Autoimmune Vasculitis Flashcards

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Linear Morphea (En coup de sabre)

  • Differs from other forms of liner morphea by presenting in childhood
  • Atrophic depression resembling a stroke from a sword
  • May be extensive and cause hemifacial atrophy
  • Neurologic abnormalities may occur
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Acute Cutaneous Lupus Erythematosus

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2
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Localized Scleroderma

  • Also known as morphea
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Cutaneous Vasculitis

  • Term referring to a specific pattern of blood vessel inflammation
  • Skin involvement may occur alone or as part of a systemic disorder
  • Arteries and veins in any organ may be affected in systemic disease
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3
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Dermatomyositis

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Dermatomyositis

  • DX: Two major criteria or one major and two minor combined with biposy showing changes consistent with DM
  • Major: heliotrope rash, Gottron’s papules, and Gottron’s sign
  • Minor: macular violaceous erythemas (scalp, malar eminences, forehead, chin, V sign, shawl sign, extensor arms, periungal areas, holster sign, dorsal hands, medial malleoli) periungal nail fold telangiectasia poikiloderma, mechanic’s hands, cutaneous calcinosis, cutaneous ulcers, and pruritis
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4
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Dermatomyositis

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5
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Localized Scleroderma

Classification:

  • Raynaud’s and internal involvement does not occur
  • Plaque morphea (variants include morphea en plaque, guttate, keloidal or nodular, and atrophoderma of pasini and pierini)
  • Linear scleroderma (variants include linear morphea, en coup de sabre or frontoparietal linear morphea, and Parry-Romberg syndrome)
  • Generalized Morphea
  • Bullous Morphea
  • Deep Morphea (variants include eosinophilic fascitis, morphea profunda, and disabling pansclerotic morphea)
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7
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Chronic Cutaneous Lupus Erythematosus

Discoid Lupus

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9
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Systemic Scleraderma

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9
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Linear Morphea

  • Discrete indurated linear bands
  • May cross joint lines and lead to contractures
  • Underlying subcutaneous tissue and muscle sometimes involved
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10
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Acute Cutaneous Lupus Erythematosus

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10
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Dermatomyositis

  • Gottron’s Papules
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10
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Cutaneous Vasculitis

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11
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Dermatomyositis

  • Heliotrope Rash
  • Multisystem disorder affecting the skin and skeletal muscles but may affect other organ systems such as the joints, esophagus, heart, and lungs
  • Believed to be an autoimmune process targeting the endothelium of endomysial capillaries leading to vascular compromise.
  • Genetic predisposition
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12
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Lupus Erythematosus

  • Multisystem autoimmune disorder of unkown origin; likely the result of envrionmental factors (UV light, viruses, drugs, and hormones)
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13
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Plaque Morphea

  • Begin as poorly defined areas of non-pitting edema
  • Circumscribed, purplish or lilac indurated plaques develop
  • Eventually the surface becomes ivory colored, smooth, and shiny
  • Over several years, skin becomes atrophic often with residual hyperpigmentation
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13
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Vitiligo

  • Acquired loss of pigmentation most likely due to formation of Ab to epidermal melanocytes
  • Two main types:
  • Type A: symmetrical well-defined white macules and patches progressing slowly over many years; halo nevi, Koebner’s phenomenon, and immunologic diseased may coexist
  • Type B: segmental or asymmetric distribution
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13
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Cutaneous Vasculitits

  • Henoch-Schonlein Purpura
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14
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Systemic Scleraderma

  • Other findings:
  • Musculoskeletal: arthralgia, myalgia, weakness, loss of ROM
  • GI tract: reflux dx, dysphagia
  • Lungs: Dyspnea, restrictive lung dx, pulmonary HTN
  • Cardiovascular: conduction abnormalities, CHF, effusions, myocardial fibrosis
  • Kidneys: HTN, renal crisis, chronic renal insifficiency
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15
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Dermatomyositis

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16
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Cutaneous Vasculitis

Classification

  • Large Vessel
  • Medium Vessel
  • Small and medium vessel
  • Small vessel
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17
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Raynaud’s

