9. Skin Signs of Systemic Disease Flashcards
Which of these statements is true?
= Oral hyperpigmentation is a sign of Addison’s disease.
All of the following skin signs would make you suspect Systemic lupus erythematosus except:
= Jaundice
= He is also likely to have a violaceous rash on his shoulders, chest or elbows
= She may also have irregular periods and facial hair
= She has SLE
Nail Clubbing
- Description?
- Clinical features? (4)
- Treatment?
- 8 Respiratory Causes?
- 5 Gastrointestinal Causes?
- 5 Cardiovascular Causes?
- 3 Endocrine Causes?
- 4 Other Causes?
- Description: Nail clubbing is a deformity may be isolated or associated with a number of systemic diseases.
Treatment
- Treat the underlying cause.
- Unlikely to be reversed due to progressive tissue damage and collagen deposition.
Disseminated Intravascular Coagulation (DIC)
- What is it?
- 4 Clinical Features of Acute DIC?
- 2 Clinical Features of Chronic DIC?
- 5 Causes of Acute DIC?
- 4 Causes of Chronic DIC?
Clinical Features of Acute DIC
1. Eccymoses (bruises)
2. Mucous membrane involvement (lips, genitals)
3. Internal haemorrhage
4. Malaise & High fever
Clinical Features of Chronic DIC
1. Thromboembolism
2. Deep vein thrombosis
Disseminated Intravascular Coagulation (DIC)
- 5 Investigations?
- Treatment: Acute – Without Bleeding?
- Treatment: Acute - With Bleeding?
- Treatment: Chronic – Without Embolism?
- Treatment: Chronic – With Embolism?
Investigations
1. Prothrombin time (PT) - prolonged
2. Activated partial thromboplastin time (aPTT) - prolonged
3. Fibrinogen level - normal or elevated
4. Platelets - reduced
5. D-dimer - increased
Subacute Bacterial Endocarditis
- What is it?
- Risk Factors?
- 5 Cutaneous signs?
Infection of the endocardium (inner layer of the heart) usually caused by Strep Viridans or Staph aureus.
Risk Factors:
1. Previous rheumatic heart disease
2. IV drug abuse
3. Previous cardiac surgery
4. Congenital heart disease
- Janeway lesions = macular erythema of the palms
- Septic emboli = pustular and purpuric lesions of the lower legs and toes.
- Roth spots: haemorrhages of the conjunctiva
What is this?
= Splinter haemorrhages of Bacterial endocarditis
What is this?
= Osler Nodes of Bacterial endocarditis
Alopecia Areata
- What is it?
- 4 Clinical features?
- Aetiology?
Description: Hair loss that is often discrete, circular, and can occur anywhere on the body.
Alopecia Areata
- Treatment?
Androgenetic Alopecia
- Description?
- 4 Clinical features?
- Treatments? (3)
Aetiology
- Genetic predisposition
- Conditions associated with androgen excess such as PCOS will accelerate it.
Treatment
- Topical minoxidil
- The progression of this condition may be slowed by anti-andronergic medications like finasteride.
- Hair transplantation
Pruritis
- What is it?
- Clinical features?
- Systemic Causes: 4 Endocrine/Metabolic? 4 Haematological? 2 Pregnancy related? 2 Other?
- 5 Investigations?
Description
- An uncomfortable itching sensation that usually provokes the desire to scratch or rub the area.
- May be a symptom of an underlying pathology or systemic disease.
Clinical Features - Constant scratching may cause secondary changes to the skin:
1. Excoriations: loss of epidermis and dermis from repititive scratching
2. Lichenification: thickened hypertrophied skin
Chronic Leg Ulcers
- Description?
- Aetiology: Cause?
- Clinical features?
- Arterial ulcers: Cause? Clinical features?
Cause: Increased venous pressure and improper function of the valves in veins.
Clinical Features:
1. Ulcer - painless, irregular margin, commonly affects the gaiter region.
2. Other signs of venous disease: oedema, varicose veins, atrophie blanche, lipodermatosclerosis, dark haemosiderin staining, varicose eczema.
Chronic Leg Ulcers
- Neuropathic ulcers: Cause? Clinical features?
- Investigations for chronic leg ulcers?
Chronic Leg Ulcers - Management
- Venous?
- Arterial?
- Neuropathic?
- Wound care?
- Secondary infections?
8 Signs of Liver Cirrhosis?
4 Cutaneous signs of Cardiac Disease?
3 Paediatric Skin Signs of Cardiac Disease?
Cutaneous Changes in Inflammatory Lung Disease
- Sarcoidosis?
Cutaneous Changes in Malignancy
- List 3?
- What is Acanthosis nigricans?
- Benign causes of Acanthosis nigricans?
- Drug-induced causes of Acanthosis nigricans?
- Malignant causes of Acanthosis nigricans?
Internal malignancy may rarely present with cutaenous signs.
1. Acanthosis nigricans
2. Dermatomyositis
3. Pyoderma gangrenosum
Dermatomyositis
- Description?
- Aetiology?
Dermatomyositis
- Clinical Features?
- Investigations?
- Management?
Management
1. Sun protection and topical corticosteroids
2. Oral corticosteroids to slow disease progression.
3. Methotrexate, Mycophenate, Azathoprine, Cyclophosphamide, Cyclosporine to suppress the immune system.
4. Intravenous immunoglobulin and biologics (Rituximab) for refractory cases.
Pyodermagangrenosum
- Description?
- Aetiology?
- Clinical Features?
- Investigations?
- Management?
Lupus Erythematosus
- 2 Main categories?
- Description, Clinical features, Investigations & Treatment of each?
Lupus Erythematosus - The 2 main categories are:
1. Chronic cutaneous (discoid)
2. Systemic LE
Scleroderma
- What is it?
- Localised/Limited?
- CREST syndrome?
Scleroderma = Autoimmune connective tissue disease characterised by symmetrical hardening of the skin which may be localised or systemic.
Scleroderma
- Extensive/Diffuse?
- Other Clinical Signs?
Bullous Pemphigoid
- Description?
- 5 Clinical features?
- 2 Investigations?
- 5 Treatments?
= Oral hyperpigmentation is a sign of Addison’s disease
All of the following would make you suspect SLE except?
= Jaundice
= Psoriasis
= Hyperlipidaemia
= Puffy eyelids are a sign of myxoedema
= He is also likely to have a violaceous rash on his shoulders, chest, or elbows.
= She may also have irregular periods and facial hair
= This is necrobiosis lipoidica diabeticorum
= This is alopecia areata
= She should be investigated for hypercholestrolaemia
= The distribution of the hair loss is suggestive of androgenetic alopecia.
= This is granuloma annulare
= She should have nail clippings performed to rule out tinea (FALSE)
= The pain in this condition is a result of ischaemia
What condition are each of these describing?
What condition are each of these describing?
