Disease Flashcards
What are some endocrine-related diseases?
- Diabetes
- Hyperthyroidism (including grave’s disease)
- Hypothyroidism
- Addison’s disease (adrenal insuff.)
- Cushing’s disease
What are some skin signs of diabetes mellitus?
- Diabetic dermopathy
- Acanthosis nigricans
- Finea (fungus)
- Candidiasis (yeast)
- Cellulitis
- MRSA
- Neuropathic ulcers
- Peripheral arterial disease (ishemia)
- Various gangrene
What is diabetis dermopathy? Who gets it and where?
Common (30%) in long standing diabetes; marker for poor diabetic control (no effective treatment).
Lower legs, possibly trauma related.
Atrophic, pink and hyperpigmented macules and plaques that look like scars.
How common is acantosis nigricans? What does it look like and what is it a marker of?
Common in type II D; marker for insulin resistance.
Velvety hyperpigmented thickening of the skin. Intertriginous, flexors (not usually extensor or face).
+/- skin tags.
What are the three broad categories that can cause acanthosis nigricans?
AN1: familial
AN2: malignancy (gastric and lung)
AN3: related to obesisty, insulin resistance, and endorinopathy such as T2DM, PCOS, Cushings, and hypothyroidism
What other skin findings are commonly associated with diabetes mellitus DM?
Tinea (fungus), candidiasis (yeast), MRSA infections, and cellulitis.
What peripheral afflictions occur with DM?
Neuropathic ulcers, peripheral arterial disease (ischemia), and various gangrene (ischemia + infection).
What might the skin of someone with hyperthyroidism look/feel life?
- Fine, velvety, smooth skin
- Warm and moist due to increased sweating
- Hyperpigmentation - localized or generalized
- Pruritus
- Hair: fine, thin
- Onycholysis (lifting)
There are not characteristic of hyperthyroidism - many things could cause these.
What might the skin of someone with hypothyroidism look/feel life?
- Dry, rough, coase skin
- Cold and pale skin
- Yellow discoloration from caotenemia
- Thick scale on feet (keratoderma)
- Generalized boggy and edematosu skin (myxedema) - rare
- Hair: dull, coarse, brittle, slow to grow
- Alopecia of the later third of eyebrows
- Nails: thin, brittle, slow to grow
These are not characteristic, many things other than hypothyroidism can cause these.
What skin symtoms is seen in 1-5% of those with hyperthyroidism WITH grave’s disease?
Pretibial myxedema: cutaneous infiltration of skin of shins (rare on other sites) with MUCIN (which accumulates)
Peau d/orange, skin colored to brown red; firm
Can occur from Graves or following treatment.
What is addison’s disease? What is it caused by?
Primary adrenocortical insufficiency (can’t make cortisol)
Autoimmune in 80% (autoantibodies) - opposed to postTB, vascular, neoplstic, genetic.
Difficult to diagnose.
What skin manifestations are seen with Addison’s disease?
Hyperpigmentation (melanocyte stimulating hormone-like effect on ACTH) and mucosal pigmentation- diffuse
Loss of ambisexual hair in post-pubertal women
Fibrosis and calcification of the cartilage (ear) - rare
What is Cushing’s disease/syndrome? What are common characteristics of someone with Cushings?
Overproduction of CORTISOL by the adrenal gland.
- Moon face
- Dorsicervical fat pad (buffalo hump)
- Truncal obesity
- Spindly limbs
- Striae
- Easy bruisability
- Slow wound healing
- Acne and hirsutism (abnormal hair growth).
What are two connective tissue diseases?
Lupus and dermatomyositis
What is lupus? What is the spectrum of disease?
MULTISYSTEM disorder that can prominently affect the skin; has several subsets that are defined by appearance, timing, and pathology.
~80% of systemic lupus (SLE) pts have problems with skin; some (chronic cutaneous lupus) ONLY have problems with their skin.
What are the american college of rheumatology SKIN criteria for SLE (systemic)?
Malar (cheek) erythema
Discoid (chronic, thick) lesions
Oral ulcers
Photosensitivy
Pts must have 4 or more points (one for each affliction) in addition to the multisystem effects, to have a diagnosis of SLE systemic lupus.
What are the american college of rheumatology MULTISYSTEM criteria for SLE (systemic)?
Arthritis
Serositis (serous membrane inflamm)
Nephropathy
CNS disorder
Hematologic disorder
Immunologic
Abnormal ANA (antinucleas antibodies)
Pts must have 4 or more points (one for each affliction) in addition to the skin effects, to have a diagnosis of SLE systemic lupus.
What are risk factors for SLE (ie who is more likely to get this)?
Female > make (6:1)
Young (childbearing age) > old
African american, other dark skin > caucasion (3:1)
What are the subtypes of lupus?
Acute cutaneous lupus erythematosis (ACLE)
Chronic cutaneous lupus erythematosus (CCLE) - aka discoid
Subacute cutaneous lupus (SCLE)
Neonatal lupus
Who gets acute cutaneous lupus erythematosus (ACLE)? How long does it last? What is it associated with?
Females > males (8:1)
Acute - resolves quickly in hrs to days WITHOUT scarring.
Strongly associated with SLE development.
What rash is seen with acute cutaneous lupus erythematous (ACLE) and SLE?
Generalized or photodistributed exanthematous (rashy) eruption; often brought about by sun but not always.
“Malar rash” = butterfly
(malar rash seen with ACLE and SLE)
Who gets chronic cutaneous lupus erythematosis (CCLE)? What is the likelihood that they will develope SLE?
AKA discoid lupus; most common form.
Female > male (3:1)
Only 5% of those with CCLE develope SYSTEMIC SLE (especially likely if lesions are widespread).
15-30% of SLE patients have some of these lesions.
Where do you see lesions caused by chronic cutaneous (discoid) lupus erythematosus? What can these cause?
Face, ears, scalp, arms.
Mucosal (lips and mouth) involvement in 25%
Atrophic (thin) scarring with telangiectasia, follicular scales, too much or too little pigment.
Leaves scars! (challenging with scarring alopecia because hair will not grow back)
____ alopecia is seen in discoid lupus.
Scarring alopecia