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Raynaud’s

  • Systemic Scleroderma
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Chronic Cutaneous Lupus Erythematosus
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Cutaneous Leukocytoclastic Vasculitis - Usually localized to the skin, but may manifest in other organs - Palpable purpura, hemorrhagic macules and/or vesicles, urticarial lesions - Lesions may coalesce to form plaques, ulceration possible, but uncommon - Most frequently found on lower legs - Fever, malaise, burning pain, pruritis may be present
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Dermatomyositis -Heliotrope Rash
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Bullous Pemphigoid - Autoimmune disorder characterized by subepidermal blistering - Mostly a disease of the elderly - May initially present as urticarial lesions with severe pruritis - Classic lesions are large, tense bullae with good structural integrity (compared to flaccid, easily ruptured bullae of pemphigus) - Negative Nikolsky's sign - Bullae rupture leaving an eroded base that heals rapidly without scarring
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Cutaneous Leukocytoclastic Vasculitis/Angiitis - AKA: Cutaneous Small Vessel Vasculitis and hypersensitivity, vasculitis or drug/infection-induced vasculitis - S/S: Medication at dx onset, palpable purpura, maculopapular rash - Causes include medications, streptococcus and numerous other infections, Henoch-Schonlein purpura, connective tissue disease, malignancies, serum sickness, HCV
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Chronic Cutaneous Lupus Erythematosus - Scale
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Subacute Cutaneous Lupus Erythematosus
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Systemic Scleraderma - Initially presents with edema and induration of hands and feet - Raynaud's phenomenon - Progresses to bilateral sclerosis on the fingers, hands, and face - Eventually results in atrophy of skin and subcutaneous tissue - Dyspigmentation; salt-and-pepper appearance - Nail fold capillary dilatation and telangiectasias are common - Calcinosis - Reduced oral aperature
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Subacute Cutaneous Lupus Erythematosus - Systemic manifestations rarely severe if present (arthralgias and fatigue common) - Prognosis: intermittent recurrences over long periods of time, 15% develop SLE
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Vitiligo
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Chronic Cutaneous Lupus Erythematosus - Discoid rash refers to erythematous, rasied patches, with adherent scale and follicular plugging - Face, scalp, ears and neck commonly involved - Results in alopecia, dyspigmentation, atrophy, and scarring - Prognosis: disease can be largely controlled,
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Localized scleroderma
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Systemic Scleraderma
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Subacute Cutaneous Lupus Erythematosus - Most common in white females - Erythematous, scaly papules that evlove into hyperkeratotic papulosquamous or annular/polycyclic plaques - Dyspigmentation and telangiectasias often present - Photosensitivity prominent
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Dermatomyositis
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Localized Scleroderma
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Dermatomyositis
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Neonatal Lupus
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Dermatomyositis
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Raynaud's - Limited Systemic Scleraderma and CREST syndrome - CREST is an older term used to describe a unique subset of limited systemic scleraderma with the following features: C-calcinosis cutis R- Raynaud's E- esophageal dysmotility S- sclerodactyly T- Telangiectasia
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Systemic Scleraderma - "sausage fingers"
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Henoch-Schonlein Purpura - Palpable purpura - Often preceded by streptococcal infection - Most common vasculitis in children - DX: Presence of 2 of the 4 - Palpable purpura - Age - Bowel angina or diffuse abdominal pain - Arteriole or venule wall granulocytes on biopsy
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Subacute Cutaneous Lupus Erythematosus
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Acute Cutaneous Lupus Erythematosus - Prognosis dictated by SLE activity; HTN, nephritis Systemic vasculitis, and CNS disease
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Urticarial Vasculitis - Presents as an eruption of erythematous, pruritic wheals resembling hives - Often painful or burning in nature lasting more than 24 hours, resolves with purpura or hyperpigmentation - Pts. may have photosensitivity, lymphadenopathy, arthralgia, angioedema, fever, abdominal pain, renal dx, dyspnea, pleural and pericardial effusions
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Discoid Lupus
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Cutaneous Vasculitis - Signs and Symptoms: - Small Vessel: Palpable purpura or infiltrated erythema (urticaria); Pustules, vesicles, petechiae and urticarial papules
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Linear Scleroderma (En coup de Sabre) - Multisystem autoimmune disorder characterized by sclerosis of the skin, blood vessels, and visceral organs, including the GI tract, lungs, heart, musculoskeletal, and kidneys. - Often diagnosed between 35-64 years of age
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Bullous Pemphigoid
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Acute Cutaneous Lupus Erythematosus ACLE - Butterfly rash
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Acute Cutaneous Lupus Erythematosus - Butterfly rash on malar and nasal bridge - May have associated edema - Diffuse morbiliform or maculopapular rash, particularly on the ears and chest - Photosensitivity
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Systemic Scleroderma - DX: One major or two minor - Major: Proximal sclerosis - Minor: Sclerodactyly -finger fixed semiflexed position with tightened skin; digital pitting scars, erosions, or loss of substance of the finger pad; basilar lung fibrosis or pulmonary fibrosis
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Cutaneous Vasculitis